FVB/NJ strain as a mouse model for cutaneous leishmaniasis by Leishmania (L.) amazonensis

BACKGROUND Leishmaniases encompass a spectrum of neglected diseases caused by parasites of the genus Leishmania, grouped in two forms: tegumentary and visceral leishmaniasis. OBJECTIVES In this study, we propose Friend Virus B NIH Jackson (FVB/NJ) mouse strain as a new experimental model of infection with Leishmania (Leishmania) amazonensis, the second most prevalent agent of tegumentary leishmaniasis in Brazil. METHODS AND FINDINGS We performed in vitro infections of FVB/NJ macrophages and compared them with BALB/c macrophages, showing that BALB/c cells have higher infection percentages and a higher number of amastigotes/cell. Phagocytosis assays indicated that BALB/c and FVB/NJ macrophages have similar capacity to uptake parasites after 5 min incubations. We also investigated promastigotes' resistance to sera from FVB/NJ and BALB/c and observed no difference between the two sera, even though FVB/NJ has a deficiency in complement components. Finally, we subcutaneously infected FVB/NJ and BALB/c mice with 2 × 106 parasites expressing luciferase. Analysis of lesion development for 12 weeks showed that FVB/NJ and BALB/c mice have similar lesion profiles and parasite burdens. MAIN CONCLUSIONS This work characterises for the first time the FVB/NJ mouse as a new model for tegumentary leishmaniasis caused by Leishmania (L.) amazonensis.

Leishmaniasis tegumentaria y flebótomos en la localidad de Colonia Santa Rosa del norte de Argentina / Tegumentary leishmaniasis and sandflies in Colonia Santa Rosa locality in northern Argentina

Resumen La leishmaniasis tegumentaria (LT) es causada por parásitos del género Leishmania y transmitida por especies de flebótomos, insectos pertenecientes al orden Diptera, familia Psychodidae. El objetivo de este trabajo fue analizar la presencia de casos de LT y su variación temporal entre 1985 y 2019, las formas clínicas, la ubicación de las lesiones en los pacientes y la presencia de flebótomos en la localidad de Colonia Santa Rosa, del norte de Argentina. Los pacientes se diagnosticaron mediante frotis e intradermorreacción de Montenegro. Se colocaron trampas CDC en 14 sitios en el horario de 19 a 7. Se diagnosticaron 120 casos de LT y la prevalencia global fue del 0,75% (^16.000 habitantes). Los pacientes presentaron formas cutáneas simples y múltiples (88,79%) y mucocutáneas (10,83%). Las lesiones cutáneas fueron más frecuentes en extremidades inferiores. Del total de flebótomos, Nyssomyia neivai fue la especie predominante (95%), y, en menor proporción, estuvieron presentes Migonemyia migonei (1,9%), complejo cortelezzii (1,3%) y Evandromyia sallesi (0,09%). La persistente ocurrencia de casos y la presencia de flebótomos en la citada localidad nos sugiere la transmisión endémica en la zona. Esto senala la necesidad de planificar medidas preventivas y de control de la LT en el norte de Argentina.

Abstract Tegumentary leishmaniasis (TL) is caused by parasites of the genus Leishmania and transmitted by the sandfly species, insects belonging to the order Diptera, family Psychodidae. Historically, the most endemic area of TL in Argentina has been the northern region. The aim of this work was to analyze the presence and temporal variation of TL cases reported between 1985 and 2019 in Colonia Santa Rosa locality, northern Argentina. Furthermore, its clinical forms were characterized and sandflies were captured. Patients were diagnosed by smear and the Montenegro skin test. For sampling, CDC light traps were placed at 14 sites from 7pm to 7am. The correlation between vegetation cover and sandfly abundance was also studied. One hundred and twenty TL cases were diagnosed and the overall prevalence was 0.75% (M6 000 inhabitants). Patients presented simple and multiple cutaneous leishmaniasis (88.79%) and the mucocutaneous form (10.83%). Skin lesions were more frequent on the lower extremities (46.73%). Of the total number of sandflies, Nyssomyia neivai (95%) was the predominant species followed by Migonemyia migonei (1.9%), cortelezzii complex (1.3%) and Evandromyia sallesi (0.09%). The persistent occurrence of cases and the presence of sandflies in the locality suggest the existence of endemic transmission in the area. This highlights the need to design prevention and control measures for TL in northern Argentina.

