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España AG, Pimentel MIF, Lyra JPDM, Valete-Rosalino CM, Lyra MR. Description of the dermatoscopic features observed in sporotrichosis and American cutaneous leishmaniasis in a reference center in Rio de Janeiro, Brazil. An Bras Dermatol 2023; 98:764-773. [PMID: 37481377 PMCID: PMC10589486 DOI: 10.1016/j.abd.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/14/2022] [Accepted: 09/05/2022] [Indexed: 07/24/2023] Open
Abstract
BACKGROUND The evaluation of American cutaneous leishmaniasis (CL) and sporotrichosis (SP) with dermoscopy may improve the diagnosis accuracy and clinical monitoring. OBJECTIVES To describe the dermoscopic findings and patterns of skin lesions of patients with CL and SP followed up at the Laboratory of Clinical Research and Surveillance in Leishmaniasis (LaPClinVigiLeish), Evandro Chagas National Institute of Infectious Diseases (INI), Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. METHODS The authors included patients with a diagnosis of CL or SP, who attended at INI/ Fiocruz, between 2019‒2021. All patients had 3 dermoscopic examinations (DermLite DL4): before treatment (T0), during treatment (T1), and after healing (T2). Up to three lesions per patient were evaluated. RESULTS The authors studied 47 patients with CL (74 lesions), and 19 patients with SP (24 lesions). The authors described dermoscopic structures such as rosettes, white lines, white dots, brown focal structureless areas, brown lines and dots, white perilesional circles, perilesional hyperchromic circles, microulcerations and the rainbow patterns. The authors created specific patterns; in CL: CL-T0 "central yellow scales with a white perilesional circle pattern", CL-T1 "diffuse structureless white area pattern" and CL-T2 "white and brown focal structureless areas pattern". In SP: SP-T0 the "pustule with erythema pattern"; SP-T1 the "focal structureless white areas with erythema pattern" and SP-T2 the "white linear pattern". STUDY LIMITATIONS This study does not correlate dermoscopic findings with time of disease evolution at the first medical examination. CONCLUSIONS The recognition of CL and SP dermoscopy patterns may be helpful tool for the differential diagnosis and monitoring of disease evolution.
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Affiliation(s)
- Alejandra Galeano España
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.
| | - Maria Inês Fernandes Pimentel
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
| | | | - Cláudia Maria Valete-Rosalino
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil; Otolaryngology Department and Ophthalmology, Faculty of Medicine, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Marcelo Rosandiski Lyra
- Laboratory of Clinical Research and Surveillance in Leishmaniasis, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
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Guerra PV, Andrade CM, Nunes IV, Gama BC, Tibúrcio R, Santos WLC, Azevedo VA, Tavares NM, Rebouças JDS, Maiolii TU, Faria AMC, Brodskyn CI. Oral Tolerance Induced by Heat Shock Protein 65-Producing Lactococcus lactis Mitigates Inflammation in Leishmania braziliensis Infection. Front Immunol 2021; 12:647987. [PMID: 34248935 PMCID: PMC8264454 DOI: 10.3389/fimmu.2021.647987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/07/2021] [Indexed: 12/05/2022] Open
Abstract
Cutaneous leishmaniasis caused by L. braziliensis induces a pronounced Th1 inflammatory response characterized by IFN-γ production. Even in the absence of parasites, lesions result from a severe inflammatory response in which inflammatory cytokines play an important role. Different approaches have been used to evaluate the therapeutic potential of orally administrated heat shock proteins (Hsp). These proteins are evolutionarily preserved from bacteria to humans, highly expressed under inflammatory conditions and described as immunodominant antigens. Tolerance induced by the oral administration of Hsp65 is capable of suppressing inflammation and inducing differentiation in regulatory cells, and has been successfully demonstrated in several experimental models of autoimmune and inflammatory diseases. We initially administered recombinant Lactococcus lactis (L. lactis) prior to infection as a proof of concept, in order to verify its immunomodulatory potential in the inflammatory response arising from L. braziliensis. Using this experimental approach, we demonstrated that the oral administration of a recombinant L. lactis strain, which produces and secretes Hsp65 from Mycobacterium leprae directly into the gut, mitigated the effects of inflammation caused by L. braziliensis infection in association or not with PAM 3CSK4 (N-α-Palmitoyl-S-[2,3-bis(palmitoyloxy)-(2RS)-propyl]-L-cysteine, a TLR2 agonist). This was evidenced by the production of anti-inflammatory cytokines and the expansion of regulatory T cells in the draining lymph nodes of BALB/c mice. Our in vitro experimental results suggest that IL-10, TLR-2 and LAP are important immunomodulators in L. braziliensis infection. In addition, recombinant L. lactis administered 4 weeks after infection was observed to decrease lesion size, as well as the number of parasites, and produced a higher IL-10 production and decrease IFN-γ secretion. Together, these results indicate that Hsp65-producing L. lactis can be considered as an alternative candidate for treatment in both autoimmune diseases, as well as in chronic infections that cause inflammatory disease.
