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Leishmaniose cutânea difusa (LCD) no Brasil após 60 anos de sua primeira descrição

2009; Faculty of Medicine of Bahia; Issue: 79 Linguagem: Inglês

0016-545X

Jackson Maurício Lopes Costa, Af Ali Uthant Moreira Lima da Costa, Ana Nilce Silveira Maia Elkhoury, Ana Célia R Bezerril, Aldina Barral, Ana Cristina R. Saldanha,

Research on Leishmaniasis Studies

Diffuse cutaneous leishmaniasis (DCL) is a rare form of cutaneous leishmaniasis (CL), being scattered in some countries in America and Africa. In our continent it is caused by the Leishmania complex (Leishmania mexicana, L. pifanoi, L. amazonensis) transmitted in Brazil by the bite of Lutzomyia flaviscutellata sandflies. We performed a retrospective review of all cases related in Brazil since 1945 with the aim to study the reality of DCL. Fourty cases described in our country were evaluated, proceeding from the following states: Maranhao 16 (40%); Para 8 (20%); Bahia 5 (12.5%); Mato Grosso 4 (10%); Tocantins 2 (5%); Acre 1 (2.5%); Amapa 1 (2.5%); Amazonas 1 (2.5%); Espirito Santo 1 (2.5%) and Pernambuco 1 (2.5%). The male/ female ratio was 2.4:1, mean of age 24 years (range 6-75 years) the age of most affected patients ranged from 11 to 30 years (47.5%). The most prevalent clinical presentations were nodes (81%), plaques (67.6%), ulcers (40.6%), tubercles (46%). The lesions were predominantly localized on anterior aspect of legs and face (67.7%) and upper limbs (61.3%). Fourteen mucosal lesions were related, with only one case of septal perforation. For laboratorial, scraping was performed in all cases, Montenegro skin test in 31 patients (77.5%), 27 (87%) negative, 1 (3.4%) false positive; 3 (9.6%) positive-negative. Culture, serology, hamster inoculation (Cricetus auratus) were also performed (23 patients each) with 100% positivity. The therapeutic approaches included trivalent antimonials (potassium tartarate, fuadina, neostibosan, reprodal) amphotericin B, lipossomal amphotericin B, pentamidine (isethionate), aminosidine (sulphate), pentavalent antimonials (Glucantime®), immunotherapy, immunotherapy+pentavalent antimonials. The follow up of the patients was refractory to all the therapeutic approaches. Thus, it was demonstrated that L. amazonensis is the responsible for the disease and the treatment remains a challenge.