LEISHMANIOSE CUTÂNEA DIFUSA (LCD) NO BRASIL APÓS 60 ANOS DE SUA PRIMEIRA DESCRIÇÃO LEISHMANIOSE CUTÂNEA DIFUSA (LCD) NO BRASIL APÓS 60 ANOS DE SUA PRIMEIRA DESCRIÇÃO LEISHMANIOSE CUTÂNEA DIFUSA (LCD) NO BRASIL APÓS 60 ANOS DE SUA PRIMEIRA DESCRIÇÃO LEISHMANIOSE CUTÂNEA DIFUSA (LCD) NO BRASIL APÓS 60 ANOS DE SUA PRIMEIRA DESCRIÇÃO DIFFUSE CUTANEOUS LEISHMANIASIS (DCL) IN BRAZIL AFTER 60 YEARS OF YOUR FIRST DESCRIPTION
2009
anos), a faixa etaria de maior comprometimento foi de 11↔30 anos (47,5%). As apresentacoes clinicas mais prevalentes foram: nodulos (81%), placas infiltradas (67,6%), ulceras (40,6%), tuberculos (46%), havendo predominio nos membros inferiores e face (67,7%), e membros superiores (61,3%). Em 14 (35%) pacientes houve comprometimento mucoso, (um caso da perfuracao septal). Exames laboratoriais: esfregaco/Leishmania realizado e (+) em todos os casos, intradermorreacao de Montenegro (IDRM) em 31 (77,5%) pacientes, 27 (87%) negativos, 1 (3,4%) falso positivo; 3 (9,6%) negativo/positivo. Cultivo em meios artificiais, sorologia (RIFI/ELISA), e inoculacao de hamster (Cricetus auratus) em 23 (57,5%) pacientes (100% positividade). Em relacao aos esquemas terapeuticos utilizados, tivemos: antimonials trivalente (tartaro emetico, fuadina, neostibosan, reprodal); anfotericina B, anfotericina B lipossomal, pentamidina (isotionato), aminosidina (sulfato), antimoniais pentavalentes (Glucantime ® ), imunoterapia, imunoterapia + antimonial pentavalente. Como conclusao: Observou-se refratariedade a todos os esquemas terapeuticos utilizados; a L. amazonensis e a responsavel pela doenca no Brasil; o tratamento permanece um desafio. Palavras-chave: leishmaniose cutânea difusa (LCD), Leishmania amazonensis, Lutzomyia flaviscutellata, Brasil. Diffuse cutaneous leishmaniasis (DCL) is a rare form of cutaneous leishmaniasis (CL), being scattered in some countries in America and Africa. In our continent it is caused by the Leishmania complex (Leishmania mexicana, L. pifanoi, L. amazonensis) transmitted in Brazil by the bite of Lutzomyia flaviscutellata sandflies. We performed a retrospective review of all cases related in Brazil since 1945 with the aim to study the reality of DCL. Fourty cases described in our country were evaluated, proceeding from the following states: Maranhao 16 (40%); Para 8 (20%); Bahia 5 (12.5%); Mato Grosso 4 (10%); Tocantins 2 (5%); Acre 1 (2.5%); Amapa 1 (2.5%); Amazonas 1 (2.5%); Espirito Santo 1 (2.5%) and Pernambuco 1 (2.5%). The male/ female ratio was 2.4:1, mean of age 24 years (range 6-75 years) the age of most affected patients ranged from 11 to 30 years (47.5%). The most prevalent clinical presentations were nodes (81%), plaques (67.6%), ulcers (40.6%), tubercles (46%). The lesions were predominantly localized on anterior aspect of legs and face (67.7%) and upper limbs (61.3%). Fourteen mucosal lesions were related, with only one case of septal perforation. For laboratorial, scraping was performed in all cases, Montenegro skin test in 31 patients (77.5%), 27 (87%) negative, 1 (3.4%) false positive; 3 (9.6%) positive-negative. Culture, serology, hamster inoculation (Cricetus auratus) were also performed (23 patients each) with 100% positivity. The therapeutic approaches included trivalent antimonials (potassium tartarate, fuadina, neostibosan, reprodal) amphotericin B, lipossomal amphotericin B, pentamidine (isethionate), aminosidine (sulphate), pentavalent antimonials (Glucantime ® ), immunotherapy,
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