E.M. Netto

Long-term follow-up of patients with Leishmania (Viannia) braziliensis infection and treated with Glucantime®

Seventy-nine patients with cutaneous (62) or mucosal (17) infection with Leishmania (Viannia) braziliensis in Três Braços, Bahia, Brazil, were followed for at least 4 years after initiating treatment with antimony. Cutaneous relapses occurred in 6/62 (10%), mucosal relapse after cutaneous infection in 2/62 (3%), and mucosal relapse after mucosal disease in 2/17 (17%). It is concluded that relapse (cutaneous and mucosal) is rare after adequate antimony therapy and that no definite prediction of relapse (clinical, serological or by skin reaction) is possible.

Mucosal leishmaniasis in Brazil.

The clinical diagnosis and laboratory identification of Leish‐mania brazilicnsis braziliensis, a parasitic disease affecting the upper aerodigestive tract, is difficult. A retrospective computer‐assisted analysis of patient records was done after examination of 58 patients with mucosal leishmaniasis in an endemic area of L. braziliensis braziliensis in Bahia, Brazil during January 1987. Biopsies of clinically active and clinically inactive mucosal patients were examined for parasites using routine hematoxylin and eosin histopathology and a new technique for rapid detection of Leishmania amastigotes using a genus‐specific indirect immunofluorescent assay.

An outbreak of human Leishmania (Viannia) braziliensis infection

The occurrence of acute cutaneous leishmaniasis among inhabitants of 10 farms within 10 Km of the hamlet of Corte de Pedra, Bahia, Brazil was studied prospectively from 1984-1989. A mean population of 1,056 inhabitants living in 146 houses were visited every 6 months and the number of skin ulcers recorded. A leishmanin skin test survey was done people with suggestive skin scars or active disease in 1984. The incidence of skin ulcers due to Leishmania (Viannia) braziliensis (Lvb) reached 83/1,000 inhabitants but declined sharply in the subsequent 2 years. Retrospective data shows that leishmaniasis is a sporadic endemic disease. Although the reasons for this epidemic are unclear some possible aetiological factors are discussed.

Conceitos de uma população local a respeito da leishmaniose mucocutânea em uma área endêmica

An enquiry regarding the localpeoples views on the nature of mucocutaneous leishmaniasis is reported from Tres Bracos, Bahia, an area of high prevalence of L. braziliensis braziliensis infections. The results of this survey indicate a generally good understanding by the population of the treatment of this endemic disease, with little knowledge regarding etiology or prevention. Such base line data provides valuable insight into how the group should proceed with plans to eventually control transmission in this rural community.

Aspectos psicossociais e estigmatizantes da leishmaniose cutâneo-mucosa

The authors selected 15 patients with severe mucocutaneous leishmaniasis. By means of an interview concentrating on sociopsychological aspects they sought to understand aspects of the life of each patient before, during and after treatment of the disease. At the same time similar interviews were recorded on 25 healthy members of the same community to gauge their reaction to subjects with leishmaniasis. Among the patients interviewed, in 14(93.3%) their lives were affected by the disease and (73.3%) were suffering from discrimination. Nine (60%) felt di vorced from society and 10(66.6%) had difficulty in returning to work. Of the healthy community members interviewed 11(44%) associated the disease with bodily deformities and 8(32%) were afraid of catching the disease due its destructive nature. Twenty-four (96%) thought patients had social problems.

Procedência de pacientes portadores de leishmaniose tegumentar americana nas áreas endêmicas de Três Braços e Corte de Pedra - Estado da Bahia - Brasil

An analysis of 1416 records of patients with American tegumentary leishmaniasis recorded from 1976 to 1987 in the endemic areas of Tres Bracos and Corte de Pedra as regards details of the origin of the patient was performed. The patients came from 24 of the 89 municipalities which constitute the cocoa growing zone of Bahia. The municipalities of Valenca, Wenceslau Guimaraes and Teolândia had the highestprevalence accounting for 923 cases (65,1 %). Five hundred twenty of these cases lived in ten localities which form an endemic area with transmission probably occurring in the peri and intradomiciliary area, as well as the plantations of cocoa and cloves. We note that from 1983 there has been an increase in the number of cases throughout the region. There is evidence that tegumentary leishmaniasis in an ocupational disease in the region under study.