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vol.17 issue4Human mucocutaneous leishmaniasis in Três Braços, Bahia - Brazil: an area of Leishmania braziliensis braziliensis transmission. II. Cutaneous disease. Presentation and evolutionPatogenia da leishmaniose cutânea experimental: a importância da necrose na eliminação dos parasitos das lesões author indexsubject indexarticles search
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Revista da Sociedade Brasileira de Medicina Tropical

Print version ISSN 0037-8682

Rev. Soc. Bras. Med. Trop. vol.17 no.4 Uberaba Oct./Dec. 1984

http://dx.doi.org/10.1590/S0037-86821984000400004 

ARTICLES

 

Leishmaniose mucocutânea humana em Três Braços, Bahia - Brasil. Uma área de transmissão de Leishmania braziliensis braziliensis. III. Comprometimento mucoso e evolução inicial

 

 

Philip D. MarsdenI; Elmer A. Llanos-CuentasI; Edinaldo L. LagoII; César C. CubaI; Air C. BarretoI; Jackson M. Costa; Thomas C. JonesIII

INúcleo de Medicina Tropical e Nutrição, University of Brasília, Brazil
IISUCAM, Ministry of Health Brazil
IIICornell Medical Center, New York

 

 


ABSTRACT

In an analysis of 57 patients mucosal disease was commonestin males(77%) in the third decade of life although the age range was wide and even two children were affected. All but nine patients (16%) had signs of cutaneous leishmaniasis but in only 8(14%) was this lesion active. The nose was affected in 100% of 19 patients with multiple lesions and 92% of 38 patients with single lesions. The pharynx, palate, larynx and upper lip were affected in this order. 42% of patients with multiple lesions had laryngeal disease and in two patients this site existed as a lone lesion. No age difference could be discemed as to whether lesions were single or multiple. Duration of mucosal disease was very variable from less than 4 months to 264 months. Only 7% developed mucosal disease more than ten years after the cutaneous lesion.
Usually patients responded to adequate antimonial treatment but there were exceptions, when amphotericin B had to be used Three patients who refused to collaborate regarding treatment died Only 18% of patients in whom measurements were made had positive fluorescent antibodies two years after treatment.

Keywords: Leishmama braziliensis braziliensis. Mucosal leishmaniasis. Clinical presentation. Evolution. Treatment.


RESUMO

Numa análise de 57 pacientes o acometimento da mucosa foi mais comumente observado em homens (77%) na terceira década de vida, embora fosse grande a variação das idades e ocorrendo mesmo o acometimento de duas crianças. Com a exceção de nove pacientes (16%) todos os outros tinham sinais de leishmaniose cutânea sendo que em somente oito (14%) de lesão era ativa. O acometimento do nariz foi observado em 100% de 19 pacientes que apresentavam lesões múltiplas e em 92% de 38 pacientes apresentando uma única lesão. A faringe, palato, laringe e lábio superior foram afetados nesta experiência. 42% dos pacientes com lesões múltiplas apresentavam acometimento da laringe sendo que em dois pacientes a única lesão existente apresentava-se neste ponto. Não foi observada qualquer diferença relacionada com a idade no que se referia à existencia de lesões únicas ou múltiplas.
A duração do acometimento da mucosa variou de menos de 4 até 264 meses. Somente 7% desenvolveram o acometimento da mucosa após mais de dez anos o desenvolvimento da lesão cutânea.
Os pacientes usualmente responderam ao tra-tamento adequado por antimonial embora em algumas exceções fosse usada amphotericina B. Morreram três pacientes que se recusaram a colaborar no tratamento.
Dois anos após o tratamento observou-se positividade de anticorpos fluorescentes em somente 18% dos pacientes entre aqueles acompanhados.

Palavras-chave: Leishmania braziliensis braziliensis. Leishmaniose de mucosa. Apresentação clínica. Evolução. Tratamento.


 

 

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Texto completo disponível apenas em PDF.

 

 

REFERENCES

1. Anonymous. Report of the workshop on the chemotherapy of mucocutaneous leishmaniasis. World Health Organization TDR/Leish/MCL/79 3, 1979.         [ Links ]

2 Anonymous. Report of the informal meeting on the chemotherapy of visceral leishmaniasis. World Health Organization TDR/Chem. Leish/VL 82 3, 1982.         [ Links ]

3. Barbosa JER. Dados estatísticos sobre os casos de leishmaniose das mucosas observados no Serviço de Otorrinolaringologia da Santa Casa de São Paulo. Revista Otorrinolaringológica de São Paulo 4:697-714, 1936.         [ Links ]

4. Barreto AC, Cuba CC, Marsden PD, Vexenat JA, De Belder M. Características epidemiológicas da leishmaniose tegumentar americana em uma região endêmica do Estado da Bahia, Brasil. I. Leishmaniose humana. Boletin de la Oficina Sanitaria Panamericana 90: 415- 424, 1981.         [ Links ]

5. Bradley DL. Genetics of resistance to infection with special reference to leishmaniasis. Transactions of the Royal Society of Tropical Medicine and Hygiene 76: 143-146, 1982.         [ Links ]

