Biomedical subjects
Publications and source records attributed to A C Saldanha.
The authors provide a brief report on the historical evolution of visceral leishmaniasis in the State of Maranhão, Brazil, evaluating possible factors for growth of the disease in the State and control measures by the Brazilian Ministry of Health to integrate health services into the maintenance of control programs.
A 16-year-old man had long-standing diffuse cutaneous leishmaniasis with the following characteristics: diffuse infiltrated lesions rich in amastigotes, absence of mucosal involvement, and lack of parasite-specific cell-mediated immune response. In situ identification of Leishmania mexicana amazonensis was achieved by the use of monoclonal antibodies. Clinically, as an atypical finding there was deep and extensive ulceration in the lower limbs. Histologically, an atypical characteristic was the presence of a high number of eosinophils in the infiltrate predominantly in the ulcerated lesion. Ultrastructurally, parasitized and lysed eosinophils with dispersion of their granules were seen in the vicinity of parasitized or lysed macrophages.
In field clinics in the communities of Três Braços and Corte de Pedra, Bahia, we have attended 1.416 patients with tegumentary leishmaniasis in fourteen years, the predominant species in transmission is Leishmania Viannia brasi liensis (LVB). Because of the danger of metastasis with this infection treatment was routinely recommended with Glucan-time. However sixteen patients refused injection therapy and six women were pregnant when seen and not treated. All patients were followed up in our clinic. All these patients closed their skin ulcers although one subsequently relapsed. Patients were followed up for variable periods (four to twelve years), after the diagnosis. In nine patients (40.9%) of the cohort, the time to healing after initiation of the lesion was calculated as six months of evolution. At twelve months, nineteen patients (86.3%) had complete healing of their lesions. In three patients an active lesion was present for longer than one year. The determinants of this variable natural evolution of human LVB lesion remains completely unknown. It is difficult for us to understand and compare the effects of therapeutic agents in mucocutaneous leishmaniasis.
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The authors describe a retrospective and prospective study of 6 patients with diffuse cutaneous leishmaniasis observed in the state of Maranhão, since 1974. The patients come from different rural regions of the state and in all of them Leishmania (Leishmania) amazonensis was the cause five of the patients initiated their disease in the first decade of life. All the patients first had a solitary, nodular lesion, that after a variable period of time, disseminated and acquired other aspects. Sequentially the patients presented multiple nodular and ulcerative lesions, negative Leishmania skin tests and a refractory response to the therapeutic schedules used up to the present.
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The authors describe a case of a patient from Barreirinhas, MA with disseminated cutaneous leishmaniasis, who presented 58 lesions spread all over his body, with many different aspects, but ulcerative lesions were predominant. They discuss the difficulty of laboratory diagnosis in the beginning of the investigation and its therapeutics implications. The parasite isolated was identified as Leishmania viannia braziliensis using monoclonal antibodies in the fluorescent antibody test. This form of the disease is different from the diffuse cutaneous leishmaniasis found in Maranhão, due to Leishmania (Leishmania) amazonensis which is responsible for most of the cases of cutaneous leishmaniasis in our state. The possible mechanisms of lesions dissemination are discussed.
Thirty cases of chromoblastomycosis were diagnosed at Hospital dos Servidores do Estado do Maranhão, from November, 1988 to March, 1993. The authors report 2 (6.6%) cases, that presented an association with leprosy. The first patient developed both diseases together, showing palpable bilateral cubital nerves, perforanting ulcer of the right foot, infiltration and lesions in verrucoid plaques in left leg, with positive biopsy for dimorphic leprosy. The second case, a patient with history of lepromatous leprosy for 30 years without treatment, with vegetant lesions with a warty aspect in right elbow for 12 months, histopathologic and positive culture for chromoblastomycosis. The possible factors for development of this disease in these patients are discussed.
The authors report a case of diffuse cutaneous leishmaniasis, with longstanding evolution and presenting with diffuse infiltrated lesions rich in amastigotes in the absence of mucosal involvement. In situ characterization with monoclonal antibodies revealed Leishmania amazonensis. Large regional lesions have presented spontaneous healing without specific therapy. Considering that DCL presents with a defect in the cellular immune response, this fact demonstrate that this patient may develop a regional cellular immune response enough to destroy the parasites and to produce clearing of some lesions.
