Department of Physiology, Faculty of Medicine, Beirut Arab University, Beirut, Lebanon.
Int J Infect Dis. 2011 Jul;15(7):e491-4. doi: 10.1016/j.ijid.2011.03.022. Epub 2011 May 31.
The consequences of the spread of Leishmania parasites to the blood from lesions in patients with cutaneous leishmaniasis are numerous. To assess the magnitude of this invasion we conducted the present study on patients referred to the American University of Beirut Medical Center for cutaneous leishmaniasis.
Patients referred for the management of cutaneous leishmaniasis were included in the study. Skin and blood cultures for Leishmania were taken from these patients.
One hundred sixty-two patients were proven to have cutaneous leishmaniasis by pathology; 52% were males and 44% females (gender information was missing for 4%). Patient age ranged from 5 months to 70 years. None of the patients had received treatment for Leishmania. We obtained parasite isolates from 85 patients (52.5%), proven by cultures from skin and blood/blood components. Interestingly, the parasite was isolated in the blood and blood components of 50 patients (30.9%). Isoenzyme analysis confirmed the fact that the organisms in blood and skin were the same; from the 28 isolates that were positive in both skin and blood, eight isolates were Leishmania major and two were Leishmania tropica. The remaining isolates, whether positive in both blood and skin or in either of these tissues, skin or blood and its products, were Leishmania infantum sensu lato.
In the current study, the detection rate of parasites in the blood of patients with cutaneous leishmaniasis was high. This illustrates the invasive characteristic of the parasite that has escaped the skin. Testing should be considered in areas other than Lebanon, especially around the Mediterranean basin. Whether these findings support the administration of systemic treatment for cutaneous leishmaniasis or not needs to be confirmed in larger prospective studies.
从皮肤病变部位扩散到血液中的利什曼原虫会引起诸多后果。为了评估这种入侵的程度，我们对转诊至贝鲁特美国大学医学中心的皮肤利什曼病患者进行了本次研究。
纳入本研究的患者均为转诊来治疗皮肤利什曼病的患者。我们从这些患者身上采集皮肤和血液的利什曼菌培养物。
162 名患者经病理证实患有皮肤利什曼病；其中 52%为男性，44%为女性（4%的患者性别信息缺失）。患者年龄从 5 个月至 70 岁不等。所有患者均未接受过利什曼原虫治疗。我们从 85 名患者（52.5%）中获得了寄生虫分离物，这些患者的皮肤和血液/血液成分培养均为阳性。有趣的是，有 50 名患者（30.9%）的血液和血液成分中分离出了寄生虫。同工酶分析证实了血液和皮肤中的寄生虫是相同的；在皮肤和血液均为阳性的 28 个分离物中，有 8 个分离物为利什曼原虫，2 个为热带利什曼原虫。其余分离物无论是在血液和皮肤中均为阳性，还是在皮肤或血液及其产物中为阳性，均为利什曼原虫婴儿亚种。
在本次研究中，皮肤利什曼病患者血液中寄生虫的检出率较高。这表明寄生虫具有入侵性，已经逃离皮肤。在黎巴嫩以外的地区，尤其是在地中海盆地周围，应考虑进行检测。这些发现是否支持对皮肤利什曼病进行全身治疗，需要在更大的前瞻性研究中加以证实。
