RESUMO
INTRODUCTION: American tegumentary leishmaniasis (ATL) can affect the skin or mucosa (mucocutaneous leishmaniasis - MCL) including the oral cavity. MCL oral lesions are often confused with other oral diseases, delaying diagnosis and specific treatment, and increasing the likelihood of sequelae. Thus, increasing the knowledge of the evolution of ATL oral lesions can facilitate its early diagnosis improving the prognosis of healing. OBJECTIVES: Evaluate the frequency of ATL oral lesion and describe its clinical, laboratory and therapeutic peculiarities. METHODS: A descriptive transversal study was carried out, using data from medical records of 206 patients with MCL examined at the outpatient clinics-IPEC-Fiocruz between 1989 and 2013. Proportions were calculated for the categorical variables and the association among them was assessed by the Pearson's chi-square test. Measures of central tendency and dispersion were used for the continuous variables and their differences were assessed by both parametric (t test) and non parametric (Mann-Whitney) tests. P-values <0.05 were considered as significant. RESULTS: The most affected site was the nose, followed by the mouth, pharynx and larynx. Seventy eight (37.9%) have oral lesions and the disease presented a lower median of the evolution time than in other mucous sites as well as an increased time to heal. The presence of oral lesion was associated with: the presence of lesions in the other three mucosal sites; a smaller median of the leishmanin skin test values; a longer healing time of the mucosal lesions; a higher recurrence frequency; and a smaller frequency of treatment finishing and healing. When the oral lesion was isolated, it was associated with an age 20 years lower than when the oral lesion was associated with other mucosal sites. CONCLUSION: Considering the worst therapy results associated with the presence of oral lesions, we suggest that lesions in this location represent a factor of worse prognosis for MCL.
Assuntos
Leishmaniose Mucocutânea/parasitologia , Doenças da Boca/patologia , Mucosa Bucal/patologia , Doenças Nasais/patologia , Nariz/patologia , Antiprotozoários/uso terapêutico , Feminino , Humanos , Laringe/parasitologia , Laringe/patologia , Leishmania braziliensis/patogenicidade , Leishmaniose Mucocutânea/tratamento farmacológico , Masculino , Meglumina/uso terapêutico , Antimoniato de Meglumina , Pessoa de Meia-Idade , Doenças da Boca/parasitologia , Mucosa Bucal/parasitologia , Nariz/parasitologia , Doenças Nasais/parasitologia , Compostos Organometálicos/uso terapêutico , Faringe/parasitologia , Faringe/patologia , Prognóstico , Estudos RetrospectivosRESUMO
La leishmaniasis es un problema creciente de salud pública, que produce un gran impacto social. La leishmaniasis laríngea y sin puerta de entrada evidente es rara, en especial en pacientes inmunocompetentes. Describimos un caso de leishmaniasis laríngea con extensión traqueal y estenosis secundaria en un adolescente previamente sano y sin factores de riesgo ambiental o personal.
Leishmaniasis is a growing public health problem and it produces a great social impact. Laryngeal leishmaniasis without obvious gateway is rare; especially in immunocompetent patients. We report a case of laryngeal leishmaniasis with tracheal involvement and stenosis on a previously healthy teenager without environmental or personal risk factors.
Assuntos
Adolescente , Criança , Humanos , Masculino , Leishmaniose , Doenças da Laringe/parasitologia , Doenças Nasais/parasitologia , Doenças da Traqueia/parasitologia , Doenças da Laringe/complicações , Leishmaniose/diagnóstico , Mucosa , Doenças Nasais/complicações , Doenças da Traqueia/complicaçõesRESUMO
Leishmaniasis is a growing public health problem and it produces a great social impact. Laryngeal leishmaniasis without obvious gateway is rare; especially in immunocompetent patients. We report a case of laryngeal leishmaniasis with tracheal involvement and stenosis on a previously healthy teenager without environmental or personal risk factors.
