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FIRST REPORT OF CUTANEOUS LEISHMANIASIS CAUSED BY Leishmania (Leishmania) infantum chagasi IN AN URBAN AREA OF RIO DE JANEIRO, BRAZIL.

Lyra MR, Pimentel MI, Madeira Mde F, Antonio Lde F, Lyra JP, Fagundes A, Schubach Ade O - Rev. Inst. Med. Trop. Sao Paulo (2015 Sep-Oct)

Bottom Line: An eighty-one-year-old woman presented three pleomorphic skin lesions that were not associated with systemic symptoms or visceromegalies.Multilocus enzyme electrophoresis identified L. (L.) infantum chagasi, but direct smear and PCR of bone narrow were negative for Leishmania sp. (suggesting exclusively cutaneous involvement).Etiologic diagnosis of ATL based upon exclusive clinical criteria may lead to incorrect conclusions.

View Article: PubMed Central - PubMed

Affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

ABSTRACT
American tegumentary leishmaniasis (ATL) is an infectious disease caused by protozoa of the genus Leishmania, and transmitted by sandflies. In the state of Rio de Janeiro, almost all of the cases of American tegumentary leishmaniasis (ATL) are caused by Leishmania (Viannia) braziliensis, while cases of visceral leishmaniasis (VL) are caused by Leishmania (Leishmania) infantum chagasi. The resurgence of autochthonous VL cases in Rio de Janeiro is related to the geographic expansion of the vector Lutzomyia longipalpis and its ability to adapt to urban areas. We report the first case of leishmaniasis with exclusively cutaneous manifestations caused by L. (L.) infantum chagasi in an urban area of Rio de Janeiro. An eighty-one-year-old woman presented three pleomorphic skin lesions that were not associated with systemic symptoms or visceromegalies. Multilocus enzyme electrophoresis identified L. (L.) infantum chagasi, but direct smear and PCR of bone narrow were negative for Leishmania sp. (suggesting exclusively cutaneous involvement). We discuss the different dermatological presentations of viscerotropic leishmaniasis of the New and Old World, and the clinical and epidemiological importance of the case. Etiologic diagnosis of ATL based upon exclusive clinical criteria may lead to incorrect conclusions. We should be aware of the constant changes in epidemiological patterns related to leishmaniases.

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- Round ulcer with infiltrated borders in the right elbow.
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f02: - Round ulcer with infiltrated borders in the right elbow.

Mentions: An eighty-one-year-old woman, from Rio de Janeiro, residing for the previous two years in a nursing home in Caju neighborhood, reported the appearance of skin lesions about seven months earlier. She had cardiac disease and chronic renal failure (CRF) and was referred to the Laboratory of Leishmaniases Surveillance of the Evandro Chagas National Institute of Infectious Diseases, of the Oswaldo Cruz Foundation. Dermatological examination revealed the presence of three pleomorphic lesions that measured between 3 and 4 cm in diameter and were located in the frontal and left malar regions of the face, and in the right elbow (Fig. 1 and 2). The lesions were not associated with systemic symptoms such as fever, weight loss or poor general condition. The patient had no lymphadenopathy or visceromegalies. Laboratory tests were within normal range, except for increased urea (135 mg/dL) and creatinine (2.65 mg/dL) due to pre-existing CRF. Electrocardiogram showed cardiac arrhythmia and enlargement of the corrected QT space (QTc) (0.50 seconds). Abdominal ultrasound did not reveal the presence of hepatomegaly or splenomegaly. Histopathology, direct smear, culture in McNeal, Novy, Nicolle (NNN) medium, and polymerase chain reaction (PCR) performed on cutaneous lesions fragments confirmed the clinical diagnosis of ATL. Montenegro skin test and enzyme-linked immunosorbent assay (ELISA) serology for leishmaniasis resulted positive. Since no previous cases of ATL were known in this neighborhood, and a recent case of VL had been described in this location18, we performed the multilocus enzyme electrophoresis assay as previously described5, and the identification of L. (L.) infantum chagasi was confirmed (Fig. 3). Culture and PCR of a bone marrow sample were negative for parasite isolation orLeishmania DNA detection. Since the patient presented a history of heart disease and chronic renal failure, we discarded the use of meglumine antimoniate. The patient received liposomal amphotericin B 4 mg/kg/day with a cumulative dose of 1.25 g. During hospitalization, the patient did not present any systemic manifestations compatible to VL. Two months post-treatment, the facial lesions had healed and the lesion of the arm was partially epithelialized.


