Cintia Xavier de Mello; Armando de Oliveira Schubach; Maria de Fátima Madeira
Leishmaniasis Surveillance Laboratory, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
A 44 year-old HIV-positive male patient with ulcerated lesions in the palate, third left toe and right thigh (Figure A) was treated at the Leishmaniasis Clinic of the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation (IPEC/FIOCRUZ) for diagnostic investigation. A biopsy of the thigh and palate lesion was performed for culture isolation of Leishmania, fungi and mycobacteria, while for direct examination, scarification and imprint slides were prepared with material from the thigh lesion. Following fixation by methanol and Giemsa staining, scarification and imprint slides of the thigh lesion were examined under a light microscope with an immersion objective (x 1.000). Analysis revealed the presence of numerous rounded and ellipsoid structures located inside and outside macrophages (Figure B). Although these structures are similar to amastigotes in size and shape, they presented no kinetoplast, which is a key feature for Leishmania parasite confirmation. The mycological culture of fragments of the palate and thigh lesion was positive for Sporothrix schenckii.
In the State of Rio de Janeiro, both sporotrichosis and American tegumentary leishmaniasis (ATL) occur in overlapping areas. This affects different animal species, including man, and is a confounding factor in the diagnosis (clinical and laboratory) of both diseases. In the present study, probably due to the HIV infection, numerous structures of yeast-like form of S. schenckii were observed. The presence of such structures in the direct examination is a rare event; however, they indicate the need for skilled professionals and thorough analyses of direct examinations, taking into account the morphological features specific to the parasite, in order to adequately diagnose the case.
REFERENCES
1. Barros MBL, Schubach TMP, Galhardo MCG, Schubach AO, Monteiro PCF, Reis RS, et al. Sporotrichosis: an Emergent Zoonosis in Rio de Janeiro. Mem Inst Oswaldo Cruz 2001; 96:777-779. [ Links ]
2. Neto RJP, Machado AA, Castro G, Quaglio ASS, Martinez R. Esporotricose cutânea disseminada como manifestação inicial da síndrome da imunodeficiência adquirida – relato de caso. Rev Soc Bras Med Trop 1999; 32:57-61. [ Links ]
3. Schubach A, Barros MB, Wanke B. Epidemic sporotrichosis. Curr Opin Infect Dis 2008; 21:129-133. [ Links ]
Address to:
Dra. Cintia Xavier de Mello
Laboratório em Vigilância em Leishmanioses/IPEC/FIOCRUZ
Av. Brasil 4365, Manguinhos
21040-900 Rio de Janeiro, RJ
Telefax: 55 21 3865-9541
e-mail: cintia.mello@ipec.fiocruz.br
Received in 23/07/2010
Accepted in 06/10/2010