Biodiversity assessment of Phlebotomine (Diptera: Psychodidae) in an environmental impacted area in Rio de Janeiro State, Brazil

ABSTRACT From October 1994 to September 1996, in the municipality of Mangaratiba, Rio de Janeiro State, phlebotomines were captured on the walls of the houses by means of a manual suction tube and light traps, in the household, the peridomicile and in the forest. As it is an area undergoing a real expansion and an increment in the local tourism, with the purpose of assessing changes in the phlebotomine fauna caused by environmental changes in the region, new captures were made in the same location from October 2015 to September 2016, this time using only light traps. In the two phases of the study, a total of 6,681 phlebotomines were captured. The results indicated that Ny. intermedia and Mg. migonei are fully adapted to this anthropic environment, while Pi. fischeri was more abundant and eclectic, and was probably attracted to exercise hematophagy. Nyssomyia intermedia can be suggested as the main vector of the etiological agent of the American Tegumentary Leishmaniasis in the studied areas. Pintomyia fischeri can also transmit Leishmania braziliensis, both in the environment altered by human action, and in the wild environment. Phlebotomines were captured in greater numbers between 6 and 8 pm in the peridomicile and between 9 and 11 pm in the household. The highest densities of phlebotomines were recorded in December, January and February. Despite almost 20 years between the two studies in the municipality of Mangaratiba, there was no change in the profile of the phlebotomine fauna in general; however, there was a greater density of species of medical importance in areas that suffered environmental impacts.

Study on the zoonotic cycle of tegumentary leishmaniasis in an endemic area of a metropolitan region in the Northeastern region of Brazil

ABSTRACT This study was conducted to characterize the transmission cycle of the tegumentary leishmaniasis (TL) in an old colonization area at Pernambuco State, Brazil. The aims were to identify autochthonous cases, sandflies fauna, domestic animals as possible reservoir hosts and the Leishmania species involved in this endemic area. A total of 168 suspected human cases of TL and 272 domestic animals (canine, feline, equine, goat, and sheep) were included. The sandflies were captured and identified by species. Patients were predominantly male and the average age was 37+18.1 years old. Of 85 patients who had skin lesions, 25.6% of them had direct positive smears for TL and 34 isolates were identified as Leishmania (Viannia) braziliensis. The confirmation for TL diagnosed by molecular detection (PCR) was almost three times more sensitive than the direct test [p < 0.001; PR = 2.72] associated with clinical examination. The Kappa test on PCR between two different specimens, biopsy, and skin lesion swab was 60.8% (p < 0.001). More than 200 specimens of sandflies (80 males and 159 females) were captured and identified as Lutzomyia whitmani (99.6%) and Lu. evandroi (0.4%). The detection of L. (V.) braziliensis by Real-Time PCR in the blood of a captured fed female was positive in 59.3% of Lu. whitmani. Of the 272 domestic animals included, 61.76% were male (n = 168). Thirty-six animals (13.2%) had lesions compatible with TL (34 dogs, 1 cat and 1 sheep) and 3 of them, all dogs, had lesions on the snout, showing destruction of cartilage and mucosa. The study suggests the participation of domestic animals as possible reservoirs. However, further studies are necessary to better understand the transmission cycle and take recommended measures in order to control the disease.

Perfil epidemiológico da leishmaniose tegumentar americana na Região Amazônica, Brasil, entre 2010 e 2019 / Epidemiological profile of American tegumentary leishmaniasis in the Amazon Region, Brazil, between 2010 and 2019

Objetivo: descrever o perfil epidemiológico dos casos de leishmaniose tegumentar americana (LTA) no município de Altamira, Pará, no período de 2009 a 2019. Métodos: trata-se de um estudo transversal, descritivo, retrospectivo de abordagem quantitativa, utilizando dados secundários de casos confirmados LTA, ocorridos entre os anos de 2010-2019 registrados no Sistema de Informações de Agravos de Notificação (SINAN) e disponibilizados no site do Departamento de Informática do Sistema Único de Saúde (DATASUS). Resultados: foram notificados 1.177 casos de LTA no município de Altamira entre 2010 e 2019, com média de 117,7 casos notificados e incidência média de 107,66 casos para cada 100 mil habitantes. Predomínio do sexo masculino (83,3%), idade entre 20-39 anos (51,8%) e autodeclarado pardo (71,7%). Quanto à forma, a cutânea foi a mais registrada, com 96% dos casos, e em 97% destes evoluíram para a cura. Conclusões: a LTA apresentou alta incidência em Altamira no período analisado, assim se caracterizando como um problema de saúde pública. Acometendo, sobretudo, o sexo masculino, pardos e a faixa etária de 20 a 39 anos, estando, dessa forma, intrinsecamente relacionada às atividades laborais dessa população, além do desequilíbrio ambiental relacionado a desmatamento na zona rural. Sugere-se a existência de transmissão peri e intradomiciliar relacionada ao acometimento de crianças e idosos. A distribuição espacial dos casos não foi homogênea, possuindo maior concentração em áreas centrais do município de altamira. É importante ressaltar que a incidência tem uma forma não linear, que não se deve ao aumento gradual do número de casos, mas ao aumento da população.

