Estudio epidemiológico y clinico de la leishmaniasis mucocutanea en Yapacaní ( oriente boliviano). / De Muynck, A; Orellana, H; Ribera, B; Melgar, B; Silva de. Deteccion de amastigotas en Leishmaniasis cutanea y mucocutanea por el of tegumentary lesions caused by subspecies of the Leishmania braziliensis. Fifteen years of cutaneous and mucocutaneous leishmaniasis in Bolivia: a retrospective Estudio epidemiologico y clinico de la leishmaniasis mucocutanea en.

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Leishmaniasis is caused by an intracellular parasite transmitted to humans by the bite of a sand fly. It is endemic in Asia, Africa, the Americas, and the Mediterranean region. Clinical features depend on the species of Leishmania involved and the immune response of the host. Manifestations range from the localized cutaneous to the visceral form with potentially fatal outcomes.

Many drugs are used in its treatment, but the only effective treatment is achieved with current pentavalent antimonials. Leishmaniasis is a tropical and subtropical disease caused by an intracellular parasite transmitted to humans by the bite of a sand fly, mainly Phlebotomus and Lutzomyia Europe, Northern Africa, the Middle East, Asia, and part of South America ; exceptionally, transmission has also been reported as a laboratory accident 1.

According to the World Health Organization Mucocjtanealeishmaniasis is one of the seven most important tropical diseases and it represents a serious world health problem that presents a broad spectrum of clinical manifestations with a potentially fatal outcome 23. The clinical features include a broad range of manifestations with different degrees of severity that depend on the species of Leishmania involved and the immune response of the host 3.

Leishmaniasis is a disease with a worldwide distribution; it is found in about 89 countries 45. In the American continent, it is mainly a leisymaniasis zoonosis but umcocutanea can be acquired in semi-desert or cold regions transmitted by sand flies mainly of the genera Phlebotomus and Lutzomyia. It is found in many countries, from the southern United States to the northern provinces of Argentina seroprevalence of 0.

Between 12 and 15 million people in the world are infected, and million are at risk of acquiring the disease. In Turkey, around 2, autochthonous cases of CL are reported each year. Owing to the civil war in Syria, Turkey mucocutanwa around 3 million refugees, and they are located mainly at either camps or homes in the south or southeastern part of Turkey. An epidemiological study conducted in Turkey from to with patients positive for leishmaniasis using real-time and semi-nested polymerase chain reactions PCRs revealed that Khezzani and Bouchemal, in Algeria, reported 4, confirmed cases of CL in a period mmucocutanea 13 years: The most affected individuals were 10 to 19 years old In Iran, Holakouie-Naieni et al.

VL, also known as kala-azar, is a clinical form endemic in Bangladesh, India, and Nepal. In this respect, in Nepal, approximately 5. Moreover, from toa total of 23, cases, including deaths, were reported. In Latin America, it is estimated that around 60, new cases including all types occur each year. More commonly, it affects men, and in Mexico the main risks are seen among farmers gum tree harvesters, cocoa and banana farmers, among othersloggers, hunters, leishmaniassi timber exploiters, military personnel, biologists, ornithologists, and those who practice ecological leisumaniasis it affects the collectors of yerba mate tearubber, banana, coffee, and coca in Peru and Brazil 117 Women, the elderly, and children are also at risk of exposure in endemic zones.

In Mexico, the disease has been known since the pre-Hispanic era 18and all of the clinical forms of leishmaniasis have been reported In this country, an annual incidence of 5. leishmaniasiis

Also, in Tabasco, an incidence and prevalence rate of 2. Positive serology is observed in In an epidemiological study in Matto Grosso BrazilThies et al. Lutzomyia dasypodogeton was mucocutane most frequent species in areas of preservation, Lutzomyia antunesi was more frequent in neighborhoods with forest fragments and semi-urban areas, and Lutzomyia aragaoi was the most frequent species in completely urbanized neighborhoods; In a descriptive study conducted by Vita et al.

These researchers concluded that there mucocytanea a decrease in the number of cases based on a coefficient of detection from 1. In an epidemiological and historic study in Palestine, Al-Jawabreh et al. Statistically significant clusters of cases caused by Leishmania major were restricted to the Jericho District, and those caused by L.



In an epidemiological study in Afghanistan, Fakhar et al. On the other hand, the cases of cutaneous disseminated leishmaniasis have been described in the northeast of Mexico and in states neighboring the southern United States and in the state of Texas 7 Muco-cutaneous leishmaniasis is found in Latin America and less frequently in Africa Ethiopia and Sudan. Transmission of this disease is low in deforested areas, and the only isolated species in those habitats has been Lutzomyia deleoniwhich is not an anthropophilic species Nevertheless, sinceForattini has emphasized the leishmanaisis capability leishmaniasix vectors to adapt to suburban and urban environments 7.

Important contributors for the spread of leishmaniasis include environmental factors such as alterations in temperature and water storage, irrigation patterns, deforestation, climate changes, immunosuppression by HIV, organ transplant or immunotherapy, development of drug resistance, increased traveling to endemic regions, dog importation, wars, natural disasters, and communities with poor socioeconomic status Despite its great epidemiological importance, leishmaniasis is considered by the WHO to be a disease that has been neglected by different public and private organizations financing health improvement and research 14.

As part of the adaptation phenomenon of vectors to semi-urban and urban environments, domestic animals play a role as new opportunistic hosts 4. The populations at risk are defined by patterns of human travel related to tourism and by populations displaced by wars, economic crises, and natural disasters 4. In this regard, the case of Afghanistan is mucouctanea telling. In its capital, Kabul, there were practically no reported cases of leishmaniasis before ; however, by25, cases were documented and treated.

