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American tegumentary leishmaniasis - a case of therapeutic challenge.

Couto DV, Hans Filho G, Medeiros MZ, Vicari CF, Barbosa AB, Takita LC - An Bras Dermatol (2014 Nov-Dec)

Bottom Line: Treatment for ATL recommended by the Brazilian Ministry of Health is similar for the whole country, regardless of the species of Leishmania.It is known that the response to treatment may vary with the strain of the parasite, the immune status of the patient and clinical form.We report the case of a healthy patient, coming from Manaus, Amazonas state, Brazil, who presented resistance to treatment with N-methyl-glutamine and liposomal amphotericin B, only being healed after using pentamidine.

View Article: PubMed Central - PubMed

Affiliation: Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil.

ABSTRACT
American Tegumentary Leishmaniasis (ATL) is a chronic, non-contagious, infectious disease affecting millions of people worldwide. The timely and proper treatment is of great importance to prevent the disease from progressing to destructive and severe forms. Treatment for ATL recommended by the Brazilian Ministry of Health is similar for the whole country, regardless of the species of Leishmania. It is known that the response to treatment may vary with the strain of the parasite, the immune status of the patient and clinical form. We report the case of a healthy patient, coming from Manaus, Amazonas state, Brazil, who presented resistance to treatment with N-methyl-glutamine and liposomal amphotericin B, only being healed after using pentamidine.

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Epidermis with pseudoepitheliomatous hyperplasia, dermis with dense inflammatoryinfiltrate constituted of lymphocytes, plasmocytes, macrophages and some giantmultinucleated cells. Macrophages were observed containing corpuscles withcharacteristics suggesting amastigote forms of Leishmania sp (arrows)
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f02: Epidermis with pseudoepitheliomatous hyperplasia, dermis with dense inflammatoryinfiltrate constituted of lymphocytes, plasmocytes, macrophages and some giantmultinucleated cells. Macrophages were observed containing corpuscles withcharacteristics suggesting amastigote forms of Leishmania sp (arrows)

Mentions: Female patient, 6 years old, originally from Manaus-AM, had resided in Campo Grande-MSfor the last 4 months. Two months ago she progressively developed an erythematous,crusted and erosive plaque with infiltrated edges, measuring 2.5 cm in diameter in thedistal extensor region of left arm (Figure 1).Direct investigation (imprint) detected amastigote structurescompatible with Leishmania sp. Histopathological examination revealedepidermis with pseudoepitheliomatous hyperplasia, dermis with a dense inflammatoryinfiltrate constituted of lymphocytes, plasmocytes, macrophages and some multinucleatedgiant cells. Macrophages containing corpuscles with characteristics of amastigote formsof Leishmania (Figure 2) wereobserved. She received N-methylglucamine (NMG) (5.3ml/day for 20 days) with discreetlesion regression. As she showed no improvement 2 months after the end of the NMGtreatment, liposomal amphotericin B was initiated (total dose of 575mg). Thirty daysafter the treatment active lesions still persisted. Suspecting that theLeishmania was acquired in the Amazon region, we began usingpentamidine, prescribing 7mg/kg IM in a single dose. The patient presented regression ofthe lesion and a cicatricial plaque remained (Figure3).


American tegumentary leishmaniasis - a case of therapeutic challenge.

Couto DV, Hans Filho G, Medeiros MZ, Vicari CF, Barbosa AB, Takita LC - An Bras Dermatol (2014 Nov-Dec)

Epidermis with pseudoepitheliomatous hyperplasia, dermis with dense inflammatoryinfiltrate constituted of lymphocytes, plasmocytes, macrophages and some giantmultinucleated cells. Macrophages were observed containing corpuscles withcharacteristics suggesting amastigote forms of Leishmania sp (arrows)
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4230669&req=5

f02: Epidermis with pseudoepitheliomatous hyperplasia, dermis with dense inflammatoryinfiltrate constituted of lymphocytes, plasmocytes, macrophages and some giantmultinucleated cells. Macrophages were observed containing corpuscles withcharacteristics suggesting amastigote forms of Leishmania sp (arrows)
Mentions: Female patient, 6 years old, originally from Manaus-AM, had resided in Campo Grande-MSfor the last 4 months. Two months ago she progressively developed an erythematous,crusted and erosive plaque with infiltrated edges, measuring 2.5 cm in diameter in thedistal extensor region of left arm (Figure 1).Direct investigation (imprint) detected amastigote structurescompatible with Leishmania sp. Histopathological examination revealedepidermis with pseudoepitheliomatous hyperplasia, dermis with a dense inflammatoryinfiltrate constituted of lymphocytes, plasmocytes, macrophages and some multinucleatedgiant cells. Macrophages containing corpuscles with characteristics of amastigote formsof Leishmania (Figure 2) wereobserved. She received N-methylglucamine (NMG) (5.3ml/day for 20 days) with discreetlesion regression. As she showed no improvement 2 months after the end of the NMGtreatment, liposomal amphotericin B was initiated (total dose of 575mg). Thirty daysafter the treatment active lesions still persisted. Suspecting that theLeishmania was acquired in the Amazon region, we began usingpentamidine, prescribing 7mg/kg IM in a single dose. The patient presented regression ofthe lesion and a cicatricial plaque remained (Figure3).

Bottom Line: Treatment for ATL recommended by the Brazilian Ministry of Health is similar for the whole country, regardless of the species of Leishmania.It is known that the response to treatment may vary with the strain of the parasite, the immune status of the patient and clinical form.We report the case of a healthy patient, coming from Manaus, Amazonas state, Brazil, who presented resistance to treatment with N-methyl-glutamine and liposomal amphotericin B, only being healed after using pentamidine.

View Article: PubMed Central - PubMed

Affiliation: Universidade Federal de Mato Grosso do Sul, Campo Grande, MS, Brazil.

ABSTRACT
American Tegumentary Leishmaniasis (ATL) is a chronic, non-contagious, infectious disease affecting millions of people worldwide. The timely and proper treatment is of great importance to prevent the disease from progressing to destructive and severe forms. Treatment for ATL recommended by the Brazilian Ministry of Health is similar for the whole country, regardless of the species of Leishmania. It is known that the response to treatment may vary with the strain of the parasite, the immune status of the patient and clinical form. We report the case of a healthy patient, coming from Manaus, Amazonas state, Brazil, who presented resistance to treatment with N-methyl-glutamine and liposomal amphotericin B, only being healed after using pentamidine.

Show MeSH
Related in: MedlinePlus