FIRST REPORT OF CUTANEOUS LEISHMANIASIS CAUSED BY Leishmania (Leishmania) infantum chagasi IN AN URBAN AREA OF RIO DE JANEIRO, BRAZIL.

Lyra MR, Pimentel MI, Madeira Mde F, Antonio Lde F, Lyra JP, Fagundes A, Schubach Ade O - Rev. Inst. Med. Trop. Sao Paulo (2015 Sep-Oct)

- Round ulcer with infiltrated borders in the right elbow.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4660459&req=5

f02: - Round ulcer with infiltrated borders in the right elbow.
Mentions: An eighty-one-year-old woman, from Rio de Janeiro, residing for the previous two years in a nursing home in Caju neighborhood, reported the appearance of skin lesions about seven months earlier. She had cardiac disease and chronic renal failure (CRF) and was referred to the Laboratory of Leishmaniases Surveillance of the Evandro Chagas National Institute of Infectious Diseases, of the Oswaldo Cruz Foundation. Dermatological examination revealed the presence of three pleomorphic lesions that measured between 3 and 4 cm in diameter and were located in the frontal and left malar regions of the face, and in the right elbow (Fig. 1 and 2). The lesions were not associated with systemic symptoms such as fever, weight loss or poor general condition. The patient had no lymphadenopathy or visceromegalies. Laboratory tests were within normal range, except for increased urea (135 mg/dL) and creatinine (2.65 mg/dL) due to pre-existing CRF. Electrocardiogram showed cardiac arrhythmia and enlargement of the corrected QT space (QTc) (0.50 seconds). Abdominal ultrasound did not reveal the presence of hepatomegaly or splenomegaly. Histopathology, direct smear, culture in McNeal, Novy, Nicolle (NNN) medium, and polymerase chain reaction (PCR) performed on cutaneous lesions fragments confirmed the clinical diagnosis of ATL. Montenegro skin test and enzyme-linked immunosorbent assay (ELISA) serology for leishmaniasis resulted positive. Since no previous cases of ATL were known in this neighborhood, and a recent case of VL had been described in this location18, we performed the multilocus enzyme electrophoresis assay as previously described5, and the identification of L. (L.) infantum chagasi was confirmed (Fig. 3). Culture and PCR of a bone marrow sample were negative for parasite isolation orLeishmania DNA detection. Since the patient presented a history of heart disease and chronic renal failure, we discarded the use of meglumine antimoniate. The patient received liposomal amphotericin B 4 mg/kg/day with a cumulative dose of 1.25 g. During hospitalization, the patient did not present any systemic manifestations compatible to VL. Two months post-treatment, the facial lesions had healed and the lesion of the arm was partially epithelialized.

Bottom Line: An eighty-one-year-old woman presented three pleomorphic skin lesions that were not associated with systemic symptoms or visceromegalies.Multilocus enzyme electrophoresis identified L. (L.) infantum chagasi, but direct smear and PCR of bone narrow were negative for Leishmania sp. (suggesting exclusively cutaneous involvement).Etiologic diagnosis of ATL based upon exclusive clinical criteria may lead to incorrect conclusions.

View Article: PubMed Central - PubMed

Affiliation: Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil.

ABSTRACT
American tegumentary leishmaniasis (ATL) is an infectious disease caused by protozoa of the genus Leishmania, and transmitted by sandflies. In the state of Rio de Janeiro, almost all of the cases of American tegumentary leishmaniasis (ATL) are caused by Leishmania (Viannia) braziliensis, while cases of visceral leishmaniasis (VL) are caused by Leishmania (Leishmania) infantum chagasi. The resurgence of autochthonous VL cases in Rio de Janeiro is related to the geographic expansion of the vector Lutzomyia longipalpis and its ability to adapt to urban areas. We report the first case of leishmaniasis with exclusively cutaneous manifestations caused by L. (L.) infantum chagasi in an urban area of Rio de Janeiro. An eighty-one-year-old woman presented three pleomorphic skin lesions that were not associated with systemic symptoms or visceromegalies. Multilocus enzyme electrophoresis identified L. (L.) infantum chagasi, but direct smear and PCR of bone narrow were negative for Leishmania sp. (suggesting exclusively cutaneous involvement). We discuss the different dermatological presentations of viscerotropic leishmaniasis of the New and Old World, and the clinical and epidemiological importance of the case. Etiologic diagnosis of ATL based upon exclusive clinical criteria may lead to incorrect conclusions. We should be aware of the constant changes in epidemiological patterns related to leishmaniases.

Show MeSH
Related in: MedlinePlus