Objective: to describe the epidemiological profile of cases of American tegumentary leishmaniasis (ATL) in the municipality of Altamira, Pará, from 2009 to 2019. Methods: this is a cross-sectional, descriptive, retrospective study with a quantitative approach, using secondary data from confirmed cases of LTA, which occurred between the years 2010-2019, registered in the Information System of Notifiable Diseases (SINAN) and available on the website of the Department of Informatics of the Unified Health System (DATASUS). Results: 1,177 cases of ATL were reported in the municipality of Altamira between 2010 and 2019, with an average of 117.7 reported cases and an average incidence of 107.66 cases per 100,000 inhabitants. Male predominance (83.3%), aged between 20-39 years (51.8%) and self-declared brown (71.7%). As for the form, the cutaneous one was the most registered with 96% of the cases, and in 97% they evolved to cure. Conclusions: ATL had a high incidence in Altamira in the analyzed period, thus characterizing it as a public health problem. Affecting, above all, males, browns and the age group from 20 to 39 years. being, therefore, intrinsically related to the work activities of this population, in addition to the environmental imbalance related to deforestation in rural areas. It is suggested the existence of peri- and intra-household transmission related to the involvement of children and the elderly. The spatial distribution of cases was not homogeneous, with a greater concentration in central areas of the municipality of altamira. It is important to emphasize that the incidence has a non-linear form, which is not due to the gradual increase in the number of cases, but to the increase in the population.

Leishmaniasis mucocutánea con manifestacion oral: reporte de un caso / Mucocutaneous leishmaniasis with oral manifestation: case report

La Leishmaniasis es un grupo de enfermedades transmitidas por vectores y causada por la Leishmania, un parásito intracelular, que se presenta de preferencia en regiones tropicales y subtropicales. Se manifiesta mediante un amplio rango de formas clínicas como la cutánea, mucocutánea, y visceral, dependiendo de la especie y respuesta inmunológica del paciente. Se presenta el caso de un hombre de 35 años que acudió derivado a Unidad de Estomatología del Hospital Señor del Milagro, Salta, Argentina, presentando en la cavidad oral lesión, granulomatosa, ulcerada, dolorosa a la palpación, única, en paladar blando, de tres meses de evolución. Se realizaron estudios serológicos, parasitológicos y PCR. Los ELISAs lisados, PCRs y cultivos de materiales de lesiones fueron positivos, confirmando diagnóstico de leishmaniasis mucocutánea. El paciente fue derivado al Servicio de Dermatología donde recibió tratamiento con Antimoniato de Meglumina, con repuesta clínica favorable. El conocimiento de las manifestaciones orales puede llevar al diagnóstico clínico de leishmaniasis mucocutánea por parte del odontólogo, pudiendo entregar un tratamiento oportuno y a la vez ayudar al paciente, evitando complicaciones de esta enfermedad.

Leishmaniasis is a group of vector-borne diseases caused by Leishmania, an intracellular parasite, which occurs preferentially in tropical and subtropical regions. It manifests itself through a wide range of clinical forms such as cutaneous, mucocutaneous, and visceral, depending on the species and the patient's immune response. We present a case of a 35-year-old man who was referred to the Stomatology Unit of the Señor del Milagro Hospital, Salta, Argentina, presenting in the oral cavity lesion, granulomatous, ulcerated, painful on palpation, unique, soft palate with three months of evolution. Serological, parasitological and PCR studies were performed. Lysed ELISAs, PCRs and cultures of lesion materials were positive, confirming diagnosis of mucocutaneous leishmaniasis. The patient was referred to the Dermatology Service where he received treatment with Meglumine Antimony, with favorable clinical response. The knowledge of the oral manifestations can lead to the clinical diagnosis of mucocutaneous leishmaniasis by the dentist, being able to provide timely treatment and at the same time help the patient, avoiding complications of this disease.

Favorable responses to treatment with 5 mg Sbv/kg/day meglumine antimoniate in patients with American tegumentary leishmaniasis acquired in different Brazilian regions

Abstract INTRODUCTION: Favorable responses in American tegumentary leishmaniasis (ATL) patients to treatment with 5 mg Sbv/kg/day meglumine antimoniate (MA) has been reported in Rio de Janeiro, but little is known regarding the therapeutic response to low doses in patients from other locations. METHODS: A retrospective review of medical records was conducted to compare the therapeutic response to 5 mg Sbv/kg/day MA treatment among 36 patients who acquired ATL in Brazilian states other than Rio de Janeiro (OS group) and 72 patients from Rio de Janeiro (RJ group). RESULTS: One course of 5 mg Sbv/kg/day MA cured 72.8% of 81 cutaneous (CL) and 66.6% of 27 mucosal (ML) leishmaniasis-infected patients: 70% in the CL/RJ group, 81% in the CL/OS group, 50% in the ML/RJ group, and 80% in the ML/OS group. After up to two additional treatment courses at the same dose, 88.9% and 85.2% of the CL and ML patients were cured, respectively. Adverse events were observed in 40% of patients in the CL/RJ group, 57% of the CL/OS group, 58% of the ML/RJ group, and 80% of the ML/OS group. No significant differences were observed in the cure rates or adverse effects between the RJ and OS groups. No patients required permanent discontinuation of treatment due to adverse events. CONCLUSIONS: Patients with ATL acquired in both RJ and OS may respond to low-dose MA. While high-dose MA should remain the standard treatment for ATL, low-dose MA might be preferred when toxicity is a primary concern.