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Affiliation(s)
- Priscila Valera Guerra
- Laboratório da Interação Parasita-Hospedeiro e Epidemiologia (LAIPHE) Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Curso de Medicina, Centro Universitário Christus, Fortaleza, Brazil
| | - Camila Mattos Andrade
- Laboratório da Interação Parasita-Hospedeiro e Epidemiologia (LAIPHE) Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Ivanéia Valeriano Nunes
- Laboratório da Interação Parasita-Hospedeiro e Epidemiologia (LAIPHE) Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Brena Cardoso Gama
- Laboratório da Interação Parasita-Hospedeiro e Epidemiologia (LAIPHE) Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Rafael Tibúrcio
- Laboratório da Interação Parasita-Hospedeiro e Epidemiologia (LAIPHE) Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
| | - Washington Luis Conrado Santos
- Laboratório de Patologia Estrutural e Molecular (LAPEM), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Departamento de Patologia e Medicina Legal Faculdade de Medicina da Universidade Federal da Bahia, Salvador, Brazil
| | - Vasco Ariston Azevedo
- Departamento de Genética, Ecologia e Evolução, Instituto de Ciências Biomédicas, Universidade Federal de Minais Gerais, Belo Horizonte, Brazil
| | - Natalia Machado Tavares
- Laboratório da Interação Parasita-Hospedeiro e Epidemiologia (LAIPHE) Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Instituto de Investigação em Imunologia, Instituto Nacional de Ciência e Tecnologia (INCT), São Paulo, Brazil
| | - Juliana de Souza Rebouças
- Instituto de Ciências Biológicas, Programa de Pós Graduação em Ciências da Saúde, Universidade de Pernambuco, Recife, Brazil
| | - Tatiani Uceli Maiolii
- Departamento de Nutrição, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana Maria Caetano Faria
- Instituto de Investigação em Imunologia, Instituto Nacional de Ciência e Tecnologia (INCT), São Paulo, Brazil.,Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Cláudia Ida Brodskyn
- Laboratório da Interação Parasita-Hospedeiro e Epidemiologia (LAIPHE) Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil.,Instituto de Investigação em Imunologia, Instituto Nacional de Ciência e Tecnologia (INCT), São Paulo, Brazil
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Gupta G, Santana AK, Gomes CM, Turatti A, Milanezi CM, Bueno Filho R, Fuzo C, Almeida RP, Carregaro V, Roselino AM, Silva JS. Inflammasome gene expression is associated with immunopathology in human localized cutaneous leishmaniasis. Cell Immunol 2019; 341:103920. [DOI: 10.1016/j.cellimm.2019.04.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/04/2019] [Accepted: 04/19/2019] [Indexed: 12/22/2022]
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Oliveira-Ribeiro C, Pimentel MIF, Oliveira RDVC, Fagundes A, Madeira MDF, Mello CX, Mouta-Confort E, Valete-Rosalino CM, Vasconcellos EDCF, Lyra MR, Quintella LP, Fatima Antonio LD, Schubach A, Conceição-Silva F. Clinical and laboratory profiles of patients with early spontaneous healing in cutaneous localized leishmaniasis: a historical cohort study. BMC Infect Dis 2017; 17:559. [PMID: 28793868 PMCID: PMC5550953 DOI: 10.1186/s12879-017-2658-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 08/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Skin ulcers in American cutaneous leishmaniasis (ACL) may heal spontaneously after months/years. However, few cases may present quick heal even during diagnosis procedure (early spontaneous healing- ESH). The main objective of this study was to compare ESH patients with cases requiring specific treatment [non-ESH (NESH)]. METHODS A historical cohort study of ACL patients (n = 445) were divided into 2 groups: ESH - spontaneously healed patients (n = 13; 2.90%), and NESH- treated patients (n = 432; 97.10%). We compared clinical and laboratorial findings at diagnosis, including the lesion healing process. RESULTS ESH patients had a higher percentage of single lesions (p = 0.027), epithelialized lesion on initial examination (p = 0.001), lesions located in the dorsal trunk (p = 0.017), besides earlier healing (p < 0.001). NESH presents higher frequency of ulcerated lesions (p = 0.002), amastigotes identified in histopathology exams (p = 0.005), positive cultures (p = 0.001), and higher positivity in ≥3 parasitological exams (p = 0.030). All ESH cases were positive in only a single exam, especially in PCR. CONCLUSIONS ESH group apparently presented a lower parasitic load evidenced by the difficulty of parasitological confirmation and its positivity only by PCR method. The absence or deficiency of specific treatment is commonly identified as predisposing factors for recurrence and metastasis in ACL. However, due to the drugs toxicity, the treatment of cases which progress to early spontaneous healing is controversial. ESH patients were followed for up to 5 years after cure, with no evidence of recrudescence, therefore suggesting that not treating these patients is justifiable, but periodic dermatological and otorhinolaryngological examinations are advisable to detect a possible relapse.
