Sousa A de Q, Parise M E, Pompeu M M, Coehlo Filho J M, Vasconcelos I A, Lima J W, Oliveira E G, Vasconcelos A W, David J R, Maguire J H
Nucleo de Medicina Tropical, Universidade Federal do Ceara, Fortaleza, Ceara, Brazil.
Am J Trop Med Hyg. 1995 Oct;53(4):380-5. doi: 10.4269/ajtmh.1995.53.380.
Enlarged regional lymph nodes have been reported to accompany the cutaneous lesions of Leishmania (Viannia) braziliensis (= L. braziliensis). A survey in Ceara State, Brazil indicated that 77% of persons (456 of 595) with parasitologically confirmed cutaneous leishmaniasis reported lymphadenopathy in addition to skin lesions. A group of 169 persons with recently diagnosed leishmaniasis and lymph nodes measuring > or = 2 cm in diameter (mean = 3.6 cm, maximum = 10.5 cm) underwent detailed clinical examination. Lymphadenopathy preceded the skin lesions in more than two-thirds of these, on the average by two weeks. Cultures of lymph node aspirates yielded Leishmania more frequently (86%) than cultures of aspirates of skin (53%) or biopsies of skin (74%). Parasites were isolated from the peripheral blood of one patient. Persons with lymphadenopathy gave a history of fever and had enlarged livers or spleens more often than a comparison group of 50 persons with cutaneous lesions but no lymphadenopathy. Persons with lymphadenopathy had more intense leishmanin skin reactions and lymphocyte proliferation following stimulation with specific antigens, whereas persons without lymphadenopathy had a higher frequency of previous infection. Isolates of parasites from both groups were identified as L. braziliensis. These data demonstrate the early spread of L. braziliensis beyond the skin and suggest differences in host immunity between persons with and without lymphadenopathy. Leishmaniasis braziliensis should be considered in cases of unexplained lymphadenopathy in endemic areas.
据报道，巴西利什曼原虫（维氏亚属）（=巴西利什曼原虫）的皮肤病变会伴有局部淋巴结肿大。在巴西塞阿拉州进行的一项调查表明，在经寄生虫学确诊的皮肤利什曼病患者中，77%（595人中的456人）除皮肤病变外还伴有淋巴结病。一组169名近期诊断为利什曼病且淋巴结直径≥2厘米（平均=3.6厘米，最大=10.5厘米）的患者接受了详细的临床检查。在这些患者中，超过三分之二的人淋巴结病先于皮肤病变出现，平均提前两周。淋巴结穿刺液培养分离出利什曼原虫的频率（86%）高于皮肤穿刺液培养（53%）或皮肤活检（74%）。从一名患者的外周血中分离出了寄生虫。与50名有皮肤病变但无淋巴结病的对照组相比，有淋巴结病的患者有发热史，肝脏或脾脏肿大更为常见。有淋巴结病的患者在用特异性抗原刺激后，利什曼菌素皮肤反应和淋巴细胞增殖更为强烈，而无淋巴结病的患者既往感染频率更高。两组分离出的寄生虫均被鉴定为巴西利什曼原虫。这些数据表明巴西利什曼原虫在皮肤外的早期传播，并提示有和无淋巴结病的患者在宿主免疫方面存在差异。在流行地区，对于不明原因的淋巴结病病例应考虑巴西利什曼病。
