RESUMO
Abstract Cutaneous leishmaniasis is characterized by ulcers with raised edges and a granular bottom, mainly on the lower limbs. This is a case report of a male patient with an ulcer on the left plantar region. The diagnosis was confirmed by positive PCR for L. braziliensis and the presence of amastigotes of Leishmania sp. in the histopathological examination. After treatment with Glucantime, the patient showed full healing of the ulcer. The unusual location of the ulceration calls attention to atypical presentations of leishmaniasis, and the importance of histopathological examination and PCR, leading to the appropriate diagnosis and treatment.
Assuntos
Humanos , Masculino , Leishmania braziliensis , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Úlcera do Pé , Leishmania , Úlcera , Antimoniato de MegluminaRESUMO
Cutaneous leishmaniasis is characterized by ulcers with raised edges and a granular bottom, mainly on the lower limbs. This is a case report of a male patient with an ulcer on the left plantar region. The diagnosis was confirmed by positive PCR for L. braziliensis and the presence of amastigotes of Leishmania sp. in the histopathological examination. After treatment with Glucantime, the patient showed full healing of the ulcer. The unusual location of the ulceration calls attention to atypical presentations of leishmaniasis, and the importance of histopathological examination and PCR, leading to the appropriate diagnosis and treatment.
Assuntos
Úlcera do Pé , Leishmania braziliensis , Leishmania , Leishmaniose Cutânea , Humanos , Leishmaniose Cutânea/diagnóstico , Leishmaniose Cutânea/tratamento farmacológico , Masculino , Antimoniato de Meglumina , ÚlceraRESUMO
BACKGROUND: Studies investigating the nutritional status of patients with leprosy and plantar ulcers are sparse. Therefore, the objective of this study was to describe the protein profile of leprosy patients with plantar ulcers from the Eastern Amazon region. METHODS: A case record form was created for 75 patients with leprosy (31 with plantar ulcers and 44 without plantar ulcers) with the following data: sociodemographic characteristics, clinical form of leprosy, presence or absence of plantar ulcers, and nutritional assessment using anthropometry consisting of the measurement of body mass index, arm circumference, arm muscle circumference, and triceps skinfold. Levels of blood albumin, transferrin, and C-reactive protein (CRP) were also measured. Data regarding protein intake were obtained using a Food Frequency Questionnaire. RESULTS: Plantar ulcers occurred more frequently in male patients (67.7%), patients aged 40-49 years (mean ± SD: 47.3 ± 8.0 years), and patients receiving 300 or 600 USD (71.0%). The mean weight and height of patients were 71.6 ± 11.4 kg and 1.62 ± 0.1 m, respectively. High levels of CRP were detected in 51.6% of leprosy patients with plantar ulcers and only 9.1% of patients without plantar ulcers (P < 0.001). Nutritional depletion of transferrin was observed in 14.3% of patients with paucibacillary leprosy and 44.3% of patients with multibacillary leprosy (P = 0.0447). Most patients had normal levels of serum albumin (74.2% with plantar ulcers and 77.3% without plantar ulcers). CONCLUSIONS: Most leprosy patients with plantar ulcers have normal levels of serum albumin and transferrin and high CRP levels, which indicates the presence of an inflammatory process. Our findings suggest the need to monitor patients with leprosy to prevent the occurrence of plantar ulcers and to provide adequate treatment for patients with existing plantar ulcers.
Assuntos
Proteínas Alimentares/análise , Úlcera do Pé/metabolismo , Hanseníase Multibacilar/metabolismo , Hanseníase Paucibacilar/metabolismo , Estado Nutricional , Adulto , Brasil , Feminino , Úlcera do Pé/etiologia , Humanos , Hanseníase Multibacilar/microbiologia , Hanseníase Paucibacilar/microbiologia , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
Leprosy is a chronically evolving granulomatous disease caused by the bacillus Mycobacterium leprae, which exhibits tropism for peripheral and motor nerves and slow-growing inflammation that affects the peripheral nervous system, especially the sensory fibers. The aim of this study was to observe the relationship between peak pressure and abnormal sensitivity for the formation of plantar ulcers in patients with multibacillary (MB) and paucibacillary (PB) leprosy. A total of 51 individuals with leprosy were evaluated and classified as either MB or PB and then submitted to the Semmes-Weinstein sensitivity test; 20 normal individuals were examined as a control group and took a baropodometric test. The pressure peaks and sensitivity alterations were noted and compared within groups. Leprosy patients exhibited a greater loss of sensitivity at the heel area that might compromise gait. During dynamic analysis, the MB group with altered sensitivity for right and left feet and PB (left feet) group showed the highest plantar pressure values. Skin damage (calluses or ulcers) did not occur within the areas of high plantar pressure in 80% of MB patients, whereas skin damage was observed in 38% of PB patients in the areas of higher peak pressures. According to these findings, baropodometry and sensitivity tests play an important role in the understanding of ulcer biodynamics. In addition, it could be inferred that the loss of protective sensibility in MB patients is predictive of plantar ulcers, whereas plantar pressure peaks seem to be of greater importance in PB patients.