Philip D. MarsdenI; Elmer A. Llanos-CuentasI; Edinaldo L. LagoII; César C. CubaI; Air C. BarretoI; Jackson M. Costa; Thomas C. JonesIII
INúcleo de Medicina Tropical e Nutrição, University of Brasília, Brazil IISUCAM, Ministry of Health Brazil IIICornell Medical Center, New York
ABSTRACT
In an analysis of 57 patients mucosal disease was commonestin males(77%) in the third decade of life although the age range was wide and even two children were affected. All but nine patients (16%) had signs of cutaneous leishmaniasis but in only 8(14%) was this lesion active. The nose was affected in 100% of 19 patients with multiple lesions and 92% of 38 patients with single lesions. The pharynx, palate, larynx and upper lip were affected in this order. 42% of patients with multiple lesions had laryngeal disease and in two patients this site existed as a lone lesion. No age difference could be discemed as to whether lesions were single or multiple. Duration of mucosal disease was very variable from less than 4 months to 264 months. Only 7% developed mucosal disease more than ten years after the cutaneous lesion.
Usually patients responded to adequate antimonial treatment but there were exceptions, when amphotericin B had to be used Three patients who refused to collaborate regarding treatment died Only 18% of patients in whom measurements were made had positive fluorescent antibodies two years after treatment.
Keywords: Leishmama braziliensis braziliensis. Mucosal leishmaniasis. Clinical presentation. Evolution. Treatment.
RESUMO
Numa análise de 57 pacientes o acometimento da mucosa foi mais comumente observado em homens (77%) na terceira década de vida, embora fosse grande a variação das idades e ocorrendo mesmo o acometimento de duas crianças. Com a exceção de nove pacientes (16%) todos os outros tinham sinais de leishmaniose cutânea sendo que em somente oito (14%) de lesão era ativa. O acometimento do nariz foi observado em 100% de 19 pacientes que apresentavam lesões múltiplas e em 92% de 38 pacientes apresentando uma única lesão. A faringe, palato, laringe e lábio superior foram afetados nesta experiência. 42% dos pacientes com lesões múltiplas apresentavam acometimento da laringe sendo que em dois pacientes a única lesão existente apresentava-se neste ponto. Não foi observada qualquer diferença relacionada com a idade no que se referia à existencia de lesões únicas ou múltiplas.
A duração do acometimento da mucosa variou de menos de 4 até 264 meses. Somente 7% desenvolveram o acometimento da mucosa após mais de dez anos o desenvolvimento da lesão cutânea.
Os pacientes usualmente responderam ao tra-tamento adequado por antimonial embora em algumas exceções fosse usada amphotericina B. Morreram três pacientes que se recusaram a colaborar no tratamento.
Dois anos após o tratamento observou-se positividade de anticorpos fluorescentes em somente 18% dos pacientes entre aqueles acompanhados.
Palavras-chave: Leishmania braziliensis braziliensis. Leishmaniose de mucosa. Apresentação clínica. Evolução. Tratamento.
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Recebido para publicação em 16/8/84.
This work was supported by the Brazilian Conselho Nacional de Desenvolvimento Cientifico e Tecnológico (CNPq – Grants No. 403682/82 and 403690/82), The Brazilian Ministry of Health (SUCAM), UNDP/World Bank/W. H. O. Special Programme for Research and Training in Tropical Diseases and a United States Public Service grant (AI 16282-04) administered by the Department of International Medicine, Comell Medical College, New York.