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Affiliation(s)
- Carla Oliveira-Ribeiro
- Laboratório de Imunoparasitologia, Instituto Oswaldo Cruz IOC/FIOCRUZ, Pavilhão 26 - 4° andar, sala 406-C, Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria Inês Fernandes Pimentel
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | | | - Aline Fagundes
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Maria de Fatima Madeira
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
- Jovem Cientista do Nosso Estado, Fundação Carlos Chagas Filho de Amparo à Pesquisa no Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil
- Fellow Researcher of the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Rio de Janeiro, Brazil
| | - Cintia Xavier Mello
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Eliame Mouta-Confort
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Claudia Maria Valete-Rosalino
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
- Jovem Cientista do Nosso Estado, Fundação Carlos Chagas Filho de Amparo à Pesquisa no Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil
- Departamento de Otorrinolaringologia e Oftalmologia, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Erica de Camargo Ferreira Vasconcellos
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Marcelo Rosandiski Lyra
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Leonardo Pereira Quintella
- Serviço de Anatomia Patológica- SEAP, Instituto Nacional de Infectologia Evandro Chagas. INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Liliane de Fatima Antonio
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
| | - Armando Schubach
- Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses - LAPCLIN VIGILEISH, Instituto Nacional de Infectologia Evandro Chagas INI/FIOCRUZ, Rio de Janeiro, Brazil
- Fellow Researcher of the Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq), Rio de Janeiro, Brazil
- Cientista do Nosso Estado, Fundação Carlos Chagas Filho de Amparo à Pesquisa no Estado do Rio de Janeiro (FAPERJ), Rio de Janeiro, Brazil
| | - Fatima Conceição-Silva
- Laboratório de Imunoparasitologia, Instituto Oswaldo Cruz IOC/FIOCRUZ, Pavilhão 26 - 4° andar, sala 406-C, Av. Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-360, Brazil.
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Calixto P, Fagundes D, Oliveira J. Estrutura Tridimensional da Major Surface Protease de Leishmania guyanensis Resolvida por Modelagem Comparativa. BIOTA AMAZÔNIA 2014. [DOI: 10.18561/2179-5746/biotaamazonia.v4n1p74-80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Vasconcellos EDCFE, Pimentel MIF, Schubach ADO, de Oliveira RDVC, Azeredo-Coutinho RB, Silva FDC, Salgueiro MDM, Moreira JS, Madeira MDF, Baptista C, Valete-Rosalino CM. Intralesional meglumine antimoniate for treatment of cutaneous leishmaniasis patients with contraindication to systemic therapy from Rio de Janeiro (2000 to 2006). Am J Trop Med Hyg 2012; 87:257-60. [PMID: 22855754 DOI: 10.4269/ajtmh.2012.11-0612] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
We evaluated the effectiveness and safety of intralesional meglumine antimoniate (MA) in 24 not submitted to previous treatment patients with cutaneous leishmaniasis (CL) and with contraindication to systemic therapy. Each treatment consisted of one to four intralesional applications of MA at 15-day intervals. Patients' age ranged from 3 to 90 years; fourteen were females. Intralesional treatment in the absence of any relevant toxicity was successful in 20 (83.3%) patients. Three patients required additional treatment with amphotericin B and one required systemic MA. None of the patients developed mucosal lesions when followed up to 60 months. Intralesional MA is an effective and less toxic alternative treatment of patients with CL and contraindication to systemic therapy.
