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.

Evaluation of different diagnostic methods of American Cutaneous Leishmaniasis in the Brazilian Amazon.

Epidemiological studies have been conducted to better understand the dynamics of American Cutaneous Leishmaniasis (ACL) in the Amazon region where distinct species of Leishmania circulate. In endemic areas, the optimal diagnosis must be made in the earlier clinical presentation to avoid the complications of chronic disease. The scarcity of financial support, laboratory infrastructure and trained persons are the major obstacles in this reality. This paper describes the result of performing different diagnostic methods for ACL in Amazonas State between the years 2010 and 2011. The tests used were the intradermal skin test (Montenegro's skin test), ELISA (Enzyme-Linked Immunosorbent Assay), direct examination, culture isolation and identification of Leishmania species. A total of 38 suspected human cases of ACL were diagnosed by different methods, of which 71.0% (n = 27) were positive by direct examination, 75.6% (n = 28) had positivity in the culture isolates and, of these, 54.0% (n = 19) had infection with Leishmania (Viannia) guyanensis. The positivity of the intradermal skin test with the leishmanin solution was observed in 77.0% of cases analyzed and the serology with detection of IgG and IgM showed the presence of antibodies in 100% of exams realized results, showing variation in the titles of antibodies. The success of Leishmaniasis treatment depends on an effective and early diagnosis. Parasitological diagnosis is highly specific, but sensitivity is subject to variation because the tissue distribution of parasites generally is not homogeneous and depends on the specie of parasite. Moreover, parasitological tests require invasive procedures and depend on restrictive conditions for the collection of biological sample, which limit their use in large-scale for epidemiological studies. ELISA has been the most widely used serological method for the diagnosis of Visceral Leishmaniasis (VL) as it is easy to perform and has a low cost. However, flaws in specificity are observed in the diagnosis of cutaneous leishmaniasis. Actually the diagnosis needs to be done as an associated methods depending on the question to be solved.

The role of inflammatory, anti-inflammatory, and regulatory cytokines in patients infected with cutaneous leishmaniasis in Amazonas State, Brazil.

The authors discuss in this paper the role of inflammatory, anti-inflammatory, and regulatory cytokines in patients infected with different species of Leishmania in Amazonas State, Brazil. A comparative analysis was made of serum concentrations of these cytokines in the peripheral blood of 33 patients infected with cutaneous leishmaniasis. The isolates were identified as Leishmania guyanensis, L. naiffi, and L. amazonensis. Most (64%) of the patients were male ranging in age from 18 to 58 years. Protein expression profiles of IL-2, IL-4, IL-6, IL-10, IFN-γ, TNF-α, and IL-17 cytokines were shown to vary significantly between infected and noninfected (control group) individuals and according to the Leishmania species. Infection caused by L. guyanensis accounted for 73% of the cases and patients with this parasite also showed higher concentrations of IL-2, IFN-γ, IL-4, and IL-17 when compared to infection by L. amazonensis. Patients with infection caused by L. naiffi showed higher concentration of the cytokines analyzed when compared to uninfected patients; however, there was no statistically significant difference with the other species analyzed.

Distribuição de casos de leishmaniose tegumentar no município de Rio Preto da Eva, Amazonas, Brasil / Distribution of cases of cutaneous leishmaniasis in the city of Rio Preto da Eva, Amazonas, Brazil

Foram analisados os aspectos clínicos e epidemiológicos de 90 pacientes com leishmaniose tegumentar americana (LTA) no município de Rio Preto da Eva, estado do Amazonas, Brasil, entre os anos de 2005 e 2012. Todos os pacientes apresentavam lesões cutâneas cujas cepas isoladas foram caracterizadas por eletroforese de isoenzimas e identificadas como Leishmania (Viannia) guyanensis (n=80), Leishmania (V.) naiffi (n=3) e Leishmania (Leishmania) amazonensis (n=7). A maior parte dos pacientes era do sexo masculino (70 porcento) e a faixa etária com maior número de casos foi de 11 a 20 anos (31,7 porcento). Em relação à ocupação, a maioria era constituída por agricultores ou caseiros (37,7 porcento). Um percentual de 95 porcento dos casos de LTA era proveniente de focos endêmicos de zonas rurais. O Assentamento Iporá, localizado no km 127 da AM 010, apresentou o maior número de casos (33,3 porcento). Concluímos que a LTA é uma parasitose endêmica de importância no município de Rio Preto da Eva, ocorre principalmente ao longo da rodovia AM 010 e, nos pacientes analisados, a aquisição da infecção ocorreu, majoritariamente, por meio de contato com o ciclo silvestre de transmissão, ressaltando-se, porém, a possibilidade de transmissão da doença no intra e peridomicílio...

