Clinical observations of unresponsive mucosal leishmaniasis.

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.

Long-term follow-up of patients with Leishmania (Viannia) braziliensis infection and treated with Glucantime.

Seventy-nine patients with cutaneous (62) or mucosal (17) infection with Leishmania (Viannia) braziliensis in Três Braços, Bahia, Brazil, were followed for at least 4 years after initiating treatment with antimony. Cutaneous relapses occurred in 6/62 (10%), mucosal relapse after cutaneous infection in 2/62 (3%), and mucosal relapse after mucosal disease in 2/17 (17%). It is concluded that relapse (cutaneous and mucosal) is rare after adequate antimony therapy and that no definite prediction of relapse (clinical, serological or by skin reaction) is possible.

Disseminated cutaneous leishmaniasis in a field clinic in Bahia, Brazil: a report of eight cases.

Eight Bahian patients with cutaneous leishmaniasis who had 20 or more ulcerative lesions of short duration are described. Of five identifications of isolated parasites, four were Leishmania braziliensis braziliensis and one was L. mexicana amazonensis. All but one had positive Montenegro tests initially, and all did after treatment. All had circulating anti-leishmanial antibodies and five responded well to glucantime therapy suggesting a functioning immune response. This is quite different to the anergic hansenoid leishmaniasis seen with L. mexicana amazonensis infections in Brazil. Possible reasons for the occurrence of this type of leishmaniasis are briefly discussed.

[Epidemiological characteristics of American cutaneous leishmaniasis in an endemic region of the State of Bahia. III. Phlebotomine fauna]. / Características epidemiológicas da leishmaniose tegumentar americana em uma região endémica do Estado da Bahia. III. Fauna flebotomínica.

The phlebotomine fauna is highly varied in Três Braços, an endemic area of american cutaneous leishmaniasis, situated in the cacao growing region in the southeast of Bahia State, Brazil. Thirty spécies of the Lutzomyia genus were identified in 13,535 specimens collected between 1976 and 1984. Lutzomyia whitmani was the dominant species accounting for 99% of flies in the peridomicile and 97.5% of those caught in homes. In the forest the predominant species were Lu. ayrozai and Lu. yuilli. Lu. whitmani accounted for only 1.0% of the specimens examined. Lu. flaviscutellata, the proven vector of Leishmania mexicana amazonensis, was also collected in small numbers. Lu. wellcomei, a known vector of L. braziliensis braziliensis in the Serra dos Carajás, Pará, Brazil was not encountered in the Três Braços region where the parasite causing human infections is usually L.b. braziliensis. Although we have not encountered a natural infection with leishmanial promastigotes in 1,832 females of the various species examined, we discuss the probability that Lu. whitmani is the vector of L.b. braziliensis in the region maintaining transmission in dogs and man.