Pertinencia intercultural de la atención en salud. El camino a seguir en Leishmaniosis Tegumentaria Americana / Intercultural relevance of health care. The way to follow in American Tegumentary Leishmaniosis

La Leishmaniosis tegumentaria americana (LTA) es considerada un problema de salud pública por su elevada incidencia. Además, es una patología abordada en muchos países a través de programas sanitarios con estructura vertical, sin contacto social y sin considerar la cultura de los grupos poblacionales, a sabiendas que existen diferencias en cuanto a ésta en el tratamiento de la enfermedad. El objetivo es la descripción y análisis de la pertinencia cultural del proceso de atención en salud en el caso de LTA, con base en la revisión bibliográfica de literatura científica sobre esta patología y sobre el papel de la cultura sobre la misma como aporte de ideas y de conocimientos para el debate necesario en el diseño de políticas y programas sanitarios de control de patologías parasitarias.(AU)

American tegumentary Leishmaniasis (LTA) is considered a public health problem because of its high incidence. In addition, it is a pathology addressed in many countries through health programs with vertical structure, without social contact and without considering the culture of the population groups, knowing that there are differences in the treatment of the disease. The objective is the description and analysis of the cultural relevance of the health care process in the case of LTA, based on the bibliographical review of scientific literature on this pathology and on the role of culture in the same as contribution of ideas and of knowledge for the necessary debate in the design of health policies and programs to control parasitic diseases.(AU)

Low dose systemic or intralesional meglumine antimoniate treatment for American tegumentary leishmaniasis results in low lethality, low incidence of relapse, and low late mucosal involvement in a referral centre in Rio de Janeiro, Brazil (2001-2013)

BACKGROUND American tegumentary leishmaniasis (ATL) is a non-lethal parasitic disease that presents with cutaneous (CL) and mucosal (ML) clinical forms. ATL treatment aims at healing the lesions and preventing the development of the late mucosal form. Systemic meglumine antimoniate (MA) therapy with 10-20 mg Sb5+/kg/day is the first choice of treatment. However, alternative therapies using 5 mg Sb5+/kg/day or intralesional (IL) MA are the usual regimens at the National Institute of Infectious Diseases (NIID), Rio de Janeiro, Brazil. OBJECTIVES To evaluate lethality and the incidence of relapse and development of late ML in CL patients treated at NIID from 2001 until 2013. METHODS Data were recovered from records of all ATL patients diagnosed during that period. FINDINGS Out of 777 patients, 753 were treated with MA (96.9%). Of those, 89.1% received alternative therapy of 9.9% IL and 79.2% systemic 5 mg Sb5+/kg/day. Some patients required 1-3 additional courses of treatment, thus making a total of 997 courses; 85.2% of them were subjected to alternative therapies. Lethality was 0.1%, relapse incidence 5.8%, and late ML incidence 0.25%. As a final outcome for the 777 patients, 95.9% were cured, 0.1% died and 4.0% were not able to follow-up. MAIN CONCLUSIONS Alternative MA schedules resulted in low lethality without increase of relapse or late ML incidence.

Rol del Consultorio de Leishmaniosis en las investigaciones del IICS / Leishmaniasis Consulting Room at the IICS: its role in research

La leishmaniosis tegumentaria es una enfermedad desatendida y descontrolada que afecta a sectores sensibles de la población. El IICS, a través de este consultorio especializado, brinda los servicios de establecer el diagnóstico y acompañar el tratamiento de los casos que se presentan, así como de realizar seguimiento de los casos curados. Esta labor aporta permanentemente datos y suscita discusiones científicas que se convierten en fuentes de trabajos de investigación para la Institución. Y estamos hablando de una enfermedad con bastantes aspectos aún desconocidos, que amerita ser estudiada con prioridad en nuestro país

Tegumentary leishmaniasis is a neglected and uncontrolled disease affecting sensitive sectors of the population. The IICS, through this specialized practice, provides the services of establishing the diagnosis and to accompany the treatment of the cases presented, as well as to follow up the cured cases. This work provides data permanently and raises scientific discussions that become sources of research to the institution. And we are talking about a disease with many still unknown aspects that deserve to be studied with priority in our country.

