ABSTRACT
PURPOSE: Overlapping clinical features of cutaneous leishmaniasis (CL) with ulcers caused by fungi and mycobacteria necessitate confirmatory diagnostic testing. We evaluated a handheld battery-operated device for detection of CL and common fungal and mycobacterial causes of ulcers. METHODS: We validated Palm PCR™ for detection of common ulcerative skin pathogens using ATCC® reference and clinical strains of Leishmania, mycobacteria, and fungi in the lab and field. Amplified products were Sanger sequenced. Performance characteristics were calculated using conventional PCR as a reference standard. RESULTS: Palm PCR™ detected 100% of ATCC® strains of Leishmania, fungi, and mycobacteria, with sensitivity and specificity of 90% and 91.7%, respectively. In the field, the sensitivity for detection of Leishmania in patients with suspected CL was 100%. In 61% of CL patients, co-colonization with genera such as Malassezia, Aspergillus, Candida, and Cladosporium was detected. In 50% of CL patients with an inflammatory (secondarily infected) phenotype, detected fungal species had known associations with human cutaneous disease. CONCLUSIONS: Palm PCR™ performs comparably to conventional PCR for detection of Leishmania, fungi, and mycobacteria. This work has implications for the diagnostic approach to tropical ulcers, and has the potential to improve field detection of ulcerative pathogens in resource constrained areas.
Subject(s)
Leishmania , Leishmaniasis, Cutaneous , Mycobacterium , Fungi , Humans , Leishmania/genetics , Leishmaniasis, Cutaneous/diagnosis , Peru , Point-of-Care Systems , Sensitivity and Specificity , UlcerABSTRACT
RESUMEN: Las leishmaniasis son un grupo de enfermedades parasitarias zoonóticas endémicas en las provincias del norte argentino, producidas por diferentes especies de protozoarios (leishmania), transmitidas por un vector flebótomo, la Lutzomyianeivai (mosquito hembra), que tiene como reservorio los animales vertebrados y accidentalmente al hombre. Presentamos un caso clínico de leishmaniasis cutánea primaria en una paciente de sexo femenino de 56 años de edad, de provincia de Tucumán, con dos lesiones atípicas localizadas en región mentoniana y supraorbitaria derecha, con diagnostico confirmado por frotis e histopatología, con buena respuesta al tratamiento con antimoniato de metglumina.
ABSTRACT: The Leishmaniases are a group of zoonotic diseases caused by protozoan parasites from different Leishmania species. They are transmitted by phlebotomine vectors such asLutzomyianeivai,whichhas its reservoir in vertebrate animals and, accidentally, infects human beings. Since the beginnings of the 21stcentury, it is an endemic disease in the provinces of the North of Argentina. We present a clinical case of primary cutaneous leishmaniasis in a 56-year-old female patient from the province of Tucumán. The patient presents two atypical lesions in the form of an erysipeloid plaque with a crusted ulcer in its centre, located on the right supraorbital and mandibular regions. The patient was treated with melamine antimoniate and showed clinical improvement of the lesions.
ABSTRACT
La leishmaniasis mucocutánea tiene una presentación relativamente frecuente en las zonas tropicales de Bolivia. Coexiste con otra enfermedad endémica de la zona: la tuberculosis. Esta también afecta frecuentemente la vía aérea superior. Ambas pueden ser confundidas, por tanto el tratamiento también podría ser erróneo. Presentamos un caso de leishmaniasis con características de afectación propia a la tuberculosis.
Mucocutaneous leishmaniasis is relatively frequent in the tropical regions of Bolivia. It coexists with another endemic disease of the region: tuberculosis. Tuberculosis frequently affects the upper airways, too. Leishmaniasis may be confused with tuberculosis, thus, its treatment can be erroneous. We report a case of leishmaniasis whose involvement profle is typical of tuberculosis.
Subject(s)
Ulcer , Leishmaniasis, MucocutaneousABSTRACT
Se describe el caso de un paciente con leishmaniasis cutáneo-mucosa proveniente de Israel, quien viajó por regiones endémicas de esta enfermedad en América Latina durante el último año. Consultó por la presencia de lesiones úlcero-costrosas, levemente dolorosas, de 45 días de evolución, una en la región del mentón (acompañada de inflamación local y adenopatía regional submentoniana), de aproximadamente 2 cm de diámetro, y otra, más pequeña, en el borde lateral del ojo derecho. Con material tomado por escarificación de los bordes de las lesiones, se realizaron extendidos que fueron fijados y coloreados con la técnica de Giemsa. La microscopia reveló la presencia de amastigotes de Leishmania. Conocida la etiología, se inició tratamiento específico con antimonio de meglumina (Glucantime®), a razón de 20 mg/kg/día, durante 21 días, con buena tolerancia y cicatrización de las lesiones. Las lesiones de leishmaniasis cutáneo-mucosa deben incluirse en el diagnóstico diferencial de las úlceras tropicales y su diagnóstico etiológico requiere de un procedimiento sencillo, al alcance de laboratorios de baja complejidad.
An Israeli patient with cutaneous leishmaniasis who had been travelling in Latin America during the previous year was described. The patient presented with two lesions, one crusty ulcer in the chin region which was slightly painful and with regional adenopathy, and a smaller ulcer in the lateral edge of the right eye. The diagnosis was established by microscopic observation of Leishmania sp. in skin scrapings stained with Giemsa. Systemic treatment with meglumine antimony (Glucantime ®), 20 mg / kg / day during 21 days was administered without adverse events and ulcer reepithelialization. Cutaneous leishmaniasis should be included in the differential diagnosis of tropical ulcers, and etiologic diagnosis requires a simple procedure, available to low-complexity laboratories.