[Origin of patients with mucosal leishmaniasis in an endemic area of Bahia, Brazil]

[Origin of patients carrying American tegumentary leishmaniasis in the endemic areas of Tres Braços and Corte de Piedra--State of Bahia-Brazil]

De acordo com o cadastro de 1416 pacientes portadores de leishmaniose tegumentar americana (L. T.A) referentes ao período de janeiro de 1976 a maio de 1987, os autores realizaram um levantamento da procedência dos casos dessa parasitose atendidos nas áreas endêmicas de Três Braços e Corte de Pedra no estado da Bahia. Os pacientes procediam de 24 dos 89 municípios que compõem a região cacaueira da Bahia, destacando-se os municípios de Valença, Wenceslau Guimarães e Teolândia como os de maior prevalência, somando juntos 923 casos (65,1%), com 520 destes residindo em umas poucas localidades contínuas entre si, formando uma área endêmica, com transmissão ocorrendo provavelmente no peri, intradomicílio e nas lavouras de cacau e cravo localizadas nas encostas da floresta atlântica. Nota-se que a partir de 1983, houve um aumento do número de casos em toda a região, havendo evidências da leishmaniose tegumentar americana comportasse como uma doença ocupacional em toda a região estudada.

Mucosal leishmaniasis ("espundia" Escomel, 1911)

One of the more serious clinical forms of leishmaniasis occurs in espundia when the mucosae of the upper respiratory passages are inflamed. This complication is a metastasis from a skin lesion caused by Leishmania braziliensis braziliensis (Lbb) although cases have been described associated with other leishmanial species. Epidemiological data suggest that a detectable mucosal metastasis occurs in fewer than 5% of patients infected with Lbb in our study area. The determinants of this complication are still largely obscure. The granuloma usually commences on the nasal septum. In about two-thirds of our patients the lesion remained restricted to the nose. In the rest the pharynx, palate, larynx and lips were involved, in this order. It is often difficult to isolate the parasite and for routine diagnosis the leishmanin skin reaction and serological tests are helpful. Although a serious condition, with possible mutilation and even death as subsequent complications, treatment is still mainly with pentavalent antimonials, introduced 40 years ago. These are most unsatisfactory for field use, being given parenterally and relatively toxic. In mucosal leishmaniasis, if sufficient antimony can be administered in a regular daily dose, the relapse rate is small (3 of 42 patients followed for a mean of 5 years). Also, antimony treatment of the initial skin ulcer due to Lbb followed for a mean of 4 years of 83 patients resulted in subsequent mucosal metastasis in only 2. Since espundia is relatively rare, specific treatment targeted to this specific problem is the efficient short term solution. At present there is no satisfactory alternative drug to those in current use.