6. Bryceson ADM. Diffuse cutaneous leishmaniasis in Ethiopia. II Treatment. Transactions of the Royal Society of Tropical Medicine and Hygiene 64: 369-379, 1970.         [ Links ]

7. Cuba CC, Barreto AC, Llanos-Cuentas AE, Magalhães I, Lago EL, Reed SG, Marsden PD. Human mucocutaneous leishmaniasis in Três Braços, Bahia - Brazil. An area of Leishmania braziliensis braziliensis transmission. I Laboratory diagnosis. Revista da Sociedade Brasileira de Medicina Tropical 17: 161-167, 1984.         [ Links ]

8. Guerra M, Marsden PD, Cuba CC, Barreto AC. Further studies on nifurtimox in the treatment of mucocutaneous leishmaniasis. Transactions of the Royal Society of Tropical Medicine and Hygiene 75: 335-337, 1981.         [ Links ]

9. Kanan MW, RyanTJ. The localisation ofgranulomatous diseases and vasculitis in the nasal mucosa. In: Vasculitis Stasis and Ischaemiap. 195-220. WB Saunders, Philadelphia, 1975.         [ Links ]

10. Klotz O, Lindenberg H. Pathology of leishmaniasis of the nose. American Journal of Tropical Medicine 3: 117-141, 1923.         [ Links ]

11. Llanos-Cuentas EA, Marsden PD, Cuba CC, Barreto AC, Campos M. Possible risk factors in development of mucosal lesions in leishmaniasis. Lancet 2: 295, 1984.         [ Links ]

12. Llanos-Cuentas AE, Marsden PD, Lago EL, Barreto AC, Cuba CC, Johnson W. Human mucocutaneous leishmaniasis in Três Braços, Bahia - Brazil. An area of Leishmania braziliensis braziliensis transmission. II Cutaneous disease. Presentation and evolution. Revista da Sociedade Brasileira de Medicina Tropical 17: 169-177, 1984.         [ Links ]

13. Marsden PD, Sampaio RNR, Rocha R, Radke M. Mucocutaneous leishmaniasis - an unsolved clinical problem. Tropical Doctor 83: 131-139, 1977.         [ Links ]

14. Marsden PD, CubaCC, Sampaio RN, Rocha R, Barreto AC. Nifurtimox in the treatment of mucocutaneous leishmaniasis. Transactions of the Royal Society of Tropical Medicine and Hygiene 73: 391-394, 1979.         [ Links ]

15. Poulter IW, Randolph CR. Mechanisms of immunity in leishmaniasis. IV Significance of lymphatic drainage from the site of infection. Clinical and Experimental Immunology 48: 396-402, 1982.         [ Links ]

16. Rocha RAA, Sampaio RN, Guerra M, Magalhães I, Cuba CC, Barreto AC, Marsden PD. Apparent giucantime failure in five patients with mucocutaneous leishmaniasis. The Journal of Tropical Medicine e Hygiene 83: 131-139, 1980.         [ Links ]

17. Sampaio RNR, Rocha RAA, Marsden PD, Cuba CC, Barreto AC. Leishmaniose tegumentar americana. Casuística do Hospital Escola da UnB. Anais Brasileiro de Dermatologia 55: 69-76, 1980.         [ Links ]

18. Veiga JPR, Wolff ER, Sampaio RN, Marsden PD. Renal tubular dysfunction in patients with mucocutaneous leishmaniasis treated with pentavalent antimonials. Lancet, 2. 569. 1983.         [ Links ]

19. Villela F. Dados estatísticos sobre a leishmaniose das mucosas em Araçatuba, São Paulo. Folha Médica do Rio de Janeiro 20: 243-244, 1939.         [ Links ]

20. Walton BC, Chinel LV, Equia OE. Ònset of espundia after many years of occult infection with Leishmania braziliensis. The American Journal of Tropical Medicine e Hygiene 22: 696-698, 1973.         [ Links ]

21. Walton BC, Valverde L. Racial differences in espudia. Annals of Tropical Medicine and Parasitology 73: 23- 29. 1979.         [ Links ]

22. Walton BC. Evaluation of chemotherapy of American leishmaniasis by the indirect fluorescent antibody tesL The American Journal of Tropical Medicine e Hygiene 29: 747-752, 1980.         [ Links ]

23. Wilson HR, Dieckmann BS, Childs GE. Leishmania braziliensis and Leishmania mexicana: experimental cutaneous infections in golden hamsters. Experimental Parasitology 47: 270-283, 1979.         [ Links ]

24. Zeledón R. Efecto de la temperatura de la piel en la leishmaniasis cutanea experimental. Revista da Sociedade Brasileira de Medicina Tropical 5: 131-134, 1971.         [ Links ]

 

 

Recebido para publicação em 16/8/84.

 

 

This work was supported by the Brazilian Conselho Nacional de Desenvolvimento Cientifico e Tecnológico (CNPq - Grants No. 403682/82 and 403690/82), The Brazilian Ministry of Health (SUCAM), UNDP/World Bank/W. H. O. Special Programme for Research and Training in Tropical Diseases and a United States Public Service grant (AI 16282-04) administered by the Department of International Medicine, Comell Medical College, New York.

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