RESUMO
Since 2009, the largest reported outbreak of leishmaniasis by Leishmania infantum in Europe was reported in Fuenlabrada, Spain. In our hospital, 90 adults with localized leishmanial lymphadenopathy (LLL) or visceral leishmaniasis (VL) were treated during this outbreak; 72% were men, and the mean age was 46.2 years (range 15-95 years). A total of 17 cases (19%) were LLL, an atypical form with isolated lymphadenopathies without other symptoms. All LLL cases occurred in immunocompetent subjects, and only one subject (6%) was a native of sub-Saharan Africa. Diagnosis was performed by fine needle aspiration cytology of the lymphadenopathy. Serology was negative in 38%. LLL outcomes at 6 months were benign, even with doses of liposomal amphotericin B that were often lower (10 mg/kg) than those recommended for VL in Mediterranean areas. A total of 73 subjects (81%) presented with typical VL; 66% of this group were immunocompetent, and 50% of those who were immunocompetent were descendants of natives of sub-Saharan Africa. The rK39 test and polymerase chain reaction were the most useful tests for confirmation of the diagnosis. An initial response to treatment was observed in 99% of cases, and relapses occurred in 14% of cases. Leishmaniasis should be included in the differential diagnosis of isolated lymphadenopathies in endemic areas. LLL could be considered a more benign entity, one different than VL, and less aggressive management should be studied in future investigations.
Assuntos
Surtos de Doenças , Leishmania infantum , Leishmaniose/epidemiologia , Leishmaniose/parasitologia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Leishmania infantum/classificação , Leishmaniose/diagnóstico , Leishmaniose/tratamento farmacológico , Leishmaniose Visceral/diagnóstico , Leishmaniose Visceral/tratamento farmacológico , Leishmaniose Visceral/epidemiologia , Leishmaniose Visceral/parasitologia , Doenças Linfáticas/diagnóstico , Doenças Linfáticas/tratamento farmacológico , Doenças Linfáticas/epidemiologia , Doenças Linfáticas/parasitologia , Masculino , Pessoa de Meia-Idade , Espanha/epidemiologia , Resultado do Tratamento , Adulto JovemRESUMO
The hydatid cyst is an endemic zoonosis in Spain. The central nervous system is seldom affected, the hydatid cyst in cerebellum being very rare. A patient with hydatid cyst affecting the vermis and right cerebellar hemisphere is presented. The case is described and discussed. The use of CT scan is encouraged as the most worthwhile election of diagnosis techniques. We highlight the need for very careful surgical treatment, preserving the hydatid cyst complete, to avoid relapses and to prevent the change of a benign disease to a chronic one with very high mortality.