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Tegumentary Leishmaniasis (TL) caused by Leishmania Viannia Braziliensis in the genital organs

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

0016-545X

Rosse Carneiro Osório, Daniel Almeida Ferreira Barbosa, Marcelo de Jesus Martins, Renata Dórea Leal, Diego Zapelini do Nascimento, Eljimar Fernandes, Eliane G. Nascimento, Armando Nascimento, Carlos César Machado, Aldina Barral, Jackson M. L. Costa,

Research on Leishmaniasis Studies

Clinical aspects of tegumentary leishmaniasis (TL) depend on the interaction between parasite virulence and the host immune response, with lesions most frequently occurring in uncovered areas of the body. About 80% of the lesions are located on upper and lower limbs. Genital lesions are rare. We followed up five patients with this presentation at the outpatient clinic. Objective – Report the clinical and laboratory of five patients with genital lesions caused by Leishmania braziliensis. Material and methods: Five cases of tegumentary leishmaniasis (TL) in the genital organs followed up at the outpatient clinic, as part of a series of 350 cases between 2000 and 2005, were studied. The patients were submitted to clinical-epidemiological assessment and exams (Montenegro skin test/MST, enzyme linked-immunosorbent assay/ ELISA and histophatology) for diagnostic. Treatment with N-methylglucamine antimonate (Glucantime®) at a dose of 15 to 17 mg/Sb+5/kg/day/20 to 30 days, with follow-up of 12 months after treatment. Results - Patient age ranged from 6 to 62 years (mean: 32.8). There was a predominance of males 4(80%). All patients were from TL risk areas (Florestal/ Jequie, Itagiba, Jaguaquara, Sao Goncalo/Contendas do Sincora, Bahia) and none had a history of TL. The duration of the lesions until diagnosis ranged from 60 to 120 days (mean: 80). The most affected areas were the corpus of the penis and glans. Ulcerated lesions and a clean or granular base in the absence of satellite lymphadenopathy were observed in most cases (80%). The diagnosis was confirmed by leishmanin skin test positive (MST+/100%), Leishmaniareactive ELISA (60%), and histopathology with amastigote of Leishmania in 5(100%). All patients were cured. Conclusions - In our cases studied, only one patient had concomitant lesions but none of the patients had a history of TL, indicating that the disease started by direct inoculation of the parasite into the affected area. Patient habits such as sleeping naked and the lack of intradomiciliary sanitary installations support this hypothesis since they permit the exposure of normally covered body areas. Another important aspect is the inclusion of genital lesions of TL in the differential diagnosis of sexually transmitted and neoplastic diseases since its clinical can simulate diseases such as syphilis and carcinoma. An early diagnosis facilitates adequate treatment and a favorable prognosis for the patients. Key words: Tegumentary leishmaniasis, genital organs, genital ulcer, Leishmania braziliensis, state of Bahia, Brazil.