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The authors report a case of a male patient from Bacabal, MA with diffuse cutaneous leishmaniasis (DCL), for at least nine years, with 168 lesions on his body. These were tumour-like nodules with some ulceration. He used pentavalent antimonial (glucantime) and an association of gamma interferon plus glucantime with improvement of the lesions but relapsed later. Recently, pentamidine isethionate (pentacarinat) was given a dosage of 4mg/kg/weight/day on alternate days for 20 applications. After 3 months a similar course of 10 application was given 2 times. Later he developed diabetic signs with weight loss of 10kg, polydypsia, polyuria and xerostomia. The lower limbs lesions showed signs of activity. Blood glucose levels normalised and remain like this at moment. Attention is drawn to the fact that pentamidine isethionate should be used as a therapy option with care, obeying rigorous laboratory controls including a glucose tolerance test.
Efficacy and safety of meglumine antimoniate and sodium stibogluconate BP 88R were compared in cutaneous leishmaniasis treatment in Corte de Pedra, Bahia, an endemic area of leishmaniasis due to Leishmania (Viannia) braziliensis. An open trial was developed with one hundred twenty seven patients who were diagnosed based on clinical criteria and Montenegro's skin test. Fifty eight patients were treated with meglumine antimoniate and 69 received sodium stibogluconate. Both groups received 20 mg/Sbv/kg/day for 20 days. Patients were followed every ten days during treatment and every month thereafter for three months. Sixty two percent patients cured with meglumine antimoniate and 55% cured with sodium stibogluconate (p = 0.42). Headache was more frequent during the first half of treatment in patients receiving sodium stibogluconate (p = 0.026). During the second half, patients treated with sodium stibogluconate showed a greater frequency of myalgia/arthralgia (p = 0.004) and abdominal pain/anorexia (p = 0.004). Three patients treated with sodium stibogluconate had severe side effects.
Toxicity of two antimonial pentavalents were evaluated in 111 patients with cutaneous leishmaniasis. Forty-seven patients received meglumine antimoniate (Group I) and 64 patients, sodium stibogluconate BP 88 (Group II), 20 mg Sbv/kg/day for 20 days. Evaluation of aminotransferases, alkaline phosphatase, amilase, creatinine, urea, urine analysis and electrocardiogram were performed at baseline, on the tenth and twentieth day of treatment. Greater frequency of aminotransferase abnormal levels were observed on the tenth and twentieth days in group II (p < 0.001) and a greater proportion of amilase abnormal levels at the tenth day in the same group (p < 0.001). There was a greater variation of aminotransferases, alkaline phosphatase and amilase in the first ten days of treatment in group II (p < 0.01). On the twentieth day there was a greater variation of aminotransferase levels in group II (p = 0.02 and p = 0.03, respectively). Forty-three percent of group I and 54% of group II showed electrocardiographic abnormalities (p = 0.30).
The aim of this study was to observe the clinical and of epidemiological behavior of chromoblastomycosis in the State of Maranhão. A retrospective and prospective study of 13 cases was performed at the infectious diseases section of the Hospital dos Servidores do Estado do Maranhão, from November, 1988 to July, 1991. In the investigation a protocol record was used with a view to further analysis. A higher prevalence between 50 and 60 years of age (46.1%) and in male patients (92.3%) was noted. Twelve patients (92.3%) were from Maranhão State, and 10 of them (76.9%) came from the western microregion of the State of Maranhão. Regarding occupation, 92.3% were land workers, and most of them presented the lesions on the lower limbs (84.6%) of a vegetant warty aspect, brown in color with itching. Histopathological examination diagnosed chromomycosis in 100% of the cases. Culture was performed in 11 cases, and Fonsecaea pedrosoi isolated in 9 of them. Treatment with 5-fluorocytosine resulted in a good evolutive response. This study indicates the existence of a probable endemic area of chromomycosis in hinterland of Maranhão (western microregion) that hither to unknown.