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