Machado Paulo, Araújo Cibele, Da Silva Andréa T, Almeida Roque P, D'Oliveira Jr Argemiro, Bittencourt Achiléa, Carvalho Edgar M
Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
Clin Infect Dis. 2002 Jun 15;34(12):E69-73. doi: 10.1086/340526. Epub 2002 May 17.
The clinical characteristics and treatment outcome were determined for 26 patients who presented with early-stage cutaneous leishmaniasis. Illness duration ranged from 8 to 20 days, and the commonest clinical presentation was the presence of a papule with small central crust on a lower extremity. Prominent regional adenopathy was found in 22 (85%) of 26 patients. The results of an intradermal skin test for Leishmania were positive for 96% of those patients, and results of serologic testing were positive for 61% of patients tested. Ten (46%) of 22 patients for whom follow-up data were available developed enlargement and ulceration of the lesion despite early antimony therapy and required additional courses of treatment. Histopathological studies of samples from the lesions of 3 patients showed vasculitis. These data show that early therapy for cutaneous leishmaniasis does not prevent the development of an ulcer in one-half of patients. This unfavorable outcome underlines the relevance of local exacerbated inflammatory and immune response in the pathogenesis of the disease.
对26例早期皮肤利什曼病患者的临床特征和治疗结果进行了测定。病程为8至20天，最常见的临床表现是下肢出现带有中央小痂皮的丘疹。26例患者中有22例（85%）出现明显的区域淋巴结病。利什曼原虫皮内皮肤试验结果在96%的患者中呈阳性，血清学检测结果在61%接受检测的患者中呈阳性。在有随访数据的22例患者中，有10例（46%）尽管早期接受了锑剂治疗，但病变仍出现增大和溃疡，需要额外疗程的治疗。对3例患者病变样本的组织病理学研究显示有血管炎。这些数据表明，皮肤利什曼病的早期治疗并不能预防一半患者出现溃疡。这一不良结果突显了局部炎症和免疫反应加剧在该疾病发病机制中的相关性。