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Maretti-Mira AC, Bittner J, Oliveira-Neto MP, Liu M, Kang D, Li H, Pirmez C, Craft N. Transcriptome patterns from primary cutaneous Leishmania braziliensis infections associate with eventual development of mucosal disease in humans. PLoS Negl Trop Dis 2012; 6:e1816. [PMID: 23029578 PMCID: PMC3441406 DOI: 10.1371/journal.pntd.0001816] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 07/31/2012] [Indexed: 12/03/2022] Open
Abstract
Introduction Localized Cutaneous Leishmaniasis (LCL) and Mucosal Leishmaniasis (ML) are two extreme clinical forms of American Tegumentary Leishmaniasis that usually begin as solitary primary cutaneous lesions. Host and parasite factors that influence the progression of LCL to ML are not completely understood. In this manuscript, we compare the gene expression profiles of primary cutaneous lesions from patients who eventually developed ML to those that did not. Methods Using RNA-seq, we analyzed both the human and Leishmania transcriptomes in primary cutaneous lesions. Results Limited number of reads mapping to Leishmania transcripts were obtained. For human transcripts, compared to ML patients, lesions from LCL patients displayed a general multi-polarization of the adaptive immune response and showed up-regulation of genes involved in chemoattraction of innate immune cells and in antigen presentation. We also identified a potential transcriptional signature in the primary lesions that may predict long-term disease outcome. Conclusions We were able to simultaneously sequence both human and Leishmania mRNA transcripts in primary cutaneous leishmaniasis lesions. Our results suggest an intrinsic difference in the immune capacity of LCL and ML patients. The findings correlate the complete cure of L. braziliensis infection with a controlled inflammatory response and a balanced activation of innate and adaptive immunity. In Brazil, American tegumentary leishmaniasis is mainly caused by Leishmania braziliensis infection. Usually, it begins as a solitary skin lesion, which is called Localized Cutaneous Leishmaniasis (LCL). However, after this lesion heals, 5% of the patients may develop destructive lesions of the mucosa of nose and throat, which is called Mucosal Leishmaniasis (ML). Currently, there is no technology to identify individuals at risk for ML, and the factors that control the evolution to ML remain unknown. This work aims to study the human gene expression patterns that may contribute to the clinical manifestation of the disease. We used the RNA-Seq technique to study skin lesions from individuals that had LCL (LCL group) and those who developed ML (ML group). Our results suggest that individuals that progressed to ML expressed low levels of genes involved in the immune and inflammatory responses, which might lead to insufficient control of the infection. We were also able to identify a potential gene expression signature to predict long-term disease outcome.
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Affiliation(s)
- Ana Claudia Maretti-Mira
- Division of Molecular Medicine, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, United States of America
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jaime Bittner
- Division of Molecular Medicine, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, United States of America
| | - Manoel Paes Oliveira-Neto
- Ambulatório de Leishmanioses, Instituto de Pesquisas Clínicas Evandro Chagas, Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Minghsun Liu
- Infectious Diseases Section (111 F) and Research Service, VA Medical Center West Los Angeles, Los Angeles, California, United States of America
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
| | - Dezhi Kang
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Molecular and Medical Pharmacology, Crump Institute for Molecular Imaging, UCLA-DOE Institute for Genomics and Proteomics, Los Angeles, California, United States of America
| | - Huiying Li
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- Department of Molecular and Medical Pharmacology, Crump Institute for Molecular Imaging, UCLA-DOE Institute for Genomics and Proteomics, Los Angeles, California, United States of America
| | - Claude Pirmez
- Laboratório Interdisciplinar de Pesquisas Médicas, Instituto Oswaldo Cruz, Fiocruz, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Noah Craft
- Division of Molecular Medicine, Department of Medicine, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, United States of America
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, United States of America
- * E-mail:
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Sousa-Franco J, Araújo-Mendes E, Silva-Jardim I, L-Santos J, Faria DR, Dutra WO, Horta MDF. Infection-induced respiratory burst in BALB/c macrophages kills Leishmania guyanensis amastigotes through apoptosis: possible involvement in resistance to cutaneous leishmaniasis. Microbes Infect 2005; 8:390-400. [PMID: 16242371 DOI: 10.1016/j.micinf.2005.07.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2005] [Revised: 05/12/2005] [Accepted: 07/04/2005] [Indexed: 11/17/2022]
Abstract
The immune mechanisms that underlie resistance and susceptibility to leishmaniasis are not completely understood for all species of Leishmania. It is becoming clear that the immune response, the parasite elimination by the host and, as a result, the outcome of the disease depend both on the host and on the species of the infecting Leishmania. Here, we analyzed the outcome of the infection of BALB/c mice with L. guyanensis in vivo and in vitro. We showed that BALB/c mice, which are a prototype of susceptible host for most species of Leishmania, dying from these infections, develop insignificant or no cutaneous lesions and eliminate the parasite when infected with promastigotes of L. guyanensis. In vitro, we found that thioglycollate-elicited BALB/c peritoneal macrophages, which are unable to eliminate L. amazonensis without previous activation with cytokines or lipopolysaccharide, can kill L. guyanensis amastigotes. This is the first report showing that infection of peritoneal macrophages with stationary phase promastigotes efficiently triggers innate microbicidal mechanisms that are effective in eliminating the amastigotes, without exogenous activation. We demonstrated that L. guyanensis amastigotes die inside the macrophages through an apoptotic process that is independent of nitric oxide and is mediated by reactive oxygen intermediates generated in the host cell during infection. This innate killing mechanism of macrophages may account for the resistance of BALB/c mice to infection by L. guyanensis.
