Predominance of Leishmania braziliensis braziliensis in the regions of Três Braços and Corte de Pedra, Bahia, Brazil

Rosa, Adriana Helena; Cuba, César Augusto Cuba; Vexenat, A.; Barreto, A. C.; Marsden, Philip D.

doi:10.1016/0035-9203(88)90138-1

Cited by 43 publications

(27 citation statements)

References 9 publications

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“…We have not seen skin reinfections in this area, in which transmission of L. (V.) braziliensis occurs almost exclusively. 11 This long saga of multiple unsuccessful treatments underlines the difficulty of treating some patients with mucosal leishmaniasis.…”

Section: Discussionmentioning

confidence: 99%

Clinical observations of unresponsive mucosal leishmaniasis.

Marsden

Lessa²,

Oliveira³

et al. 1998

The American Journal of Tropical Medicine and Hygiene

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Abstract. We report the long-term clinical follow-up of two patients with unresponsive mucosal leishmaniasis due to Leishmania (Viannia) braziliensis from the Três Braços area in Bahia State, Brazil. Both were agricultural male workers with extensive upper respiratory mucosal involvement that was not cured with conventional and experimental therapy.In 1985, we reported two male patients with unresponsive mucosal leishmaniasis who appeared to respond to continuous antimony therapy. 1 At that time, we did not realize how long follow-up was necessary to pronounce clinical cure and both patients subsequently relapsed. In 1986, we reported a recurrence in one of these patients. 2 We now report their long-term follow-up to the end of 1996. Given that a parasitologic cure is difficult to prove and may never occur in some forms of leishmaniasis, 3 response to treatment and relapse were established based on clinical criteria of granuloma activity followed by confirmatory biopsy. All parasite isolations identified by monoclonal antibodies and isoenzyme taxonomy have been Leishmania (Viannia) braziliensis. The last clinical evaluation 1996 showed active mucosal granulomata despite all available treatment. This is the justification for the title of this paper. One of us (PDM) had followed these patients for 18 years. Despite recurrences after treatment, recent granulomata seem less aggressive. Both patients do not have any associated disease or condition such as tuberculosis, schistosomiasis, or blastomycosis, that can explain their peculiar evolution, which we have seen complicating recovery from L. (V.) braziliensis infection in humans. These patients lead normal lives and have growing families. They have spent long periods as hospital inpatients and are not anxious to re-enter the hospital. A brief update of their case histories is given with a tabulated summary of treatment regimens. CASE REPORTSPatient MB (LTB12), a 42-year old man, developed mucosal granulomata at the age of 20. He had no history or sign of a cutaneous lesion. The nose, both palates, and the larynx were affected. Leishmania (Viannia) braziliensis was isolated from a nasal mucosal lesion and characterized by isoenzymes and monoclonal antibodies in 1984 and has been reisolated seven times during the last 20 years. He always responded well to antimony therapy only to relapse. After our last report, he relapsed two years later and subsequent treatment is detailed in Table 1. In our previous report, he appeared to have responded to 85 days of therapy with sodium stibogluconate (Pentostam; Wellcome, London, United Kingdom) (20 mg/kg/day) in the hospital to the tolerance limit. 1 In 1996, he had active granulomata around the nasal septal perfuration confirmed by histology. He also had gran-*Deceased. uloma on the right inferior turbinate and a immunofluorescent antibody titer of 1:80. In our laboratory, a titer Ͼ 1:20 is regarded as significant. Mucosal surfaces affected over time include the nasal septum, inferior turbinates, hard and soft palates, orophary...

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Section: Discussionmentioning

confidence: 99%

Clinical observations of unresponsive mucosal leishmaniasis.