Assuntos
Doenças da Laringe/parasitologia , Leishmaniose , Doenças Nasais/parasitologia , Doenças da Traqueia/parasitologia , Adolescente , Criança , Humanos , Doenças da Laringe/complicações , Leishmaniose/diagnóstico , Masculino , Mucosa , Doenças Nasais/complicações , Doenças da Traqueia/complicaçõesRESUMO
Infection by the larval form of Oestrus ovis (sheep bot fly) is common in many areas of Peru. This is an obligate parasite of sheep and goats, and it is the cause of oestrosis, or nasal myiasis, which can lead to severe clinical manifestations in livestock. A case of myiasis caused by O. ovis in a llama (Lama glama) in Cuzco, Peru, is reported here. This llama presented with respiratory distress and died due to bilateral hemorrhagic pneumonia. During the necropsy, six intact dipterous larvae were recovered from the nasal fossae and cranial sinuses being identified as O. ovis. This is the first report of nasal myiasis in llamas due to O. ovis in Peru.
Infecção pela forma larval de Oestrus ovis (bicho da cabeça) é comum em muitas regiões do Peru. Este é um parasito obrigatório de ovinos e caprinos, e é a causa de oestrose ou miíase nasal, que pode conduzir à manifestações clínicas graves nos animais. Relatou-se um caso de miíase causada por O. ovis numa lhama (Lama glama) em Cuzco, Peru. A lhama apresentou insuficiência respiratória e morreu de pneumonia bilateral hemorrágica. Durante a necropsia, seis larvas intactas do díptero foram recuperadas das fossas nasais e dos seios cranianos e identificadas como O. ovis. Este é o primeiro relato de miíase nasal em lhamas por O. ovis no Peru.
Assuntos
Animais , Masculino , Camelídeos Americanos , Dípteros , Miíase/veterinária , Doenças Nasais/veterinária , Doenças Nasais/parasitologiaRESUMO
Infection by the larval form of Oestrus ovis (sheep bot fly) is common in many areas of Peru. This is an obligate parasite of sheep and goats, and it is the cause of oestrosis, or nasal myiasis, which can lead to severe clinical manifestations in livestock. A case of myiasis caused by O. ovis in a llama (Lama glama) in Cuzco, Peru, is reported here. This llama presented with respiratory distress and died due to bilateral hemorrhagic pneumonia. During the necropsy, six intact dipterous larvae were recovered from the nasal fossae and cranial sinuses being identified as O. ovis. This is the first report of nasal myiasis in llamas due to O. ovis in Peru.
Assuntos
Camelídeos Americanos , Dípteros , Miíase/veterinária , Doenças Nasais/veterinária , Animais , Masculino , Doenças Nasais/parasitologiaRESUMO
Oestrus ovis L. (Diptera: Oestridae) is a cosmopolitan agent of myiasis in sheep and goats. The parasitic phase begins after adult females deposit first-stage larvae (L1) into the nostrils of hosts; these larvae develop into L2 and L3 in the nasal and sinus horn cavities. Sneezing and nasal discharges are the major clinical signs in infected animals. The pathogenesis of O. ovis infection is caused by: (a) the trauma resulting from the mechanical action of spines and hooks during larval movement on mucosal membranes, and, more importantly, (b) an allergenic reaction provoked by molecules excreted/secreted by larvae, of which salivary antigens are those mainly recognized by the host's immune system. The recruitment of immune reactive cells increases gradually from the nasal to sinus cavities in infected hosts. Mast cells, eosinophils, macrophages and lymphocytes are always more numerous in infected than non-infected animals. Humoral (antibody) systemic response of immunoglobulin G (IgG) usually reaches seroconversion 2-4 weeks post-first infection and the highest levels are observed during the development of L2 and L3 larvae. Local antibody responses include specific IgG, which has been found to negatively correlate with larval survival and development. Hypersensitivity reaction, immunomodulation, immunization trials and mixed infections of O. ovis and helminths are discussed.
