Fagundes-Silva Giselle Aparecida, Romero Gustavo Adolfo Sierra, Cupolillo Elisa, Yamashita Ellen Priscila Gadelha, Gomes-Silva Adriano, Guerra Jorge Augusto de Oliveira, Da-Cruz Alda Maria
Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil.
Faculdade de Medicina, Universidade de Brasília, Brasília, DF, Brasil.
Mem Inst Oswaldo Cruz. 2015 Sep;110(6):797-800. doi: 10.1590/0074-02760150128.
In the Brazilian Amazon, American tegumentary leishmaniasis (ATL) is endemic and presents a wide spectrum of clinical manifestations due, in part, to the circulation of at least seven Leishmania species. Few reports of Leishmania (Viannia) naiffi infection suggest that its occurrence is uncommon and the reported cases present a benign clinical course and a good response to treatment. This study aimed to strengthen the clinical and epidemiological importance of L. (V.) naiffi in the Amazon Region (Manaus, state of Amazonas) and to report therapeutic failure in patients infected with this species. Thirty Leishmania spp samples isolated from cutaneous lesions were characterised by multilocus enzyme electrophoresis. As expected, the most common species was Leishmania (V.) guyanensis (20 cases). However, a relevant number of L. (V.) naiffi patients (8 cases) was observed, thus demonstrating that this species is not uncommon in the region. No patient infected with L. (V.) naiffi evolved to spontaneous cure until the start of treatment, which indicated that this species may not have a self-limiting nature. In addition, two of the patients experienced a poor response to antimonial or pentamidine therapy. Thus, either ATL cases due to L. (V.) naiffi cannot be as uncommon as previously thought or this species is currently expanding in this region.
在巴西亚马逊地区，美洲皮肤利什曼病（ATL）为地方病，临床表现多样，部分原因是至少有七种利什曼原虫在该地区传播。关于奈氏利什曼原虫（Viannia亚属）感染的报道很少，表明其感染情况并不常见，且报告病例临床病程良性，对治疗反应良好。本研究旨在强化奈氏利什曼原虫（Viannia亚属）在亚马逊地区（马瑙斯，亚马孙州）的临床和流行病学重要性，并报告感染该虫种患者的治疗失败情况。从皮肤病变中分离出的30份利什曼原虫样本通过多位点酶电泳进行鉴定。不出所料，最常见的虫种是圭亚那利什曼原虫（Viannia亚属）（20例）。然而，观察到相当数量的奈氏利什曼原虫（Viannia亚属）患者（8例），表明该虫种在该地区并不罕见。在开始治疗前，没有感染奈氏利什曼原虫（Viannia亚属）的患者自行痊愈，这表明该虫种可能没有自限性。此外，两名患者对抗锑剂或喷他脒治疗反应不佳。因此，要么由奈氏利什曼原虫（Viannia亚属）引起的ATL病例不像之前认为的那么罕见，要么该虫种目前正在该地区扩散。
