Sensitivity of a vacuum aspiratory culture technique for diagnosis of localized cutaneous leishmaniasis in an endemic area of Leishmania (Viannia) braziliensis transmission.

Sixty eight patients with localized cutaneous leishmaniasis from an area with Leishmania (Viannia) braziliensis transmission had cultures performed with a modified Marzochís vacuum aspiratory puncture technique to establish sensitivity and contamination rate with this new method. Overall sensitivity of three aspirates was 47.1%; (CI95% 39.4; 59.4) significantly greater than the sensitivity of a single one aspirate. Fungal contamination was observed in 6/204 (2.9%) inoculated culture tubes. We recommend that this useful technique should be adopted as routine for primary isolation of L. (V.) braziliensis from localized cutaneous ulcers.

Sensitivity of lymph node aspiration in localized cutaneous leishmaniasis due to Leishmania (Viannia) braziliensis.

Twenty nine patients with localized cutaneous leishmaniasis had lymph node and skin ulcer aspirations for culture of Leishmania with the modified Marzochís vacuum aspiratory technique. Sensitivity of lymph node aspiration was 58.6% and 34.5% for skin ulcer aspiration (P=0.06). Combined sensitivity of the two methods was 79.3%. There was no agreement between methods (Kappa Index = -0.084; CI95% -0,45; 0,28) showing the potential complementary roles in diagnostic approach.

[Treatment of mucosal leishmaniasis with aminosidine sulfate: results of two year follow-up]. / Tratamento da leishmaniose mucosa com sulfato de aminosidine: resultados de dois anos de acompanhamento.

In 1996, 20 of 21 patients with mucosal leishmaniasis, treated in 1994 with aminosidine sulfate, 16mg/kg/day salt, by intramuscular injection for 20 days, were clinically evaluated. One patient died due to disease not related to mucosal leishmaniasis. Seven of 14 patients (66.7% N = 21) who achieved complete remission three months after treatment remained clinically cured 24 months later and seven relapsed in the same period (50% N = 14). Sorological follow-up showed poor correlation with the results of clinical examination.

Tratamento da leishmaniose mucosa com sulfato de aminosidine: resultados de dois anos de acompanhamento / Treatment of mucosal leishmaniasis with aminosidine sulfate: results of two year follow-up

In 1996, 20 of 21 patients with mucosal leishmaniasis, treated in 1994 with aminosidine sulfate, 16mg/kg/day salt, by intramuscular injection for 20 days, were clinically evaluated. One patient died due to disease not related to mucosal leishmaniasis. Seven of 14 patients (66.7% N = 21) who achieved complete remission three months after treatment remained clinically cured 24 months later and seven relapsed in the same period (50% N = 14). Sorological follow-up showed poor correlation with the results of clinical examination.

Em 1996 foram avaliados clinicamente 20 dos 21 pacientes com leishmaniose mucosa, tratados em 1994 com sulfato de aminosidine 16mg do sal/kg/dia, intramuscular, por 20 dias. Um paciente foi a óbito por causas não relacionadas com a leishmaniose mucosa. Dos 14 pacientes (66,7% N = 21) que inicialmente alcançaram a remissão completa dos sinais e sintomas durante os três primeiros meses de seguimento, sete (50% N = 14) permaneceram livres de doença por 24 meses e sete pacientes apresentaram recidiva neste período. O acompanhamento sorológico mostrou pobre correlação com a avaliação clínica.

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.

The control of Latin American trypanosomiasis

O autor apresenta seu ponto de vista pessoal sobre a situação atual do controle da doença de Chagas nos países da América Latina. Compara a situação com a tripanossomíase africana. Comenta a existência de casos em outros Continentes. Acentua o êxito da luta contra os triatomíneos domiciliados, através do uso de inseticidas residuais. Defende outras formas de transmissão do Trypansoma cruzi.

The author presents his personal point of view on the present situation of Chagas' disease control in Latin America countries. He compares the situation with African trypanosomiasis. He comments on the existence of cases in other Continents. He emphasizes the success of the fighting against domiciliated triatomine bugs by using residual insecticides. He discusses other forms of Trypanosoma cruzi transmission.

Needle autopsy.

Often in tropical practice there is not time or conditions to do a proper autopsy on a patient who has died. A needle biopsy technique is described for limited closed autopsy examination to clarify organ histology. In this way the clinician may resolve puzzling fatal disease.

