Silveira F T, Lainson R, Shaw J J, De Souza A A, Ishikawa E A, Braga R R
Instituto Evandro Chagas (FNS), Belém, Pará, Brazil.
Trans R Soc Trop Med Hyg. 1991 Nov-Dec;85(6):735-8. doi: 10.1016/0035-9203(91)90437-4.
The clinical and epidemiological features of 62 cases of cutaneous leishmaniasis due to Leishmania (Leishmania) amazonensis, from Pará State, Amazonian Brazil, are discussed. The parasite, isolated in hamster skin and/or blood-agar culture medium, was in each case identified by both biological characteristics and a monoclonal antibody specific for promastigotes of L. (L.) amazonensis. Of the 62 patients, 46 (74.2%) presented with a single cutaneous lesion, and on no occasion was evidence found indicating metastatic spread to either the naso-pharyngeal mucosae or the viscera. Recent claims that this parasite may be responsible for both mucocutaneous leishmaniasis and typical visceral leishmaniasis are discussed. Meglumine antimoniate (Glucantime) proved highly efficient in the treatment of all patients. Of the 62 patients examined by the Montenegro skin test, only 32 (51.6%) gave a positive reaction. The significance of this finding is considered and the hypothesis made that the parasite itself may induce an immunoinhibition. Field studies amply confirmed the role of Lutzomyia flaviscutellata as the major sandfly vector of L. (L.) amazonensis in Amazonia.
本文讨论了来自巴西亚马逊州帕拉州的62例由亚马逊利什曼原虫（利什曼原虫属）引起的皮肤利什曼病的临床和流行病学特征。在每例病例中，通过生物学特征和一种针对亚马逊利什曼原虫前鞭毛体的单克隆抗体，对从仓鼠皮肤和/或血琼脂培养基中分离出的寄生虫进行了鉴定。62例患者中，46例（74.2%）表现为单一皮肤病变，且未发现有转移至鼻咽黏膜或内脏的证据。文中讨论了最近关于这种寄生虫可能导致黏膜皮肤利什曼病和典型内脏利什曼病的说法。葡甲胺锑酸盐（葡糖胺锑）被证明对所有患者的治疗都非常有效。在接受蒙氏皮肤试验检查的62例患者中，只有32例（51.6%）呈阳性反应。本文考虑了这一发现的意义，并提出了寄生虫本身可能诱导免疫抑制的假说。实地研究充分证实了黄盾罗蛉在亚马逊地区作为亚马逊利什曼原虫主要白蛉传播媒介的作用。