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Affiliation(s)
- Junia Sousa-Franco
- Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, C.P. 486, 31270-901 Belo Horizonte, MG 30161-970, Brazil
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Abstract
Leishmania braziliensis braziliensis (Lbb) is probably the most serious, leishmanial infection of the New World. Although epidemiological information is incomplete, its distribution is believed to extend from Belize in Central America to northern Argentina, involving all countries east of the Andes. Lbb causes a variety of clinical lesions and is one of the most difficult forms of leishmaniasis to treat. We still do not know how many patients suffer from mucosal disease requiring treatment. In this review of 10 years field experience in an endemic area of Brazil, Philip Marsden shows that parasitologists have much to contribute, especially in improving diagnostic methods, developing better animal models, and providing new drugs suitable for routine treatment on a large-scale.
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Affiliation(s)
- P D Marsden
- Nucleo de Medicina Tropical, Universidade de Brasilia, Brasilia - DF, 70910, Brazil
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10
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de Lima Barros MB, Schubach A, Francesconi-do-Valle AC, Gutierrez-Galhardo MC, Schubach TMP, Conceição-Silva F, de Matos Salgueiro M, Mouta-Confort E, Reis RS, de Fátima Madeira M, Cuzzi T, Quintella LP, da Silva Passos JP, Conceição MJ, de Almeida Marzochi MC. Positive Montenegro skin test among patients with sporotrichosis in Rio De Janeiro. Acta Trop 2005; 93:41-7. [PMID: 15589796 DOI: 10.1016/j.actatropica.2004.09.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2004] [Revised: 09/05/2004] [Accepted: 09/13/2004] [Indexed: 11/24/2022]
Abstract
We studied 52 patients with sporotrichosis confirmed by isolation of Sporothrix schenckii and reactivity to the Montenegro skin test (MST) during an ongoing outbreak of this mycosis in Rio de Janeiro. The objective was to emphasize the importance of parasitological confirmation and the possibility of incorrect diagnosis based on the lesion's appearance, epidemiological information, and immunological tests. The antigen used for the MST was conserved in either thimerosal 1:10,000 (group 1) or 0.4% phenol (group 2). Nineteen patients (39%) in group 1 and seven (12%) in group 2 presented an induration>or=10 mm (p<0.001). Sera from three patients (6.7%) reacted to indirect immunofluorescence (IIF) for leishmaniasis, while sera from 10 patients (22.2%) reacted to enzyme-linked immunosorbent assay (ELISA). Fifteen patients (28.8%) presented up to two lesions, with a predominance of ulcers. Forty-four patients (84.6%) were treated with itraconazole. In the differential diagnosis between sporotrichosis and cutaneous leishmaniasis, the possibility of co-infection, allergy to the reagent diluent, and cross-reactions should be further investigated, especially in regions with limited laboratory facilities.
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Affiliation(s)
- Mônica Bastos de Lima Barros
- Instituto de Pesquisa Clínica Evandro Chagas (IPEC), Fundação Oswaldo Cruz (Fiocruz), Av. Brasil 4365, Manguinhos, Rio de Janeiro CEP 21045-900, Brazil.
