The Presence of Leishmania braziliensis DNA in the Nasal Mucosa of Cutaneous Leishmaniasis Patients and the Search for Possible Clinical and Immunological Patterns of Disease Progression: A Cross Sectional Study

L, Peralta RDC, Villegas V. N, Pinela M. E, Torres R. E. Severe Inflammatory and Disseminated Cutaneous Leishmaniasis in a Pregnant Woman: A Case Report from Portoviejo, Ecuador

BACKGROUND Leishmaniasis is a zoonosis with worldwide prevalence that causes dermal lesions and can be serious in humans. This report presents a case of cutaneous leishmaniasis (CL) that was apparently associated with a zoonotic transmission in a peri-urban area of the city of Portoviejo, Ecuador, close to mountainous and forested sites. CASE REPORT For 37 years, we have studied transmission of leishmaniasis in Ecuador, and have seen a wide variety of clinical presentations of the disease caused by different strains of the parasite Leishmania in patients, including pregnant women, without marked difference among them. CL without complications causes painless lesions of different clinical aspect. The present study reports a case of a 25-year-old woman presenting with severely inflamed, disseminated, and painful lesions of CL. The patient was not given antimonial treatment; however, local cryotherapy was given, together with topical anti-inflammatory and antibiotic ointment. All the lesions were observed to heal, and no amastigotes were found in smear stains after clinical healing. Since there was no reactivation after 1.5 years of follow-up, conventional antileishmanial treatment with meglumine antimoniate was not given to the patient. CONCLUSIONS This report shows the importance of a properly done epidemiological and clinical presumtive diagnosis, followed by parasitological confirmation, and the benefit of using an alternative treatment for vulnerable patients, such as this pregnant woman, for whom the therapy with pentavalent antimonials is not indicated. All observed lesions healed and no amastigotes were found in the smears after clinical healing.

First Report of an Asymptomatic Leishmania (Viannia) shawi Infection Using a Nasal Swab in Amazon, Brazil

The state of Pará has recorded seven Leishmania species that cause tegumentary leishmaniasis (TL). Leishmania species induce distinct immunological responses from the host and exhibit resistance to Glucantime, the first-line drug treatment for TL in Brazil.

OBJECTIVE

Identify the etiology of TL in an Amazonian city in the state of Pará.

MATERIAL AND METHODS

Eleven patients with TL were recruited and nasal swabs, lesion swabs, and skin fragments samples were collected. In the control group (n = 6), only the nasal swabs were collected. Polymerase Chain Reaction (PCR) amplification of the gene region hsp70-234 was performed using the extracted DNA from the samples, from which nine patients with TL and five in the control group were positive. Products were sequenced, mounted in CAP3 software, aligned using MAFFT v.7.221, edited in Geneious software v.8.1.7, and compared and aligned with sequences available in GenBank using the BLAST tool.

RESULTS

For patients with TL, six molecular diagnosis at the species level (L. (Viannia) braziliensis (n = 5/9), L. (Viannia) shawi (n = 1/9)) and three at the genus level (Leishmania sp. (n = 3/9)) were obtained. In the control group, four individuals were infected with Leishmania sp. (n = 4/5) and L. (V.) shawi (n = 1/5).

CONCLUSION

This is the first report of L. (V.) shawi infection in the mucosal secretion of a healthy person in Brazil. Moreover, genetic variants were identified in the haplotypes of L. (V.) braziliensis in the gene sequence hsp70-234.