Keywords
intralesional treatment
Amazon
How to Cite
Abstract
American Tegumentary Leishmaniasis (ATL) is an infectious disease transmitted to humans by the bite of infected phlebotomine sand flies, commonly known as "sand flies." In Brazil, ATL is a significant public health challenge, with a higher prevalence in the northern region, a predominance of males aged 20 to 40 years, and a higher incidence among the mixed-race population. Methodology: The study was conducted under the Education through Work for Health Program (PET-Saúde) in Santarém, Pará, between August and December 2022. Results: The predominant profile of ATL patients was adult male rural workers with cutaneous lesions mainly on the lower limbs. The most common clinical form was localized cutaneous lesion, representing over 90% of cases. Intralesional treatment with meglumine antimoniate was well-tolerated by patients, with few local side effects and a successful therapeutic response in most cases. Discussion: The results corroborated with the literature, showing the endemic profile of ATL in the Amazon region. Intralesional treatment proved to be effective and well-tolerated, being a relevant option for areas with limited resources and difficulties in accessing healthcare. Conclusion: The study provides evidence that intralesional treatment with meglumine antimoniate is an effective therapeutic option. Its high adherence suggests its consideration in public health policies for disease treatment. It is recommended that future studies expand the sample size and follow-up period to obtain more comprehensive information about this therapeutic approach.
References
ALMAZÁN, M. C. et al. Parasitological and molecular search for Leishmania natural infection in phlebotomine sand flies in peri-urban and rural sites of an Argentinean area endemic for tegumentary leishmaniasis. Acta Tropica, 2021, v. 222, 106064.
ALMEIDA, J. V. et al. Diagnosis and identification of Leishmania species in patients with cutaneous leishmaniasis in the state of Roraima, Brazil's Amazon Region. Parasites & Vectors, 2021, v. 14, n. 1, p. 32. doi: 10.1186/s13071-020-04539-8.
ARONSON, N. E.; BILLICK, K. Intralesional Antimonial Drug Treatment for Leishmania braziliensis Cutaneous Leishmaniasis: The Knowns and the Unknowns. Clinical Infectious Diseases, 2023. https://doi.org/10.1093/cid/ciad248.
BEZEMER, J. M. et al. Leishmania species and clinical characteristics of Pacific and Amazon cutaneous leishmaniasis in Ecuador and determinants of health-seeking delay: a cross-sectional study. BMC Infectious Diseases, 2023, v. 23, n. 1, p. 395. doi: 10.1186/s12879-023-08377-8.
BRAHIM, L. R. et al. Low dose systemic or intralesional meglumine antimoniate treatment for American tegumentary leishmaniasis results in low lethality, low incidence of relapse, and low late mucosal involvement in a referral centre in Rio de Janeiro, Brazil (2001-2013). Memórias do Instituto Oswaldo Cruz, 2017, v. 112, n. 12, p. 838-843. doi: 10.1590/0074-02760160478.
CARVALHO, S. H. et al. American tegumentary leishmaniasis in Brazil: a critical review of the current therapeutic approach with systemic meglumine antimoniate and short-term possibilities for an alternative treatment. Tropical Medicine & International Health, 2019, v. 24, n. 4, p. 380-391. doi: 10.1111/tmi.13210.
CLOOTS, K. et al. Male predominance in reported Visceral Leishmaniasis cases: Nature or nurture? A comparison of population-based with health facility-reported data. PLoS Neglected Tropical Diseases, 2020, v. 14, n. 1, e0007995. doi: 10.1371/journal.pntd.0007995.
DAOUI, O. et al. Environmental, Climatic, and Parasite Molecular Factors Impacting the Incidence of Cutaneous Leishmaniasis Due to Leishmania tropica in Three Moroccan Foci. Microorganisms, 2022, v. 10, n. 9, p. 1712. doi: 10.3390/microorganisms10091712.
DODO, F. D. B. et al. Diagnosis and treatment of American tegumentary leishmaniasis in a patient from rural Ceará: case report. Revista de Medicina (São Paulo), 2023, v. 102, n. 2, e-199177.