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Lawn SD, Whetham J, Chiodini PL, Kanagalingam J, Watson J, Behrens RH, Lockwood DNJ. New world mucosal and cutaneous leishmaniasis: an emerging health problem among British travellers. QJM 2004; 97:781-8. [PMID: 15569809 DOI: 10.1093/qjmed/hch127] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Mucosal leishmaniasis (ML) is an important complication of new world cutaneous leishmaniasis (CL) caused by species of the Leishmania Viannia subgenus. Previous reports of ML among travellers to Latin America are few. AIMS To determine the annual number of cases of CL due to L. Viannia species diagnosed at this institution and to correlate this with changing patterns of travel. Secondly, to document the clinical presentation, diagnosis, treatment and outcome of ML at this institution. DESIGN Retrospective observational study. METHODS Data were collected from a clinical database, laboratory records, patient case notes and an international passenger survey. RESULTS Between 1995 and 2003, the annual number of cases of CL (total 79) steadily increased from 4 per year to 18 per year; the estimated number of travellers from the UK to Latin America increased 3.5-fold. Six cases of ML were diagnosed among British travellers in 1995 (1), 1997 (1) and 2002 (4). These infections were acquired in Bolivia (3), Colombia (2) and Belize (1). Nasopharyngeal symptoms developed 0-15 months after returning to the UK. Four patients had concurrent CL at diagnosis. Diagnosis of ML was delayed up to 6 months from the onset of symptoms. Mucosal biopsies from all 6 patients were PCR-positive for L. (Viannia) DNA; microscopy and culture were less sensitive. ML relapsed in one patient following treatment. DISCUSSION Increasing travel to Latin America from the UK was associated with an increasing number of diagnoses of L. Viannia CL. ML is likely to emerge as a more frequently imported infection among such travellers. Familiarity with these diseases is important for prompt diagnosis and optimal management.
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Affiliation(s)
- S D Lawn
- Department of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT.
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Schubach A, Cuzzi-Maya T, Oliveira AV, Sartori A, de Oliveira-Neto MP, Mattos MS, Araújo ML, Souza WJ, Haddad F, Perez MDA, Pacheco RS, Momen H, Coutinho SG, de Almeida Marzochi MC, Marzochi KB, da Costa SC. Leishmanial antigens in the diagnosis of active lesions and ancient scars of American tegumentary leishmaniasis patients. Mem Inst Oswaldo Cruz 2001; 96:987-96. [PMID: 11685267 DOI: 10.1590/s0074-02762001000700018] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cutaneous biopsies (n = 94) obtained from 88 patients with American tegumentary leishmaniasis were studied by conventional and immunohistochemical techniques. Specimens were distributed as active lesions of cutaneous leishmaniasis (n = 53) (Group I), cicatricial lesions of cutaneous leishmaniasis (n = 35) (Group II) and suggestive scars of healed mucosal leishmaniasis patients (n = 6) (Group III). In addition, active cutaneous lesions of other etiology (n = 24) (Group C1) and cutaneous scars not related to leishmaniasis (n = 10) (Group C2) were also included in the protocol. Amastigotes in Group I biopsies were detected by routine histopathological exam (30.2%), imprint (28.2%), culture (43.4%), immunofluorescence (41.4%) and immunoperoxidase (58.5%) techniques; and by the five methods together (79.3%). In Group II, 5.7% of cultures were positive. Leishmanial antigen was also seen in the cytoplasm of macrophages and giant cells (cellular pattern), vessel walls (vascular pattern) and dermal nerves (neural pattern). Positive reaction was detected in 49 (92.5%), 20 (57%) and 4 (67%) biopsies of Groups I, II and III, respectively. Antigen persistency in cicatricial tissue may be related to immunoprotection or, on the contrary, to the development of late lesions. We suggest that the cellular, vascular and neural patterns could be applied in the immunodiagnosis of active and cicatricial lesions in which leishmaniasis is suspected.
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Affiliation(s)
- A Schubach
- Centro de Pesquisa Hospital Evandro Chagas-Fiocruz, 21045-900 Rio de Janeiro, RJ, Brasil.
