Vasconcelos I de A, Sousa A de Q, Vasconcelos A W, Diógenes M J, Momen H, Grimaldi Júnior G, Menezes D B, Sleigh A C
Núcleo de Medicina Tropical, Universidade Federal do Ceará, Fortaleza, Brasil.
Bull Soc Pathol Exot. 1993;86(2):101-5.
Eighteen patients from the northeastern Brazilian State of Ceara with proven kala-azar were studied for evidence of skin parasitism: two had ulcerative or papular skin lesions and 16 had clinically normal skin. Punch biopsies (3 mm) of intact paraspinal subscapular skin were performed on all patients; in those with papular or ulcerative lesions biopsies also were taken from an active site. One of each of the subscapsular biopsies and half of each biopsy from an active lesion were studied; the other specimens were seeded on NNN Difco Blood Agar Base Medium for parasite culture. The biopsies revealed a discrete to intense mononuclear inflammatory infiltrate, predominantly perivascular in nature. No amastigotes were observed in any tissue sections but 7 of the 18 patients yielded promastigotes on skin culture identified by monoclonal antibodies and by enzyme electrophoresis as Leishmania (Leishmania) chagasi [L. (L.) chagasi]. The isolation of Leishmania (Leishmania) chagasi, the recognized aetiologic agent of visceral leishmaniasis in the New World, from the skin of nearly 40% of 18 AVL patients proves dermatotropism of L. (L.) chagasi occurs and may be frequent in neotropical human visceral leishmaniasis (AVL.). Infected persons with skin parasites could act as a reservoir of infection and allow human to human transmission.
对巴西东北部塞阿拉州18例确诊为黑热病的患者进行了皮肤寄生虫感染证据的研究：2例有溃疡性或丘疹性皮肤病变，16例皮肤临床正常。对所有患者完整的脊柱旁肩胛下皮肤进行了3毫米的钻孔活检；对有丘疹性或溃疡性病变的患者，还从病变活跃部位取材活检。对肩胛下活检组织中的一份以及病变活跃部位活检组织的一半进行了研究；其他标本接种于NNN Difco血琼脂基础培养基进行寄生虫培养。活检显示有散在至密集的单核炎性浸润，主要为血管周围性。在任何组织切片中均未观察到无鞭毛体，但18例患者中有7例在皮肤培养中培养出前鞭毛体，经单克隆抗体和酶电泳鉴定为恰加斯利什曼原虫（Leishmania (Leishmania) chagasi）。从18例美洲内脏利什曼病（AVL）患者中近40%的患者皮肤中分离出新世界内脏利什曼病公认的病原体恰加斯利什曼原虫，证明恰加斯利什曼原虫存在皮肤嗜性，且在新热带地区人类内脏利什曼病（AVL）中可能很常见。有皮肤寄生虫感染的人可能成为传染源，并导致人际传播。
