Barral A, Guerreiro J, Bomfim G, Correia D, Barral-Netto M, Carvalho E M
Servico de Imunologia, Hospital Universitario Prof. Edgard Santos, Universidade Federal da Bahia, Bahia, Brazil.
Am J Trop Med Hyg. 1995 Sep;53(3):256-9. doi: 10.4269/ajtmh.1995.53.256.
This paper describes the presence of transitory lymphadenopathy as an initial sign of cutaneous leishmaniasis, and sometimes the only manifestation of Leishmania braziliensis infection. Ten patients with lymphadenopathy living in an area of L. braziliensis transmission had Leishmania cultivated from their lymph nodes previous to any other manifestation of cutaneous leishmaniasis. Seven of the 10 developed leishmanial ulcers later in the course of infection, whereas lymphadenopathy regressed in three cases and no other sign of infection developed. Results of tests for anti-Leishmania antibodies and an intradermal skin test were positive in four and five patients, respectively, at the time of the diagnosis. The documentation of Leishmania amastigotes in the lymph nodes before any clinical evidence of cutaneous disease indicates that early spread of L. braziliensis from the skin to lymph nodes occurs before a local lesion develops. All medical doctors examining patients coming from endemic areas of leishmaniasis should be aware that lymph node enlargement, even in the absence of a typical ulceration, may be indicative of leishmanial infection and warrants further investigation.
本文描述了暂时性淋巴结病作为皮肤利什曼病的初始体征，有时也是巴西利什曼原虫感染的唯一表现。10名生活在巴西利什曼原虫传播地区且患有淋巴结病的患者，在皮肤利什曼病出现任何其他表现之前，其淋巴结中培养出了利什曼原虫。10名患者中有7名在感染过程后期出现了利什曼溃疡，而3例患者的淋巴结病消退，未出现其他感染迹象。诊断时，4例患者的抗利什曼原虫抗体检测结果呈阳性，5例患者的皮内皮肤试验呈阳性。在皮肤疾病出现任何临床证据之前，淋巴结中存在利什曼无鞭毛体，这表明巴西利什曼原虫在局部病变形成之前就已从皮肤早期扩散至淋巴结。所有检查来自利什曼病流行地区患者的医生都应意识到，即使没有典型溃疡，淋巴结肿大也可能提示利什曼原虫感染，需要进一步调查。