New human case reports of cutaneous leishmaniasis by Leishmania (Viannia) naiffi in the Amazon region, Brazil / Novos relatos de casos de leishmaniose cutânea por Leishmania (Viannia) naiffi na região amazônica, Brasil

Few cases of human cutaneous leishmaniasis (CL) caused by Leishmania naiffi were described in the medical literature. The aim of this study was to report and analyze new cases of L. naiffi in the period between the years 1992 to 2011. The strains were characterized by isoenzyme analysis. All patients assisted had small lesions; ranging from 1.0x1.0 mm and 13.5x11.5 mm. The lesions observed were widely distributed: 55.5% on the lower limb, 5.5% in the abdominal area, 16.6% on upper limb and 22.2% in upper limb and back. Seventy-two percent of patients had ulcerated lesions. Clinical course of the disease varied from 1 to 10 months. According to gender, most infected individuals were men (83.3%). The patients came from Amazonas (10), Pará (01) and Rondônia (01), north States of Brazil. Five patients were infected in experimental stations of the National Institute of Amazonian Research (INPA). Although the results of this study were similar to other reports in the literature, some of the patients had more of one skin lesion. It is also reported the first case of CL caused by L. naiffi in the State of Rondônia and identified an area of disease transmission in the experimental station of INPA.

Poucos casos de leishmaniose cutânea humana (LC) causada por Leishmania naiffi foram descritos na literatura médica. Assim, o objetivo deste estudo foi relatar e analisar novos casos de infecção por L. naiffi no período compreendido entre os anos de 1992 a 2011. As cepas foram caracterizadas por análise de isoenzimas. Todos os pacientes atendidos apresentavam lesões pequenas; variando entre 1,0x1,0 mm e 13,5x11,5 mm. As lesões observadas foram amplamente distribuídas: 55,5% no membro inferior, 5,5% na área abdominal, 16,6% no membro superior e 22,2% no membro superior e para trás. Setenta e dois por cento dos pacientes tiveram lesões ulceradas. O curso clínico da doença variou de 1 a 10 meses. De acordo com o sexo, a maioria dos indivíduos infectados eram homens (83,3%). Os pacientes vieram de Amazonas (10), Pará (01) e Rondônia (01), estados do norte do Brasil. Cinco pacientes foram infectados em estações experimentais do Instituto Nacional de Pesquisas da Amazônia (INPA). Embora os resultados encontrados neste estudo fossem semelhantes às outras descrições na literatura, alguns dos pacientes apresentavam mais de uma lesão cutânea. Também é relatado o primeiro caso de LC causada por L. naiffi no Estado de Rondônia e identificada uma área de transmissão da doença na estação experimental do INPA.

Efficiency of noninvasive sampling methods (swab) together with Polymerase Chain Reaction (PCR) for diagnosing American Tegumentary Leishmaniasis

ABSTRACT Traditional diagnostic methods used to detect American Tegumentary Leishmaniasis, such as histopathology using biopsy samples, culture techniques, and direct search for parasites, have low sensitivity and require invasive collection procedures. This study evaluates the efficiency of noninvasive sampling methods (swab) along with Polymerase Chain Reaction (PCR) for diagnosing American Tegumentary Leishmaniasis using skin and mucous samples from 25 patients who had tested positive for leishmaniasis. The outcome of the tests performance on swab samples was compatible with PCR results on biopsy samples. The findings have also shown that PCR-kDNA test is more efficient than PCR-HSP70 and qPCR tests (sensitivity of 92.3%, 40.7%, and 41%, respectively). Given the high sensitivity of the tests and the fact that the sampling method using swabs affords greater patient comfort and safety, it could be said that this method is a promising alternative to conventional biopsy-based methods for the molecular diagnosis of leishmaniasis.

Sporotrichoid leishmaniasis: a cross-sectional clinical, epidemiological and laboratory study in Rio de Janeiro State, Brazil

ABSTRACT Background Atypical presentations of cutaneous leishmaniasis include sporotrichoid leishmaniasis (SL), which is clinically described as a primary ulcer combined with lymphangitis and nodules and/or ulcerated lesions along its pathway. Aims To assess the differences between patients with sporotrichoid leishmaniasis and typical cutaneous leishmaniasis (CL). Methods From January 2004 to December 2010, 23 cases of SL (4.7%) were detected among 494 CL patients diagnosed at a reference center for the disease in Rio de Janeiro State, Brazil. These 23 cases were compared with the remaining 471 patients presenting CL. Results SL predominated in female patients (60.9%, p = 0.024), with older age (p = 0.032) and with lesions in upper limbs (52.2%, p = 0.028). CL affected more men (64.5%), at younger age, and with a higher number of lesions exclusively in lower limbs (34.8%). Conclusions Differences in clinical and epidemiological presentation were found between SL patients as compared to CL ones, in a region with a known predominance of Leishmania (Viannia) braziliensis. The results are similar to the features of most of the sporotrichosis patients as described in literature, making the differential diagnosis between ATL and sporotrichosis more important in overlapping areas for both diseases, like in Rio de Janeiro State.

