Disseminated Leishmaniasis: A New and Emerging Form of Leishmaniasis Observed in Northeastern Brazil

• Published in: The Journal of infectious diseases Vol. 186; no. 12; pp. 1829 - 1834
• Main Authors: Turetz, Meredith L., Machado, Paulo R., Ko, Albert I., Alves, Fábio, Bittencourt, Achiléa, Almeida, Roque P., Mobashery, Niloufar, Johnson, Warren D., Carvalho, Edgar M.
• Format: Journal Article
• Language: English
• Published: Chicago, IL The University of Chicago Press 15-12-2002; University of Chicago Press; Oxford University Press
• Subjects: Acne; Adult; Aged; Agriculture; Animals; Biological and medical sciences; Biopsies; Brazil - epidemiology; Cutaneous leishmaniasis; Cytokines; Diseases; Epidemiology; Female; Human protozoal diseases; Humans; Infectious diseases; Interferon-gamma - biosynthesis; Leishmania braziliensis; Leishmaniasis; Leishmaniasis, Diffuse Cutaneous - diagnosis; Leishmaniasis, Diffuse Cutaneous - epidemiology; Leishmaniasis, Diffuse Cutaneous - immunology; Leishmaniasis, Mucocutaneous - diagnosis; Leishmaniasis, Mucocutaneous - epidemiology; Leishmaniasis, Mucocutaneous - immunology; Leshmaniasis; Lesions; Leukocytes, Mononuclear - metabolism; Major Article; Male; Medical sciences; Middle Aged; Mucous Membrane - pathology; Parasites; Parasitic diseases; Prevalence; Protozoal diseases; Risk Factors; Skin - pathology; Tumor Necrosis Factor-alpha - biosynthesis; Brazil; Kinetoplastida; Human; Leishmania braziliensis; Protozoa; Protozoal disease; Cytokine; Parasitosis; Leishmaniasis; Endemy; Infection; Symptomatology; Comparative study; Tumor necrosis factor α; Gamma interferon
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1086/345772

During the past decade, there has been an increase in the number of patients with disseminated leishmaniasis (DL), which is characterized by a large number of acneiform and papular skin lesions, with very few or no parasites in the skin tissue. The present report describes 42 cases of DL identified between 1992 and 1998 in an area where Leishmania braziliensis transmission is endemic; 8 of the patients were prospectively diagnosed. In a contrast to localized cutaneous leishmaniasis (LCL), acquisition of DL was associated with age >19 years (P<.05), male sex (P<.05), and agricultural occupation (P<.001). Patients with DL presented with 10–300 lesions that were a mixture of acneiform, papular, nodular, and ulcerated types. Twelve (29%) of 42 patients had mucosal involvement. Patients with DL had lower levels of interferon-γ (P<.05) and tumor necrosis factor–α (P<.05) production, compared with patients with LCL. DL is an emerging clinical distinct form of leishmaniasis associated with agricultural activities and host immunological response