Leishmaniose tegumentar americana: casuística hospitalar no Rio de Janeiro American tegumentary Leishmaniasis: hospitalized cases in Rio de Janeiro

FUNDAMENTOS: A leishmaniose tegumentar americana distribui-se amplamente no Brasil, e o Estado do Rio de Janeiro (capital e interior) constitui área endêmica onde o vetor é encontrado dentro e ao redor das habitações. OBJETIVOS: Análise prospectiva de 48 casos de leishmaniose tegumentar americana atendidos no Hospital Universitário Clementino Fraga Filho/UFRJ, no período de 1990 a 2002. MÉTODOS: Todos os pacientes foram submetidos à biópsia de pele ou mucosa, teste de Montenegro e exame otorrinolaringológico; SbV (10 a 20mg/kg), no total de 10, 30 e 90 doses. foi empregado em 44 pacientes; em quatro casos, anfotericina B (0,5mg/kg/dose) até dose cumulativa de 30mg/kg. RESULTADOS: 28 homens e 20 mulheres na faixa etária de 10 a 89 anos, dos quais 38 (79,1%) infectados no Rio de Janeiro, apresentaram úlcera de membro inferior e comprometimento de mucosa nasal como manifestações mais freqüentes; 41 casos (85,4%) foram reatores à intradermorreação de Montenegro (5mm); 17 casos (35,4%) foram positivos para o achado de amastigotas em macrófagos no infiltrado inflamatório dérmico; predominou o processo inflamatório crônico granulomatoso; cura clínica foi observada em 47 casos; um caso evoluiu para óbito no décimo dia de tratamento. CONCLUSÕES: O estudo da leishmaniose tegumentar (HUCFF/UFRJ) no período 1990/2002 evidenciou padrão conhecido nos aspectos epidemiológicos, clínicos e de resposta terapêutica ao antimonial (SbV) e anfotericina B.<br>BACKGROUND: American tegumentary Leishmaniasis is widely found in Brazil; the state of Rio de Janeiro (capital and hinterland) is an endemic area where the vector is found inside and outside houses. OBJECTIVES: prospective study of 48 cases attended at the Teaching Hospital Clementino Fraga Filho - UFRJ, between 1990 - 2002. METHODS: All patients were submitted to skin or mucosa biopsy, Montenegro skin test and otorhinolaryngologic examination; SbV (10 - 20 mg/kg) with 10, 30 and 90 doses was used in 44 patients; in 4 cases, Amphotericin B (0.5 mg/kg/dose) until cumulative dosage of 30 - 50 mg/kg. RESULTS: 28 males and 20 females aged 10 - 89 years mostly infected in Rio de Janeiro (38 cases/79.1%) mainly presented ulcers in the extremities and involvement of nasal mucosa; 41 cases (85.4%) were reactive to the Montenegro skin test (5 mm); 17 cases (35.4%) were positive for amastigotes in tissue sections; an inflammatory chronic granulomatous process was mostly seen. Clinical cure was observed in 47 cases; one patient died on day 10 of treatment. CONCLUSION: The study of American tegumentary Leishmaniasis (HUCFF - UFRJ) from 1990-2002 showed a well-known "status" considering epidemiological and clinical perspectives as well as therapeutic response to antimony (SbV) and amphotericin B

IFN-γ Production to Leishmania Antigen Supplements the Leishmania Skin Test in Identifying Exposure to L. braziliensis Infection

Background Cutaneous leishmaniasis due to L. braziliensis (CL) is characterized by a positive delayed type hypersensitivity test (DTH) leishmania skin test (LST) and high IFN-γ production to soluble leishmania antigen (SLA). The LST is used for diagnosis of CL and for identification of individuals exposed to leishmania infection but without disease. The main aim of the present study was to identify markers of exposure to L. braziliensis infection. Methodolgy/Principal Findings This cohort study enrolled 308 household contacts (HC) of 76 CL index cases. HC had no active or past history of leishmaniasis. For the present cross-sectional study cytokines and chemokines were determined in supernatants of whole blood culture stimulated with SLA. Of the 308 HC, 36 (11.7%) had a positive LST but in these IFN-γ was only detected in 22 (61.1%). Moreover of the 40 HC with evidence of IFN-γ production only 22 (55%) had a positive LST. A total of 54 (17.5%) of 308 HC had specific immune response to SLA. Only a moderate agreement (Kappa = 0.52; 95% CI: 0.36–0.66) was found between LST and IFN-γ production. Moreover while enhancement of CXCL10 in cultures stimulated with SLA was observed in HC with DTH+ and IFN-γ+ and in patients with IFN-γ+ and DTH−, no enhancement of this chemokine was observed in supernatants of cells of HC with DTH+ and IFN-γ−. Conclusions/Significance This study shows that in addition of LST, the evaluation of antigen specific IFN-γ production should be performed to determine evidence of exposure to leishmania infection. Moreover it suggests that in some HC production of IFN-γ and CXCL10 are performed by cells not involved with DTH reaction