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13
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de Oliveira-Neto MP, Mattos MS, Perez MA, Da-Cruz AM, Fernandes O, Moreira J, Gonçalves-Costa SC, Brahin LR, Menezes CR, Pirmez C. American tegumentary leishmaniasis (ATL) in Rio de Janeiro State, Brazil: main clinical and epidemiologic characteristics. Int J Dermatol 2000; 39:506-14. [PMID: 10940114 DOI: 10.1046/j.1365-4362.2000.00969.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Rio de Janeiro State in Brazil is an endemic area of American tegumentary leishmaniasis (ATL) induced by Leishmania (Viannia) braziliensis. Objective Our purpose was to describe the main clinical and epidemiologic characteristics of the disease in Rio de Janeiro State. METHODS Patients from endemic areas of Rio de Janeiro State attending the Evandro Chagas Hospital were included in the study. A general physical, dermatologic, and otorhinolaryngologic examination was performed in all patients, as well as a Leishmanin skin test. Skin biopsy specimens were obtained and utilized for touch preparations (stained with Leishman dye), culture in special media (Nicolle, Nevy and McNeal; NNN), and histopathologic examination after hematoxylin and eosin stain. Positive cultures were identified with regard to species by the isoenzyme technique. Therapy with pentavalent antimonial compounds was employed in all cases. Eco-epidemiologic characteristics were studied through regular field visits to endemic foci. RESULTS Cutaneous disease was present in 87.2% of patients, and mucosal disease in only 12.7%. A single ulcerative cutaneous lesion was the most common clinical presentation. Demonstration of the parasite was always difficult and culture in special media gave the best results for diagnosis. The species involved in transmission was Leishmania (Viannia) braziliensis. Vectors included phlebotomine sand flies (Diptera: Psychodidae) of the genus Lutzomyia, and the most common species was Lutzomyia intermedia, captured mainly on the external walls of houses. CONCLUSIONS ATL in Rio de Janeiro is mostly a cutaneous disease. In general, the cases showed great sensitivity to antimony. A pattern of peridomestic transmission seems to be the rule.
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Affiliation(s)
- M P de Oliveira-Neto
- Hospital Evandro Chagas, Departamento de Protozoologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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14
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Correia D, Macedo V, Marsden PD. [Measurement of the volume of the skin ulcer in cutaneous leishmaniasis]. Rev Soc Bras Med Trop 1996; 29:593-8. [PMID: 9011886 DOI: 10.1590/s0037-86821996000600011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Skin ulcers by Leishmania (Viannia) braziliensis are often deep and irregular and are difficult to measure by just the skin surface transverse and longitudinal diameters. The proposal is to mould the cavity, after local asepsis with fresh water plus soap, with a gelatinous plastic which contains silence, potassium alginate, calcium sulphate, magnesium oxide commercialized under the name of jeltrate (Dentsply Laboratory), by solving 9.5g of jeltrate in 20ml of fresh water and applying the gel on the ulcer which solidifies in 5 minutes. This mould is then filled with a self polymerising acrylic and its volume measured either by weight (by using an analytical balance)-technique 1-or by water displacement by applying Archimeds'principle-technique 2. We show data in a field trial before and after 20 days treatment in 20 patients using three different schedules as follows: 7 received pentamidine isethionate, 7 patients received aminosidine sulphate and 6 received meglumine antimoniate. The results point out that there was a uniform reduction of ulcer volume occurred during this period in the three groups, in both technique. Regarding the therapeutic schedules we are sure that there was a significant statistical difference between the three schedules using the T Student Test, which showed that aminostdine sulphate produced a better volume reduction of the ulcer than the other drugs. Serial moulds reflect clinical billing and are a permanent record. We conclude that the measure of the volume of the skin ulceration can be useful in the therapeutic evaluation, as a practical and cheap procedure, and may be used in field trials.
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Affiliation(s)
- D Correia
- Faculdade de Medicina do Triângulo Mineiro, Uberaba, MG
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Weigle K, Saravia NG. Natural history, clinical evolution, and the host-parasite interaction in New World cutaneous Leishmaniasis. Clin Dermatol 1996; 14:433-50. [PMID: 8889321 DOI: 10.1016/0738-081x(96)00036-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- K Weigle
- Fundacion Centro Internacional de Entrenamiento e Investigaciones Medicas (CIDEIM), Cali, Colombia
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16
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Amato VS, de Paula JG, Imamura R, Amato Neto V, Duarte MI, Boulos MI, Boulos M, Nicodemo AC, de Mendonca JS. [Treatment of american cutaneous leishmaniasis, with lesions in the mucosa, using pentamidine isethionate]. Rev Soc Bras Med Trop 1996; 29:477-81. [PMID: 8966312 DOI: 10.1590/s0037-86821996000500011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Ten patients with mucosal lesions caused by American tegumental leishmaniasis were treated with pentamidine isethionate at the dose 4 mg/kg on alternate days by the intravenous route. The mean posology was 2,140 mg. Healing of the lesions occurred in 9 (90%) of the patients who completed treatment. There was no recurrence during a follow-up time of 1 to 24 months (mean, 7,7 months). One patient discontinued treatment before healing of the lesion because be developed diabetes mellitus. In 3 (30%) patients, blood exams showed increased urea and creatinine levels and leucopenia, which were corrected by increasing the interval between administrations of the drug. Pentamidine isethionate is efficient in bringing about cicatrization of the lesions but needs further evaluation in terms of its value in preventing recurrence.