We analyzed the clinical and epidemiological characteristics of 90 patients with Cutaneous Leishmaniasis (CL) in Rio Preto da Eva, Amazonas state, Brazil, between 2005 and 2012. All patients had skin lesions, whose isolates were characterized by isoenzyme electrophoresis and identified as Leishmania (Viannia) guyanensis (n=80), Leishmania (V.) naiffi (n=3) and Leishmania(Leishmania) amazonensis (n=7). Most patients were male (70 percent) and the age group with the highest number of cases was 11 to 20 years old (31.7 percent). In terms of occupation, most were farmers or home caretakers (37.7 percent). Around 95 percent of cases of CL were from rural areas of endemic foci and the settlement known as Iporá, located at KM 127 of the AM 010 road, had the highest number of cases (33.3 percent). We conclude that American egumentary Leishmaniasis is a parasitic disease endemic in Rio Preto da Eva (Amazonas State), occurring mainly along the 010 AM Highway, and that infection was mainly acquired through contact with the sylvatic transmission cycle, although the possibility of disease transmission peridomiciliary was also analysed...

Ocorrência de flebotomíneos (Diptera: Psychodidae: Phlebotominae) no ambiente peridomiciliar em área de foco de transmissão de leishmaniose tegumentar no município de Manaus, Amazonas / Occurrence of sandflies (Diptera: Psychodidae: Phlebotominae) in the peridomestic environment in an area of transmission focus for cutaneous Leishmaniasis in Manaus, Amazon

Leishmaniasis is an antropozoonosis with natural foci, in which infection is maintained in wild ecotopes among the population of vectors and their vertebrate hosts. This study identified sand fly species involved in transmission of Leishmaniasis in the east area of Manaus, in households in the neighborhood of Cidade de Deus, where there are outbreaks of human and animal disease. The vicinity is near to Adolpho Ducke forest reserve. In the study, 122 specimens were captured at different times, using the CDC light traps. The most commonly encountered species of phlebotomine sandflies were Lutzomyia umbratilis, L. rorotaensis and L. olmeca nociva. Near one of the residences where the collections were made, there was disposal of organic waste, a fact that favors the attraction of animal reservoirs in the forest reserve, thus enabling the occurrence of the disease transmission cycle in the peridomicile.

A leishmaniose é uma antropozoonose com focos naturais, nos quais a infecção é mantida em ecótopos silvestres entre a população de vetores e seus hospedeiros vertebrados. Neste estudo foram identificadas espécies de flebotomíneos envolvidas na transmissão de leishmaniose tegumentar no Bairro Cidade de Deus, onde há focos da doença humana e animal. O bairro está situado à margem da reserva florestal Adolpho Ducke. Foram capturados 122 espécimens em épocas variadas, utilizando-se armadilhas luminosas do tipo CDC. As espécies de flebotomíneos mais encontradas foram Lutzomyia umbratilis, L. rorotaensis e L. olmeca nociva. Nas proximidades de uma das residências onde foram realizadas as coletas de flebotomíneos, verificou-se descarte de resíduos orgânicos (lixo), o que possibilita a atração de reservatórios silvestres presentes na reserva florestal favorecendo a ocorrência do ciclo de transmissão da doença no peridomicílio.

[Isoenzymatic characterization of human isolates of Leishmania sp (Kinetoplastida: Trypanosomatidae) from the municipalities of Rio Preto da Eva and Manaus, State of Amazonas]. / Caracterização isoenzimática de isolados humanos de Leishmania sp (Kinetoplastida: Trypanosomatidae) dos municípios de Rio Preto da Eva e Manaus, Estado do Amazonas.

Twenty-three isolates of Leishmania sp from patients in the municipalities of Rio Preto da Eva and Manaus were characterized and identified by means of isoenzyme electrophoresis and the degree of similarity between the organisms was analyzed. The results indicated that Leishmania guyanensis and Leishmania naiffi were present in these two environments and that the Leishmania naiffi samples were heterogenous.

Caracterização isoenzimática de isolados humanos de Leishmania sp (Kinetoplastida: Trypanosomatidae) dos municípios de Rio Preto da Eva e Manaus, Estado do Amazonas / Isoenzymatic characterization of human isolates of Leishmania sp (Kinetoplastida: Trypanosomatidae) from the municipalities of Rio Preto da Eva and Manaus, State of Amazonas

Foram caracterizados/identificados por eletroforese de isoenzimas 23 isolados de Leishmania sp de pacientes dos municípios de Rio Preto da Eva e Manaus, analisando-se o grau de similaridade entre os organismos. Os resultados indicaram ocorrência de Leishmania guyanensis e Leishmania naiffi nestes dois ambientes e a heterogeneidade das amostras de Leishmania naiffi.

Twenty-three isolates of Leishmania sp from patients in the municipalities of Rio Preto da Eva and Manaus were characterized and identified by means of isoenzyme electrophoresis and the degree of similarity between the organisms was analyzed. The results indicated that Leishmania guyanensis and Leishmania naiffi were present in these two environments and that the Leishmania naiffi samples were heterogenous.