Marsden

Lessa²,

Oliveira³

et al. 1998

The American Journal of Tropical Medicine and Hygiene

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“…A área de estudo tem sido caracterizada como área endêmica de LTA, cujo agente etiológi-co preponderante é a Leishmania ( Viannia) braziliensis Rosa et al, 1988), e se enquadra em um padrão epidemiológico cuja característica principal é a persistência da endemia por longo tempo (Barretto et al, 1981).…”

Section: Casuística E Métodosunclassified

Fatores sócio-econômicos e atitudes em relação à prevenção domiciliar da leishmaniose tegumentar americana, em uma área endêmica do sul da Bahia, Brasil

et al. 2000

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“…We used the same aspiratory puncture system with commercial needles but the aspiration was modified by allowing air to come into the tubes when pulling the needle out to obtain a larger amount of inoculum. We studied the sensitivity of this method for diagnosis of cutaneous leishmaniasis in a group of pa- (Llanos-Cuentas et al 1984, Rosa et al 1988. …”

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confidence: 99%

Sensitivity of a Vacuum Aspiratory Culture Technique for Diagnosis of Localized Cutaneous Leishmaniasis in an Endemic Area of Leishmania (Viannia) braziliensis Transmission

Romero

Sampaio

Macêdo

et al. 1999

Mem. Inst. Oswaldo Cruz

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Sixty eight patients with localized cutaneous leishmaniasis from an area with Leishmania (Viannia) Culture sensitivity for diagnosis of cutaneous leishmaniasis caused by Leishmania (Viannia) braziliensis (L.V.b.) has shown variable results depending on quality of culture media (Shaw & Lainson 1981, Cuba et al. 1986), collection technique (Evans 1989) and other characteristics such as disease duration and previous use of anti-leishmanial drugs (Cuba et al. 1984). Marzochi et al. (1993) described a new collection technique using direct inoculation of culture tubes containing NNN media with a liquid phase through a skin puncture system with five to ten mililiters vacuum.We modified the culture medium using a smaller amount of an unenriched liquid phase composed of isotonic saline solution with gentamicin, resuming 15 ml vacuum in each tube. We used the same aspiratory puncture system with commercial needles but the aspiration was modified by allowing air to come into the tubes when pulling the needle out to obtain a larger amount of inoculum. We studied the sensitivity of this method for diagnosis of cutaneous leishmaniasis in a group of pa- (Llanos-Cuentas et al. 1984, Rosa et al. 1988. MATERIALS AND METHODSCulture medium was prepared using blood agar base no. 2 (DIFCO cod. 0696-17) with 15% defibrinated rabbit blood which was added after fusion of agar at 50 o C. Gentamicin (100 µg/ml) and 5-fluorocytosine (100 µg/ml) were added and the mixture was distributed in 10 ml glass tubes (Vacutainer R ). Tubes were covered with rubber caps and vacuum restored aspirating 15 ml with a 20 ml syringe using a 22 gauge needle. A liquid phase composed of 0.3 ml isotonic saline with gentamicin (100 µg/ml) was added immediately before the aspiratory puncture by injection through the rubber cap with a 1 ml syringe and a 22 gauge needle. All injection procedures were performed through the rubber cap after desinfecting it with 0.2% iodinated alcohol.The aspiration puncture was made with the commercial Vacutainer R needle holder dispositive and 21 gauge needles for vacuum blood extraction. The puncture site was cleaned with 0.2% iodinated alcohol and local anesthesia was induced with 0.3 ml lidocaine (2%) injected with a 1 ml syringe with a 13 gauge needle. The procedure was performed through intact skin close to the ulcer border at a 20 o angle with a rotatory movement

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Predominance of Leishmania braziliensis braziliensis in the regions of Três Braços and Corte de Pedra, Bahia, Brazil

Cited by 43 publications

References 9 publications

Clinical observations of unresponsive mucosal leishmaniasis.

Clinical observations of unresponsive mucosal leishmaniasis.

Fatores sócio-econômicos e atitudes em relação à prevenção domiciliar da leishmaniose tegumentar americana, em uma área endêmica do sul da Bahia, Brasil

Sensitivity of a Vacuum Aspiratory Culture Technique for Diagnosis of Localized Cutaneous Leishmaniasis in an Endemic Area of Leishmania (Viannia) braziliensis Transmission

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