Oral manifestations in the American tegumentary leishmaniasis.

INTRODUCTION: American tegumentary leishmaniasis (ATL) can affect the skin or mucosa (mucocutaneous leishmaniasis - MCL) including the oral cavity. MCL oral lesions are often confused with other oral diseases, delaying diagnosis and specific treatment, and increasing the likelihood of sequelae. Thus, increasing the knowledge of the evolution of ATL oral lesions can facilitate its early diagnosis improving the prognosis of healing. OBJECTIVES: Evaluate the frequency of ATL oral lesion and describe its clinical, laboratory and therapeutic peculiarities. METHODS: A descriptive transversal study was carried out, using data from medical records of 206 patients with MCL examined at the outpatient clinics-IPEC-Fiocruz between 1989 and 2013. Proportions were calculated for the categorical variables and the association among them was assessed by the Pearson's chi-square test. Measures of central tendency and dispersion were used for the continuous variables and their differences were assessed by both parametric (t test) and non parametric (Mann-Whitney) tests. P-values <0.05 were considered as significant. RESULTS: The most affected site was the nose, followed by the mouth, pharynx and larynx. Seventy eight (37.9%) have oral lesions and the disease presented a lower median of the evolution time than in other mucous sites as well as an increased time to heal. The presence of oral lesion was associated with: the presence of lesions in the other three mucosal sites; a smaller median of the leishmanin skin test values; a longer healing time of the mucosal lesions; a higher recurrence frequency; and a smaller frequency of treatment finishing and healing. When the oral lesion was isolated, it was associated with an age 20 years lower than when the oral lesion was associated with other mucosal sites. CONCLUSION: Considering the worst therapy results associated with the presence of oral lesions, we suggest that lesions in this location represent a factor of worse prognosis for MCL.

Intralesional meglumine antimoniate for treatment of cutaneous leishmaniasis patients with contraindication to systemic therapy from Rio de Janeiro (2000 to 2006).

We evaluated the effectiveness and safety of intralesional meglumine antimoniate (MA) in 24 not submitted to previous treatment patients with cutaneous leishmaniasis (CL) and with contraindication to systemic therapy. Each treatment consisted of one to four intralesional applications of MA at 15-day intervals. Patients' age ranged from 3 to 90 years; fourteen were females. Intralesional treatment in the absence of any relevant toxicity was successful in 20 (83.3%) patients. Three patients required additional treatment with amphotericin B and one required systemic MA. None of the patients developed mucosal lesions when followed up to 60 months. Intralesional MA is an effective and less toxic alternative treatment of patients with CL and contraindication to systemic therapy.

Leishmaniose tegumentar: estudo retrospectivo de 65 casos / American tegumentar leishmaniasis: retrospective study of 65 cases

Foram estudados 65 casos de leishmaniose tegumentar distribuídos em 44 pacientes do sexo masculino e 21 do sexo feminino na faixa etária de 20 a 49 anos, procedentes em sua maioria do Rio de Janeiro e atendidos no Hospital Universitário Clementino Fraga Filho - UFRJ no período de 1978-1989. A úlcera em membro inferior e em mucosa nasal foi a manifestaçäo cutânea-mucosa mais freqüente: 83,61% foram reatores à intradermorreaçäo de Montenegro (> 5mm), 68,75% sororeagentes (> 1:45) na IF-gG e 49,23% foram positivos para o achado de parasitos que se apresentaram como amastigotas em macrófagos da derme papilar. Cinqüenta e três casos foram tratados com a N-metil glucamina em doses que variaram de 8 a 25 mg SbV/Kg/dia em infusäo venosa por período de 10 a 60 dias. Os efeitos colaterais guardaram relaçäo direta com dose empregada e tempo de administraçäo