Newer data have indicated 67, new cases per year 48. The putative vectors of the different species and subspecies of protozoa of the Leishmania genus are dipterans of the genus Lutzomyia in the New World and Phlebotomus in the old continent belonging to the subfamily Phlebotominae.

The taxonomy of these vectors leishmaniaasis as follows:. Lutzomyia with six subgenera: Lutzomyia is present in the tropics of the New World. They display a dorsal hump and wings with a lanceolate oval shape.

Only females nourish from blood, usually from mammals but sometimes also from inferior terrestrial vertebrates. Usually they nourish at night; during the day, they hide in dark, humid places.

Leishmaniasis cutánea y mucosa

Lutzomyia absorb sugars that may have an important role in the development of Leishmania in the vector species 7. Laison and Shaw proposed a classification of leishmaniasis on the basis of their pattern of development in the bowel of the sand fly, which not only assumes evolution of the parasites but also allows their classification into groups such as suprapillary, peripillary, and hypopillary.

In the hypopillary group, infection is limited to the hindgut that is, pylorus ileum and rectum. Leishmania agamae and Leishmania ceramodactyli. The peripillary group requires mandatory development of the parasite in the hindgut but migrates to the midgut and foregut. In the suprapillary group, development does not occur in the hindgut, and the parasites are restricted to the midgut and foregut. The host reservoirs are mammals in the Old as well as in the New World species: Therefore, those parasites are grouped into two subgenera: Leishmaniawhich includes parasites that develop in the midgut and foregut, and Vianniawhich develops in the Phlebotomus foregut, midgut, and hindgut.

The subgenus Viannia Laison and Shaw, includes the following: The species of subgenus Leishmania Saf Janova, includes the following: Leishmania amazonensiswhich is responsible for the anergic diffuse cutaneous form and the cutaneous forms with disseminated lesions; Leishmania chagasiwhich causes visceral American leishmaniasis and has a wide distribution in Latin America, extending from Mexico to Argentina; L. The duration of the life cycle in the vector varies from 4 to 18 days, depending on the species of Leishmania ; it can be extended at low temperatures or shortened at high temperatures 7.

In Mexico, some rodent species have been identified as reservoirs for the parasites. For a species to be considered a reservoir, it must fulfill two criteria: In these mammals, the skin and the blood provide adequate environments for the parasite to reproduce. Laboratory studies from Ethiopia suggest that an L. Generally, more than half of reservoirs remain asymptomatic 22 Moreover, the demonstration of parasite in the blood of domestic animals using molecular tools such as PCR has suggested that domestic animals could serve as an alternate reservoir for an infection in India.


Domestic animals like pets or cattle could increase transmission pressure by virtue of being an untreated reservoir for the parasite, and their proximity to human owners may also increase the transmission ratio because of increased availability of blood meals for the sand fly as well as organic manure for breeding of larvae and resting.

Factors that affect the occurrence of disease include the agent species of Leishmaniathe host genetic susceptibility, degree of immunocompetence, poor nutrition, and other underlying diseasesand environment 4. Hypotheses that explain these variations include a differences in the virulence of the parasites, b differences in the cutaneous permeability, c individual variations of genetic susceptibility of the host, and d variations in the attraction of the Phlebotomus toward different individuals 34.

Parasite transmission from the sand fly to the host depends on how infective the host is, how infective the sand fly is with a single bite, the average rate of biting, and the number of sand flies present.

The biting rate was calculated as 0. The causal agent is an obligatory unicellular protozoan of the family Trypanosomatidaesuborder Trypanosomatinamucochtanea the genus Leishmania. Two stages in the life cycle have been defined: It remains in the gut of the diptera where, within 4 to 25 days, it shows a second stage as an amastigote non-flagellated ; this is an obligatory intracellular parasite that measures from 2.

The infected female Phlebotomus which is hematophagouswhen biting the infected animal, absorbs the amastigote forms from the blood of the reservoir. When the parasite is deposited by regurgitation in the host tegument, it is phagocytized by local macrophages and epidermal Langerhans cells without the involvement of circulating monocytic cells, so this is a local leishmanixsis only in the skin, constituting localized CL LCL.

The host machinery that mediates amastigote uptake is poorly understood; however, it is known that, in the human host, amastigotes bind Fc receptors and enter macrophages primarily through immunoglobulin-mediated phagocytosis. Once inside the phagolysosomes, promastigotes differentiate into amastigotes and proliferate extensively by binary fission, evading the immune response.

Leishmaniasis: a review

The biological cycle described is performed in 53 to days 189. Pathogen species for humans are classified according to their molecular biology, and in America the predominant complexes are L.

In the Old World, the disease is caused by L. According to the type of immune response elicited, the disease can be localized; it can have a tendency to be spontaneously healing or generalized and progressive These can be classified into three main categories: On the other hand, it has been recognized that different components in the saliva of the Elishmaniasis determine the local reaction after the bite. The immune response can vary depending on each clinical form.

In the LCL forms, humoral immunity is not triggered; in the muco-cutaneous form, specific IgG antibodies can be detected; and in the diffuse cutaneous form, high levels of IgA are occasionally detected.

In cases mucocutanda VL, abnormal patterns of resistance, which were related to class II molecules of the major histocompatibility complex, have been identified. In cases of leishmaniasis caused by L. During VL, intracellular parasites are managed via the activation of Th1-associated inflammation.

IL, and eventually programmed death 1-mediated T-cell exhaustion, diminishes pathology caused by inflammation. It is not known which cell types are responsible for initiating T cell—produced IL during VL; however, the population of IgD hi B cells was found to grow threefold during the progression of VL Nevertheless, it is clear that CD4 as well as CD8 lymphocytes are activated and required to control the disease The muco-cutaneous form is a variant of the hyperergic spectrum always produced by L.

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