Caracterização clínica e laboratorial das manifestações orais de leishmaniose tegumentar americana / Characterization of the oral manifestations in the american tegumentary leishmaniasis based on the clinical and laboratorial findings

A leishmaniose é uma zoonose infecciosa causada por protozoários do gênero Leishmania, que parasitam as células do sistema mononuclear fagocitário. Esta doença pode se manifestar de duas formas: leishmaniose tegumentar e a leishmaniose visceral. A leishmaniose tegumentar pode acometer pele ou mucosas inclusive da cavidade oral. As lesões orais de leishmaniose por não serem ainda bem estudadas são frequentemente confundidas com outras doenças da boca, o que atrasa o diagnóstico e o tratamento específico, aumentando a probabilidade de sequelas. Desta maneira, aumentar o conhecimento da evolução das lesões orais de leishmaniose tegumentar americana (LTA) pode auxiliar no diagnóstico precoce da infecção, melhorando seu prognóstico. Objetivos: Avaliar a frequência da ocorrência de lesões orais de LTA e descrever suas peculiaridades clínicas, laboratoriais, e terapêuticas. Métodos: Foi realizado um estudo transversal descritivo com amostra de conveniência, utilizando dados obtidos de prontuários e de exame clínico das mucosas das vias aéreo-digestivas superiores de 206 pacientes com Leishmaniose Mucosa (LM), atendidos no Laboratório de Vigilância em Leishmanioses-IPEC-Fiocruz entre 1989 e 2013...

Leishmaniasis is an infectious zoonotic disease caused by protozoa of the genus Leishmania, which infects the mononuclear phagocyte system. This disease can be clinical presented as: Tegumentary leishmaniasis (TL) and visceral leishmaniasis. The TL can affect the skin and the mucosa (mucosal leishmaniasis – ML), including oral cavity. The oral lesions of TL are often confused with mouth’s lesions with other ethiologies, and as there are few studies characterizing oral leishmaniasis , the correct diagnosis and treatment can be delayed, increasing the likelihood of sequelae. In this way, the increase of knowledge about this site of TL lesions can help an early diagnosis of the infection and improve the patients prognosis. Objectives : Identify the frequency of occurrence of ATL oral lesions and describe the clinical, laboratorial and therapeutics characteristics. Methods: Was made a cross-sectional descriptive study with a convenience sample, using data obtained from medical records and specific clinical mucosa examination, especially the oral mucosa, of 206 patients with mucosal leishmaniasis (ML), treated at the ambulatory of Otorhinolaryngology, from Laboratório de Vigilância em Leishmanioses-IPEC-Fiocruz between 1989 e 2013...

Treatment of American tegumentary leishmaniasis in special populations: a summary of evidence

We aimed to assess and synthesize the information available in the literature regarding the treatment of American tegumentary leishmaniasis in special populations. We searched MEDLINE (via PubMed), EMBASE, LILACS, SciELO, Scopus, Cochrane Library and mRCT databases to identify clinical trials and observational studies that assessed the pharmacological treatment of the following groups of patients: pregnant women, nursing mothers, children, the elderly, individuals with chronic diseases and individuals with suppressed immune systems. The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach. The available evidence suggests that the treatments of choice for each population or disease entity are as follows: nursing mothers and children (meglumine antimoniate or pentamidine), patients with renal disease (amphotericin B or miltefosine), patients with heart disease (amphotericin B, miltefosine or pentamidine), immunosuppressed patients (liposomal amphotericin), the elderly (meglumine antimoniate), pregnant women (amphotericin B) and patients with liver disease (no evidence available). The quality of evidence is low or very low for all groups. Accurate controlled studies are required to fill in the gaps in evidence for treatment in special populations. Post-marketing surveillance programs could also collect relevant information to guide treatment decision-making.

Phlebotomine saddflies in rural locations in the state of parana, southern Brazil / Flebotomineos em localidades rurais do Estado do Parana, Sul do Brasil

SUMMARY This study reports the fauna and frequency of sandflies in domestic animal shelters, residences and other ecotopes in rural areas of the municipality of Bandeirantes, Paraná State. Sandflies were collected twice in eight rural villages by using Falcon traps from 8pm to 6am in 2008. In these localities 4,790 sandflies were collected, which were represented by ten sandfly species, prevailing of Nyssomyia neivai and Nyssomyia whitmani species. It was observed that animal shelters are the domestic ecotopes where there is the greatest frequency of these insects. The localities where the collections were made had the environmental characteristics that allow the persistence of transmission of parasites from the American tegumentary leishmaniasis. Although the fauna and the behavior of sandflies species are similar in different localities, the method of controlling these insects should be adjusted to the environmental characteristics of each one of the most diverse endemic areas of American tegumentary leishmaniasis in the municipalities of Paraná State. .