[Treatment of the mucosal form of leishmaniasis without response to glucantime, with liposomal amphotericin B]. / Tratamento da forma mucosa de leishmaniose sem resposta a glucantime, com anfortericina B liposomal.

We treated six patients with mucosal leishmaniasis who failed to respond to glucantime (20 mg/kg/day) with ambisome (2-5 grams total dose). The daily dose was 2-3 mg/kg/day given for a minimum of 20 days. After 26-38 months of follow up, five patients were clinically cured. One relapsed after six months. No side effects of therapy were observed apart from headache after infection. Ambisome is a therapeutic option for patients with mucosal leishmaniasis unresponsive to antimonials.

The control of Latin American trypanosomiasis.

The author presents his personal point of view on the present situation of Chagas' disease control in Latin America countries. He compares the situation with African trypanosomiasis. He comments on the existence of cases in other Continents. He emphasizes the success of the fighting against domiciliated triatomine bugs by using residual insecticides. He discusses other forms of Trypanosoma cruzi transmission.

[Open therapeutic study with aminosidine sulfate in mucosal leishmaniasis caused by Leishmania (Viannia) braziliensis]. / Estudo terapêutico aberto com sulfato de aminosidine na leishmaniose mucosa causada por Leishmania (Viannia) braziliensis.

From September to November 1994. 21 patients with active mucosal leishmaniasis were treated with aminosidine sulphate 16 mg/kg/day by intramuscular injection for 20 days. They were principally adult male agricultural workers. Thirteen patients had not received specific treatment and eight had failed to respond to Glucantime therapy. Diagnosis was based on clinical and epidemiological observations, a search for the parasite, leishmanin skin sensitivity and indirect fluorescent antibody serological tests. Sixty seven percent of patients had leishmania parasites isolated from inoculated hamsters or visualized in imprints or histopathological sections. The mean follow-up period was 12.6 months. All patients completed treatment. Side effects were pain at the injection site (86%); mild proteinuria (24%), elevated serum creatinine (.5%) and subclinical bearing loss in one of two patients who did audiometric tests. Clinical cure was achieved in 48% and the accumulated relapse rate was 29% (4/14).

[Measurement of the volume of the skin ulcer in cutaneous leishmaniasis]. / Medida do volume da úlcera cutânea na leishmaniose tegumentar.

Skin ulcers by Leishmania (Viannia) braziliensis are often deep and irregular and are difficult to measure by just the skin surface transverse and longitudinal diameters. The proposal is to mould the cavity, after local asepsis with fresh water plus soap, with a gelatinous plastic which contains silence, potassium alginate, calcium sulphate, magnesium oxide commercialized under the name of jeltrate (Dentsply Laboratory), by solving 9.5g of jeltrate in 20ml of fresh water and applying the gel on the ulcer which solidifies in 5 minutes. This mould is then filled with a self polymerising acrylic and its volume measured either by weight (by using an analytical balance)-technique 1-or by water displacement by applying Archimeds'principle-technique 2. We show data in a field trial before and after 20 days treatment in 20 patients using three different schedules as follows: 7 received pentamidine isethionate, 7 patients received aminosidine sulphate and 6 received meglumine antimoniate. The results point out that there was a uniform reduction of ulcer volume occurred during this period in the three groups, in both technique. Regarding the therapeutic schedules we are sure that there was a significant statistical difference between the three schedules using the T Student Test, which showed that aminostdine sulphate produced a better volume reduction of the ulcer than the other drugs. Serial moulds reflect clinical billing and are a permanent record. We conclude that the measure of the volume of the skin ulceration can be useful in the therapeutic evaluation, as a practical and cheap procedure, and may be used in field trials.

[Physico-chemical characteristics of meglumine antimoniate in different storage conditions]. / Características físico-químicas do antimoniato de meglumina em diferentes condições de armazenamento.

During the period October 1992 to July 1995 we measured the osmolarity and pH of ampoules of meglumine antimoniate (glucantime) from lot 9206L-004 (manufactured by Rhodia Farma Ltd, of São Paulo, SP, Brazil) maintained in three temperature conditions namely 4 degrees C, 37 degrees C and ambiental. Although we observed statistically significant differences in osmolarity between samples, the limited number of measurements and the variation of this property in ampoules maintained at the same temperature were obstacles to obtain definitive conclusions. Such a variation was not found with pH. Assuming these parameters could reflect structural changes in the pentavalent antimony molecule, clearly further better controlled experiments are indicated.