Yébenes M, Cruz I, Cañavate C, Gilaberte M, Baena V, Pujol R M
Department of Dermatology, Hospital del March, IMAS, Barcelona, Spain.
Clin Exp Dermatol. 2008 Mar;33(2):142-4. doi: 10.1111/j.1365-2230.2007.02575.x. Epub 2007 Dec 10.
Human leishmaniases are protozoan diseases with diverse clinical features. They are transmitted by the bites of the Phlebotomus sand fly, and the reservoirs are usually wild and domestic animals, particularly dogs. In Spain, Leishmania infantum is the causative agent of both cutaneous and visceral leishmaniasis. Cutaneous leishmaniasis is a parasitic disease occurring throughout the Americas and in the Old World, particularly the Middle East and North Africa. It is spread by the female sandfly. We report a 33-year-old man who presented with a solitary plaque on the right elbow, which was found to contain Leishmania bodies. He was treated with intralesional meglumine antimoniate, but 2 weeks later, several subcutaneous nodules were noted on the inner right arm. PCR identified the organism as L. infantum. The patient was treated with itraconazole (200 mg/day) for 6 weeks was prescribed, which resulted in marked clinical improvement in the elbow plaque. However, because of the persistence and lack of response of the other lesions, systemic treatment with meglumine antimoniate (20 mg/kg/day) intravenously for 7 days and intramuscularly for 13 days was administered. A progressive improvement in both cutaneous and subcutaneous lesions was achieved, and the lesions resolved completely after 2 months.
人类利什曼病是具有多种临床特征的原生动物疾病。它们通过白蛉叮咬传播，宿主通常是野生动物和家畜，尤其是狗。在西班牙，婴儿利什曼原虫是皮肤利什曼病和内脏利什曼病的病原体。皮肤利什曼病是一种在美洲以及东半球，特别是中东和北非地区流行的寄生虫病。它由雌性白蛉传播。我们报告了一名33岁男性，其右肘部出现一个孤立斑块，经检查发现含有利什曼原虫体。他接受了病灶内注射葡甲胺锑酸盐治疗，但2周后，右上肢内侧出现了几个皮下结节。聚合酶链反应鉴定该病原体为婴儿利什曼原虫。患者接受了为期6周的伊曲康唑（200毫克/天）治疗，肘部斑块有明显临床改善。然而，由于其他病灶持续存在且无反应，给予了为期7天的静脉注射和为期13天的肌肉注射葡甲胺锑酸盐（20毫克/千克/天）进行全身治疗。皮肤和皮下病灶均逐渐改善，2个月后病灶完全消退。