RESUMO Relatam-se, neste trabalho, a fauna e frequência de flebotomíneos em abrigos de animais domésticos, residências e outros ecótopos em áreas rurais do município de Bandeirantes, Estado do Paraná. Os flebotomíneos foram coletados em oito bairros rurais, com armadilhas de Falcão, duas vezes em cada bairro, das 20 às 6 horas, em 2008. No conjunto dos bairros coletaram-se 4.790 flebotomíneos, representados por dez espécies, com predomínio de Nyssomyia neivai e Nyssomyia whitmani. Os abrigos dos animais domésticos são os ecótopos onde há maior frequência desses insetos. As localidades onde as coletas foram realizadas têm características ambientais que permitem a persistência da transmissão de parasitos da leishmaniose tegumentar americana. Apesar da fauna e do comportamento das espécies de flebotomíneos serem semelhantes nas diversas localidades, o método de controle desses insetos deve ser ajustado às características ambientais de cada uma das mais diversas áreas endêmicas de leishmaniose tegumentar americana, nos municípios do Paraná. .

APPLICABILITY OF kDNA-PCR FOR ROUTINE DIAGNOSIS OF AMERICAN TEGUMENTARY LEISHMANIASIS IN A TERTIARY REFERENCE HOSPITAL / Aplicacao do kDNA-PCR para diagnostico de rotina de leishmaniose tegumentar americana em um hospital de referencia

SUMMARY This study evaluated the applicability of kDNA-PCR as a prospective routine diagnosis method for American tegumentary leishmaniasis (ATL) in patients from the Instituto de Infectologia Emílio Ribas (IIER), a reference center for infectious diseases in São Paulo - SP, Brazil. The kDNA-PCR method detected Leishmania DNA in 87.5% (112/128) of the clinically suspected ATL patients, while the traditional methods demonstrated the following percentages of positivity: 62.8% (49/78) for the Montenegro skin test, 61.8% (47/76) for direct investigation, and 19.3% (22/114) for in vitro culture. The molecular method was able to confirm the disease in samples considered negative or inconclusive by traditional laboratory methods, contributing to the final clinical diagnosis and therapy of ATL in this hospital. Thus, we strongly recommend the inclusion of kDNA-PCR amplification as an alternative diagnostic method for ATL, suggesting a new algorithm routine to be followed to help the diagnosis and treatment of ATL in IIER. .

RESUMO Este estudo avaliou a aplicabilidade do kDNA-PCR como método de rotina para diagnóstico de leishmaniose tegumentar americana (ATL) no Instituto de Infectologia Emílio Ribas (IIER), São Paulo, SP, Brasil. O método kDNA-PCR detectou DNA de Leishmania em 87,5% (112/128) dos pacientes com suspeita de ter leishmaniose e, os métodos tradicionais apresentaram as seguintes porcentagens de positividade: 62,8% (49/78) para o teste de Montenegro, 61,8% (47/76) para a pesquisa direta e 19,3% (22/114) para cultura in vitro. O método molecular confirmou a doença em amostras negativas ou inconclusivas pelos métodos laboratoriais tradicionais e, mostrou-se capaz de auxiliar na identificação de infecções causadas pela espécie Leishmania (V.) braziliensis. Além disso, a revisão dos prontuários médicos confirmou a importância do método PCR-RFLP no diagnóstico final de ATL, prognóstico e escolha do tratamento. Assim, recomendamos a inclusão do PCR como método diagnóstico de ATL na rotina hospitalar, e sugerimos um fluxograma para solicitação de exames laboratoriais. .

Severity of tegumentary leishmaniasis is not exclusively associated with Leishmania RNA virus 1 infection in Brazil

Leishmania RNA virus (LRV) has been shown to be a symbiotic component of Leishmania parasites in South America. Nested retro-transcription polymerase chain reaction was employed to investigate LRV1 presence in leishmaniasis lesions from Brazil. In endemic areas of Rio de Janeiro (RJ), no LRV1 infection was observed even with mucosal involvement. LRV1 was only detected in Leishmania (V.) guyanensis cutaneous lesions from the northern region, which were obtained from patients presenting with disease reactivation after clinical cure of their primary lesions. Our results indicated that the severity of leishmaniasis in some areas of RJ, where Leishmania (V.) brazi-liensis is the primary etiological agent, was not associated with Leishmania LRV1 infection.