FERREIRA TERCEIRO, B. R. et al. Good response to pentamidine isethionate in a case of Mucosal Leishmaniasis caused by Leishmania (Viannia) braziliensis that was difficult to treat: Case Report. Revista da Sociedade Brasileira de Medicina Tropical, 2019, v. 52, e-20180236. doi: 10.1590/0037-8682-0236-2018.
HENRY, K. et al. Outbreak of Cutaneous Leishmaniasis among military personnel in French Guiana, 2020: Clinical, phylogenetic, individual and environmental aspects. PLoS Neglected Tropical Diseases, 2021, v. 15, n. 11, e0009938. doi: 10.1371/journal.pntd.0009938.
HERNÁNDEZ, A. et al. Spatial epidemiology of cutaneous leishmaniasis in Colombia: socioeconomic and demographic factors associated with a growing epidemic. Transactions of the Royal Society of Tropical Medicine and Hygiene, 2019, v. 113, n. 10, p. 592-600. doi: 10.1093/trstmh/trz043.
IQBAL, W. et al. Epidemiology and clinical features of cutaneous leishmaniasis in Khyber Pakhtunkhwa, Pakistan. Brazilian Journal of Biology, 2024, v. 84, e249124. Available from: https://doi.org/10.1590/1519-6984.249124.
KMETIUK, L. B. et al. Leishmania spp. in indigenous populations: A mini-review. Frontiers in Public Health, 2022, v. 10, 1033803. doi: 10.3389/fpubh.2022.1033803.
MACHADO, G. U.; PRATES, F. V.; MACHADO, P. R. L. Disseminated leishmaniasis: clinical, pathogenic, and therapeutic aspects. Anais Brasileiros de Dermatologia, 2019, v. 94, n. 1, p. 9-16. doi: 10.1590/abd1806-4841.20198775.
MARTINS, S. S. et al. American cutaneous leishmaniasis triggered by electrocoagulation. Revista da Sociedade Brasileira de Medicina Tropical, 2018, v. 51, n. 1, p. 108–110. Available from: https://doi.org/10.1590/0037-8682-0306-2017.
MINISTRY OF HEALTH OF BRAZIL. Manual of Surveillance of American Tegumentary Leishmaniasis. Brasília: Secretaria de Vigilância em Saúde, 2017. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/manual_vigilancia_leishmaniose_tegumentar.pdf.
PAN AMERICAN HEALTH ORGANIZATION. Guidelines for the Treatment of Leishmaniasis in the Region of the Americas. 2. ed. Washington, DC: PAHO, 2022. Available from: https://doi.org/10.37774/9789275725030.
PIMENTEL, M. I. F. et al. Intralesional treatment with meglumine antimoniate in three patients with New World cutaneous leishmaniasis and large periarticular lesions with comorbidities. Revista da Sociedade Brasileira de Medicina Tropical, 2017, v. 50, n. 2, p. 269-272. doi: 10.1590/0074-02760160478.
SCHRIEFER, A. et al. Multiclonal Leishmania braziliensis population structure and its clinical implication in a region of endemicity for American tegumentary leishmaniasis. Infection and Immunity, 2004, v. 72, n. 1, p. 508-514. doi: 10.1128/IAI.72.1.508-514.2004.
TELES, G. D. C. et al. American Tegumentary Leishmaniasis in the Brazilian Amazon from 2010 to 2014. Revista do Instituto de Medicina Tropical de São Paulo, 2019, v. 61, e22. doi: 10.1590/S1678-9946201961022.
TIRONI, F. C. et al. Plantar ulcer as an atypical manifestation of cutaneous leishmaniasis. Anais Brasileiros de Dermatologia, 2021, v. 96, n. 3, p. 352-354. doi: 10.1016/j.abd.2020.06.015.
TORRES-GUERRERO, E. et al. Leishmaniasis: a review. F1000Research, 2017, v. 6, p. 750. doi: 10.12688/f1000research.11120.1.