Antonio Liliane de Fátima, Lyra Marcelo Rosandiski, Saheki Maurício Naoto, Schubach Armando de Oliveira, Miranda Luciana de Freitas Campos, Madeira Maria de Fátima, Lourenço Maria Cristina da Silva, Fagundes Aline, Ribeiro Érica Aparecida Dos Santos, Barreto Leonardo, Pimentel Maria Inês Fernandes
Fundação Oswaldo Cruz-Fiocruz, Instituto Nacional de Infectologia Evandro Chagas, Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Rio de Janeiro, RJ, Brasil.
Conselho Nacional de Desenvolvimento Científico e Tecnológico, Rio de Janeiro, RJ, Brasil.
Mem Inst Oswaldo Cruz. 2017 Sep;112(9):640-646. doi: 10.1590/0074-02760160557.
Cutaneous leishmaniasis (CL) generally presents with a single or several localised cutaneous ulcers without involvement of mucous membranes. Ulcerated lesions are susceptible to secondary contamination that may slow the healing process.
This study verified the influence of non-parasitic wound infection on wound closure (epithelialisation) and total healing.
Twenty-five patients with a confirmed diagnosis of CL and ulcerated lesions underwent biopsy of ulcer borders. One direct microbial parameter (germ identification in cultures) and four indirect clinical parameters (secretion, pain, burning sensation, pruritus) were analysed. FINDINGS Biopsies of ten lesions showed secondary infection by one or two microorganisms (Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus faecalis, Streptococcus pyogenes and Candida parapsilosis). "Secretion" and "burning sensation" influenced epithelialisation time but not total healing time. Positive detection of germs in the ulcer border and "pain" and "pruritus" revealed no influence on wound closure.
Our borderline proof of clinical CL ulcer infection inhibiting CL wound healing supports the need to follow antimicrobial stewardship in CL ulcer management, which was recently proposed for all chronic wounds.
皮肤利什曼病（CL）通常表现为单个或多个局限性皮肤溃疡，不累及黏膜。溃疡病变易发生继发性污染，这可能会延缓愈合过程。
本研究验证了非寄生虫性伤口感染对伤口闭合（上皮化）和整体愈合的影响。
25例确诊为CL且有溃疡病变的患者接受了溃疡边缘活检。分析了一个直接微生物参数（培养物中的细菌鉴定）和四个间接临床参数（分泌物、疼痛、烧灼感、瘙痒）。
10个病变的活检显示有一或两种微生物继发感染（金黄色葡萄球菌、铜绿假单胞菌、粪肠球菌、化脓性链球菌和副平滑念珠菌）。“分泌物”和“烧灼感”影响上皮化时间，但不影响整体愈合时间。溃疡边缘细菌的阳性检测以及“疼痛”和“瘙痒”对伤口闭合无影响。
我们关于临床CL溃疡感染抑制CL伤口愈合的边缘性证据支持在CL溃疡管理中遵循抗菌管理的必要性，这是最近针对所有慢性伤口提出的。
