Passos V M, Barreto S M, Romanha A J, Krettli A U, Volpini A C, Gontijo C M, Falcão A L, Lima-Costa M F
Faculdade de Medicina, Universidade Federal de Minas Gerais.
Rev Soc Bras Med Trop. 2001 Jan-Feb;34(1):5-12. doi: 10.1590/s0037-86822001000100002.
This study investigated clinical, laboratorial, therapeutic and prognostic aspects of American cutaneous leishmaniasis in Belo Horizonte in 358 patients with cutaneous leishmaniasis (CL) and 25 with mucocutaneous leishmaniasis (MCL). Compared to CL patients, the MCL patients reported longer duration of disease and higher frequency of other diseases, suggesting that debilitation caused by leishmaniasis or other conditions might contribute to activation and/or mucous dissemination of the parasite. The sensitivity of skin test, indirect immunofluorescence reactions and direct detection of parasites was 78.4, 79.3 and 68.3%, respectively. The treatment with meglumine antimoniate presented 100% efficacy, but 59% patients had side-effects. During two years of follow-up, there were 32/318 relapses after successful treatment. Most relapses (31/32) were of CL patients treated with 15 mg Sb5+/kg/day. The negative response to skin test was the only factor associated with a significant threefold increased risk of relapse. Higher dose or longer duration of treatment might improve the prognosis in these patients.
本研究调查了贝洛奥里藏特地区358例皮肤利什曼病(CL)患者和25例黏膜皮肤利什曼病(MCL)患者的美国皮肤利什曼病的临床、实验室、治疗和预后方面。与CL患者相比,MCL患者报告的病程更长,其他疾病的发生率更高,这表明利什曼病或其他疾病引起的身体虚弱可能有助于寄生虫的激活和/或黏膜播散。皮肤试验、间接免疫荧光反应和寄生虫直接检测的敏感性分别为78.4%、79.3%和68.3%。葡甲胺锑酸盐治疗的有效率为100%,但59%的患者有副作用。在两年的随访期间,318例成功治疗的患者中有32例复发。大多数复发(31/32)发生在接受15 mg Sb5+/kg/天治疗的CL患者中。皮肤试验阴性反应是唯一与复发风险显著增加三倍相关的因素。更高剂量或更长疗程的治疗可能会改善这些患者的预后。