Bonfante-Garrido R, Barroeta S, de Alejos M A, Meléndez E, Torrealba J, Valdivia O, Momen H, Grimaldi Júnior G
Investigation Unit of Medical Parasitology, Deanship of Medicine, Universidad Centroccidental Lisandro Alvarado, Barquisimeto, Venezuela.
Int J Dermatol. 1996 Aug;35(8):561-5. doi: 10.1111/j.1365-4362.1996.tb03655.x.
While studying cutaneous leishmaniasis in the central part of western Venezuela, we found four cases of disseminated American cutaneous leishmaniasis, three from the Lara State and one from Portuguesa State.
A clinical history was taken for each of these patients, followed by microscopic examination of the Giemsastained smears from their cutaneous lesions and by a Montenegro skin test. Serum from a skin lesion were grown in Novy-MacNeal-Nicolle medium (NNN). Hamsters were inoculated with suspension of tissues taken from the patient's lesions. Biopsies were taken for histopathologic examination. Isolates from cultures on NNN medium and from hamsters were subcultured in Schneider's medium for parasite identification, using molecular techniques. Treatment with injections of N-methyl glucamine antimonate, 25 mg/kg/day was prescribed for each patient for 20 consecutive days and, after a week of rest, a second course of injections was administered.
Patients had disseminated papular, ulcerous, nodular, and ulceronodular lesions on the skin. Smears of the skin lesions from all of the patients showed abundant amastigotes within histiocytes or free in the tissues. The skin test was negative in two patients. On histopathologic examination of skin lesions, mainly numerous vacuolated histiocytes filled with amastigotes were observed. Isolates from all the patients were identified as Leishmania venezuelensis. One of the patients healed after treatment with N-methyl glucamine antimonate. The others were resistant to this therapy.
Diffuse cutaneous leishmaniasis can be caused also by Leishmania venezuelensis. Patients with nodular lesions who presented a negative Montenegro skin test were more resistant to treatment with specific pentavalent antimonials.
在研究委内瑞拉西部中部地区的皮肤利什曼病时，我们发现了4例播散性美洲皮肤利什曼病病例，其中3例来自拉腊州，1例来自葡萄牙萨州。
对这些患者逐一进行临床病史采集，随后对其皮肤病变的吉姆萨染色涂片进行显微镜检查，并进行蒙氏皮肤试验。从皮肤病变处采集的血清在诺维-麦克尼尔-尼科尔培养基（NNN）中培养。将取自患者病变组织的悬液接种到仓鼠体内。取活检组织进行组织病理学检查。将NNN培养基上培养物及仓鼠体内分离出的菌株在施奈德培养基中传代培养，采用分子技术进行寄生虫鉴定。为每位患者连续20天每天注射25mg/kg的N-甲基葡糖胺锑酸盐进行治疗，休息一周后，给予第二个疗程的注射治疗。
患者皮肤上出现播散性丘疹、溃疡、结节及溃疡结节性病变。所有患者皮肤病变涂片显示组织细胞内有大量无鞭毛体或在组织中游离。两名患者的皮肤试验呈阴性。对皮肤病变进行组织病理学检查时，主要观察到大量充满无鞭毛体的空泡化组织细胞。所有患者的分离菌株均鉴定为委内瑞拉利什曼原虫。一名患者经N-甲基葡糖胺锑酸盐治疗后痊愈。其他患者对此疗法耐药。
委内瑞拉利什曼原虫也可引起弥漫性皮肤利什曼病。出现结节性病变且蒙氏皮肤试验呈阴性的患者对特异性五价锑剂治疗更具耐药性。