Tratamento intralesional da leishmaniose cutânea com antimoniato de meglumina no instituto de pesquisa clínica Evandro Chagas, Fiocruz, Rio de Janeiro (2002 a julho 2011) / Intralesional treatment of cutaneous leishmaniasis with meglumine antimoniate at the institute of clinical research Evandro Chagas, Fiocruz, Rio de Janeiro (2002 to July 2011)

A leishmaniose tegumentar americana é uma doença que acomete a pele e as mucosas das vias aero digestivas superiores. Os antimoniais pentavalentes vêm sendo empregados há muitas décadas como fármacos de primeira linha para o seu tratamento. Pacientes com poucas lesões cutâneas, com impossibilidade de receber medicação parenteral regular ou com sinais de toxicidade importante ao antimonial por via sistêmica, podem ser submetidosao tratamento intralesional com antimoniato de meglumina. Objetivos:descrever a eficácia e a segurança do antimoniato de meglumina administrado por via intralesional, para o tratamento da leishmaniose cutânea. Método: Foi realizado um estudo descritivo, retrospectivo, tipo série de casos, de pacientes atendidos no Laboratório de Vigilância em Leishmanioses do Instituto de Pesquisa Clínica Evandro Chagas – FIOCRUZ, de 2002 até julho de 2011, que tivessem sido tratados para leishmaniose cutânea com aplicação intralesional de antimoniato de meglumina, após tratamento sistêmico com o mesmo fármaco...

American tegumentary leishmaniasis is a disease that affects the skin and mucous membranes of the upper aerodigestive tract. Pentavalent antimonial compounds have been used for decades as a first-line drugs for its treatment.Patients with few skin lesions, with inability to receive parenteral medication regularly or with signs of significant toxicity to antimony systemically, may be subjected to treatment with intralesional meglumine antimoniate. Objectives: Todescribe the efficacy and safety of meglumine antimoniate administered intralesionally, for the treatment of cutaneous leishmaniasis. Methods: We conducted a descriptive, retrospective case series of patients treated at the Leishmaniasis Surveillance Laboratory, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil, from 2002 until July2011, which had been treated for cutaneous leishmaniasis with intralesional meglumine antimoniate after systemic treatment with the same drug...

Ensaio clínico fase III para leishmaniose tegumentar americana forma cutânea. Equivalência entre esquemas de alta e baixa dose de antimoniato de meglumina / Phase III clinical trial for american cutaneous leishmaniasis. Equivalence between high and low dose schemes of meglumine antimoniate

Neste estudo comparamos esquemas de alta e baixa dose de antimoniato demeglumina (AM) para o tratamento da forma cutânea de leishmaniose tegumentar americana, em pacientes oriundos do estado do Rio de Janeiro. OBJETIVO:Comparar a eficácia representada pela cura imediata (epitelização em 120 dias),tardia (cicatrização em 360 dias) e definitiva (ausência de reativação ou lesão mucosa em 720 dias) e toxicidade (clínica, laboratorial e eletrocardiográfica) com duas diferentes doses de tratamento com AM para leishmaniose cutânea (LC) e comparar os critérios de cura clínica aqui adotados com aqueles estabelecidos pelo Ministério da Saúde. MÉTODO: Ensaio clínico de não inferioridade, controlado,randomizado, cego e de fase III, com 60 pacientes com LC alocados em dois grupos de tratamento: (A) 20mg Sb5+/kg/dia por 20 dias e (B) 5mg Sb5+/kg/dia por 30 dias administrados por via intramuscular. RESULTADOS: Pacientes dos grupos A e B apresentaram, respectivamente: Cura imediata 90,0% e 86,7%, com tempo médio de epitelização de 58,7 e 54,9 dias; cura tardia por intenção de tratar 76,7% e73,3%; e cura tardia por análise de protocolo 84,6% e 75,9%. Dos 53 pacientes que apresentaram epitelização em até 120 dias, 44 (83,4%)evoluíram para cura tardia...

In this study, we compare schemes of high and low dose of meglumine antimoniate(MA) for the treatment of cutaneous form of American tegumentary leishmaniasis in patients from Rio de Janeiro. OBJECTIVE: To compare the efficacy represented by immediate healing ( epithelialization in 120 days) , late healing (scarring within 360days ) and final healing (no reactivation or mucosal lesion in 720 days) and clinical ,laboratory and electrocardiographic toxicity with two different schemes of treatment with MA for cutaneous leishmaniasis (CL ) and compare the clinical cure criteria adopted here with those established by the Ministry of Health. METHOD :Randomized, controlled, blind, phase III clinical trial, of non-inferiority with 60patients presenting CL divided into two treatment groups: (A) 20 mg Sb5+ / kg / day for 20 days and (B) 5 mg Sb5+ / kg / day for 30 days administered intramuscularly.RESULTS : Patients in groups A and B presented, respectively : immediate healingof 86.7 % and 90.0 % , with a mean time of epithelialization of 58.7 and 54.9 days;late healing by intention to treat of 76.7 % and 73.3%; and late healing by protocol analysis of 84.6 % and 75.9 % .From 53 patients who presented epithelialization within 120 days , 44 (83.4 %) had late healing...