Jeffrey D. Chulay; Charles N. Oster; Patrick B. McGreevy; Larry D. Hendricks; Richard D. Kreutzer
We report our experience with the diagnosis and treatment of 60 patients with American cutaneous leishmaniasis. They were infected in Panama (55), Brazil (4) or Colombia (I). Among 35 patients with a 3 week exposure in Panama, the mean maximum incubation period was 33 days (range 4-81 days). Diagnosis was delayed an average of 93 days after onset of skin lesions, due to the patient’s delay in seeking medical attention (31 days), medical personnel’s delay in considering the diagnosis (45 days), and the laboratory’s delay in confirming the diagnosis (17 days). Forty-four patients (73%) developed ulcers typical of cutaneous leishmaniasis. Sixteen additional patients (27%) had atypical macular, papular, squamous, verrucous or acneiform skin lesions that were diagnosed only because leishmanial cultures were obtained. Of the 59 patients treated with pentavalent antimonial drugs, only 34 (58%) were cured after the first course of treatment. Lesions which were at least 2 cm in diameter, ulcerated, or caused by Leishmania braziliensis were less likely to be cured after a single course of treatment than were lesions smaller than 2 cm, nonulcerated or caused by Leishmania mexicana or Leishmania donovani.
Keywords: American cutaneous leishmaniasis. Diagnosis. Treatment. Prognosis. Clinical Pathology.
Relatamos nossa experiência em 60 pacientes com leishmaniose tegumentar americana diagnosticada e tratada entre 1977 e 1982. Cinqüenta e cinco pacientes foram infectados no Panamá, 4 no Brasil, e 1 na Colômbia. Entre 35 pacientes com uma exposição de 3 semanas no Panamá, a média do período de incubação foi 33 dias (limite sobre 4 e 81 dias). O diagnóstico foi feito, em média, 93 dias depois do início das lesões de pele, devido a demora do paciente em procurar o serviço médico (31 dias), a demora do médico em considerar o diagnóstico (45 dias), e a demora do laboratório em confirmar o diagnóstico (17 dias). Quarenta e quatro pacientes (73%) desenvolveram úlceras típicas de leishmaniose cutânea. Porém, 16 pacientes (27%) tiveram lesões de pele atípicas maculares, papulares, escamosas, verrucosas ou acneiformes que foram diagnosticadas somente através de culturas de leishmania. De 59 pacientes tratados com o antimonial pentavalente, só 34 (58%) obtiveram cura depois da primeira série de tratamento. Em pacientes com lesões maiores do que 2 cm de diâmetro, ou causada por Leishmania braziliensis, ocorrem menos índice de cura depois da primeira série de tratamento do que naqueles com lesões menores do que 2 cm, fechadas, ou causadas por L. mexicana ou L. donovani.
Palavras-chave: Leishmaniose tegumentar americana. Diagnóstico. Tratamento. Prognóstico. Patologia Clínica.
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Recebido para publicação em 9/9/88.
Walter Reed Array Institute of Research, Washington, DC 20307-5100 and Youngstown State University, Youngstown, OH 44555 USA.