Assuntos
Imunidade Adaptativa , Dípteros/crescimento & desenvolvimento , Doenças das Cabras/imunologia , Miíase/veterinária , Doenças Nasais/veterinária , Doenças dos Ovinos/imunologia , Animais , Dípteros/imunologia , Feminino , Doenças das Cabras/parasitologia , Cabras , Imunidade nas Mucosas , Imunização/veterinária , Imunoglobulina G/sangue , Imunoglobulina G/imunologia , Larva/crescimento & desenvolvimento , Larva/imunologia , Miíase/imunologia , Miíase/parasitologia , Miíase/patologia , Infecções por Nematoides/complicações , Infecções por Nematoides/veterinária , Nariz/imunologia , Nariz/parasitologia , Doenças Nasais/imunologia , Doenças Nasais/parasitologia , Doenças dos Ovinos/parasitologia , Carneiro DomésticoRESUMO
Larvae causing obligatory myiasis are numerous and they may affect cutaneous and subcutaneous tissues, wounds, nasopharyngeal cavities (nasal bots), internal organs and the digestive tract (bots) of domestic and wild animals and humans as well. Nasal bots belong to the Family Oestridae, Subfamily Oestrinae, which includes several important genera: Oestrus, Kirkioestrus, and Gedoelstia infecting Artiodactyla (except Cervidae) in Africa and Eurasia, Cephenemyia and Pharyngomyia infecting Cervidae, Rhinoestrus infecting horses, Cephalopina infecting camels, Pharyngobolus infecting African elephants, and Tracheomyia infecting Australian kangaroos. Nasal bots are widespread in Mediterranean and tropical areas and in affected animals they induce sneezing and nasal discharge which may become caked with dust making breathing very difficult. The aforementioned species of larvae are host-specific but sometimes the may be deposited in human eyes inducing a painful opthalmomyiasis of short duration. The first fascinating trait of these parasites is the very efficient morphological and biological adaptations to parasitism they show either as larvae or as adults, in order to facilitate their survival and search for a suitable host. Nasal bots have reached different degrees of complexity in their life cycles. Indeed, while for some species (e.g., Oestrus ovis, Rhinoestrus usbekistanicus) larvae are injected by flies directly into nostrils and develop in the sinuses before being ejected for external pupation, some other species migrate from eyes to blood before returning to nasal cavities either through the ethmoid bone (Gedoelstia hässleri) or via lungs and bronchi (Gedoelstia cristata). Moreover, larvae are very well-adapted to their environment being able to undergo through hypobiosis either inside or outside the host, according to the climatic environmental conditions and seasonality. The second fascinating trait of nasal bots is related to host behavioural and immune responses against the infection. Host behaviour may in fact prevent larviposition and inflammatory/immune reactions limit larval development. The main pathophysiological mechanisms involve mast cells and eosinophils which destroy the larvae in sensitized animals. The intense eosinophilic reaction has side effects both locally (i.e. on the nasal mucosa) and also generally, with possible interactions with gastrointestinal strongyles (e.g., both worm burdens and fecundity decreased in lambs infected by O. ovis). Infected animals (e.g., sheep, goat, camel, and donkey) firstly suffer from fly strike, when adult flies inject first stage larvae on nostrils: sheep may try to avoid fly swarms but eventually Rangifer tarandus can only manage a terror-stricken look! Secondly, hosts will suffer from myiasis with typical nasal discharge and sneezing related to sinusitis. Clinical manifestations may vary: for example O. ovis induces severe clinical signs in sheep whilst produces few effects in goats! These parasites are diffused in many Mediterranean and tropical countries. Unfortunately, it is commonly believed that bacterial infections induced by nasal bots are of greater clinical importance: this view is not substantiated and the control of this condition depends on treatment with macrocyclic lactones, closantel and nitroxynil. Reinfections are common, and controlling nasal bots is not so simple.
Assuntos
Artiodáctilos/parasitologia , Dípteros/fisiologia , Miíase/parasitologia , Doenças Nasais/veterinária , Perissodáctilos/parasitologia , Adaptação Biológica , Animais , Interações Hospedeiro-Parasita , Humanos , Miíase/epidemiologia , Doenças Nasais/epidemiologia , Doenças Nasais/parasitologiaRESUMO
A 74-year-old man from the rural area of Caicedonia, Valle del Cauca Province, was diagnosed with uncontrolled hypertension, stage IV chronic renal failure and severe anemia. Fifteen years earlier, while living in Guaviare Province, he was diagnosed with leishmaniasis-with lesions located on the right upper and lower eyelids, left auricle and limbs. At that time, he received an incomplete treatment with antimonials. The patient had experienced 8 years of progressive mucosal lesions located in the upper lip, nasal mucosa and right upper and lower eyelids (figure 1). A histopathological diagnosis of leishmaniasis was made and confirmed by polymerase chain reaction (figure 2). Treatment with antimonials (Glucantime) was contraindicated due to the patient's comorbidities. Inpatient supervised treatment with miltefosine (Impavido 50 mg capsules) was initiated according to the national guidelines of 1.8 mg/kg/day for 28 days. Clinical follow up and routine laboratory tests (creatinine, BUN, liver function tests and complete blood counts) were done during and after treatment; no complications were reported. Medical follow up was continued until the Internal medicine, ophthalmology, and plastic surgery consultations were provided for subsequent management of the pathology. Mucocutaneous leishmaniasis is a serious preventable complication of cutaneous leishmaniasis. This case illustrated a failure in opportune diagnosis and treatment of this disease as a consequence of an inadequate leishmaniasis control program. The case indicated the effectiveness of miltefosine as a therapeutic option in patients for whom antimonial treatment is contraindicated.