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Affiliation(s)
- V S Amato
- Laboratório de Investigação Médica/Patologia das Moléstias Infecciosas, Hospital das Clínicas e Departamentos de Doenças Infecciosas e Parasitárias, Otorrino-Laringologia da Faculdade de Medicina da Universidade de São Paulo
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Coimbra Júnior CE, Santos RV, do Valle AC. Cutaneous leishmaniasis in Tupí-Mondé Amerindians from the Brazilian Amazonia. Acta Trop 1996; 61:201-11. [PMID: 8790771 DOI: 10.1016/0001-706x(95)00145-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This paper reports the results of a cross-sectional survey aimed at characterizing the epidemiology of American cutaneous leihsmaniasis (ACL) in 3 Tupí-Mondé-speaking Amerindian groups from the Brazilian Amazon region. Data include results of Montenegro skin tests (n = 550), serology (n = 233), and physical examinations (n = 676). Rates of skin test positivity were higher for males and differed between the groups (Gavião 43.0%, Suruí 52.8%, Zoró 68.1%), with a trend toward increase with age. Strong associations were also detected for the presence of suggestive ACL scars, on the one hand, and age, sex, and tribal affiliation, on the other. Although 14.7% of the subjects showed typical scars of past ACL disease, only 3 cases of active primary leishmanial ulcers were observed. The results did not indicate any clear association between seropositivity and positivity to the Montenegro intradermal test or presence of scars. The authors discuss the epidemiology of ACL in the Tupí-Mondé in the light of their ecology and recent history.
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Affiliation(s)
- C E Coimbra Júnior
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Oliveira Neto MP, Schubach A, Araujo ML, Pirmez C. High and low doses of antimony (Sbv) in American cutaneous leishmaniasis. A five years follow-up study of 15 patients. Mem Inst Oswaldo Cruz 1996; 91:207-9. [PMID: 8736092 DOI: 10.1590/s0074-02761996000200016] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Seventeen patients proceeding from the municipality of Rio de Janeiro, Brazil presenting with the cutaneous ulcerative form of American leishmaniasis were treated with one ampoule of pentavalent antimony daily for 30 days. With this regimen the individuals doses varies greatly: from 3.8 mg/kg of body weight to 22.3 mg/kg. After five years, patients receiving either a smaller dose or a bigger one, showed the same therapeutic result: cutaneous scars and no mucosal lesions.
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19
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Marsden PD, Badaró R, Netto EM, Casler JD. Spontaneous clinical resolution without specific treatment in mucosal leishmaniasis. Trans R Soc Trop Med Hyg 1991; 85:221. [PMID: 1887476 DOI: 10.1016/0035-9203(91)90030-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- P D Marsden
- Nucleo de Medicina Tropical, University of Brasília, Brazil
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20
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Costa JM, Marsden PD. Low dose glucantime therapy in Leishmania viannia braziliensis (Lvb) infections. Rev Soc Bras Med Trop 1988; 21:85-6. [PMID: 3249826 DOI: 10.1590/s0037-86821988000200013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Costa JM, Netto EM, Vale KC, Osaki NK, Tada MS, Marsden PD. Spontaneous healing of cutaneous Leishmania braziliensis braziliensis ulcers. Trans R Soc Trop Med Hyg 1987; 81:606. [PMID: 3445344 DOI: 10.1016/0035-9203(87)90424-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Affiliation(s)
- J M Costa
- Núcleo de Medicina Tropical e Nutriçao, Universidade de Brasília, Brazil
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22
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Costa JM, Barrios LA, Netto EM, Marsden PD. Topical pentostam in an attempt to produce more rapid healing of skin ulcers due to Leishmania braziliensis braziliensis. Rev Soc Bras Med Trop 1986; 19:199-200. [PMID: 2825253 DOI: 10.1590/s0037-86821986000300014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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Barrios LA, Costa JM, Netto EM, Vexenat CO, Cuba CC, Marsden PD. Intralesional glucantime in Leishmania braziliensis braziliensis infections. Trans R Soc Trop Med Hyg 1986; 80:173-4. [PMID: 3726989 DOI: 10.1016/0035-9203(86)90236-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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Costa JM, Sampaio RN, Tada MS, Almeida EA, Veiga EP, Magalhães AV, Marsden PD. Furazolidone treatment of cutaneous leishmaniasis. Trans R Soc Trop Med Hyg 1985; 79:274. [PMID: 4002303 DOI: 10.1016/0035-9203(85)90358-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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