Assuntos
Antiprotozoários/uso terapêutico , Leishmaniose Cutânea/complicações , Leishmaniose Mucocutânea/etiologia , Fosforilcolina/análogos & derivados , Idoso , Anemia/complicações , Contraindicações , Doenças Palpebrais/tratamento farmacológico , Doenças Palpebrais/etiologia , Doenças Palpebrais/parasitologia , Humanos , Hipertensão/complicações , Falência Renal Crônica/complicações , Leishmaniose Cutânea/tratamento farmacológico , Leishmaniose Mucocutânea/tratamento farmacológico , Doenças Labiais/tratamento farmacológico , Doenças Labiais/etiologia , Doenças Labiais/parasitologia , Masculino , Meglumina , Antimoniato de Meglumina , Doenças Nasais/tratamento farmacológico , Doenças Nasais/etiologia , Doenças Nasais/parasitologia , Compostos Organometálicos , Fosforilcolina/uso terapêuticoRESUMO
The authors present the first report of Leishmania (Viannia) guyanensis (L.(V.) guyanenesis) associated with human immunodeficiency virus (HIV) in a Brazilian heterosexual man. It is also the first case of HIV infection associated with American cutaneous leishmaniasis in Brazilian Western Amazonia. The patient had cutaneous and mucous lesions with a negative Montenegro skin test. Histopathology showed large numbers of amastigotes, even in a lesion which had clinically healed. L.(V.) guyanenesis was typed by an immunoenzymatic technique. Various therapies were attempted, but the patient relapsed after each episode of treatment.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Leishmania guyanensis/isolamento & purificação , Leishmaniose Mucocutânea/diagnóstico , Doenças Nasais/parasitologia , Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Infecções Oportunistas Relacionadas com a AIDS/patologia , Adulto , Animais , Brasil , Diagnóstico Diferencial , Humanos , Leishmaniose Mucocutânea/parasitologia , Leishmaniose Mucocutânea/patologia , Masculino , Doenças Nasais/diagnósticoRESUMO
BACKGROUND: Leishmaniasis is an important protozoan disease. In the Americas it is produced by several species of the genus Leishmania, transmitted by sand flies of the genus Lutzomyia. Disease spectrum ranges from cutaneous ulceration to more serious involvement of oronasal mucosa that may progress to destruction of central structures of the face and to the life-threatening visceral forms. Leishmania Viannia braziliensis is the most widespread species in Brazil and is often associated with mucosal involvement. Cutaneous lesions are commonly localised in uncovered areas of the body. Genital lesions are rare. MATERIALS AND METHODS: A patient with an ulcerated lesion of the glans penis, followed subsequently by mucosal lesions of the nasal cavity and palate, is presented. Diagnostic procedures were: leishmanin skin test (Montenegro's test) and biopsy of the ulcer border processed for histopathological examination and culture in NNN medium. RESULTS: Leishmanin skin test was positive. Histopathology showed a granulomatous infiltrate containing some parasites. Culture was positive for Leishmania sp., and was later identified by zymodeme analysis and monoclonal antibodies as L.(V.) braziliensis. The patient was treated with pentavalent antimony at the dose of 10 (mg/kg)/day for 30 days and the lesions healed. COMMENTS AND CONCLUSIONS: In men, especially over 50 years of age, ulceration of the glans penis is highly suggestive of carcinoma. Precise differential diagnosis is imperative. A lesion, such as the one reported, may cause diagnostic difficulties when it presents in countries different from the source, where the condition is very uncommon. This is increasingly frequent in the current era of widespread air travel.