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Previous issue date: 2015-06-10 / Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. Rio de Janeiro, RJ, Brasil / Com o objetivo de descrever os padrões epidemiológicos, clínicos, laboratoriais, terapêuticos e evolutivos (incluindo seqüelas) das formas mucosa ou cutâneo-mucosa da Leishmaniose Tegumentar Americana (LTA), foram selecionados 132 prontuários de pacientes atendidos no Ambulatório de Otorrinolaringologia do Instituto de Pesquisa Clínica Evandro Chagas (IPEC)/Fiocruz, Rio de Janeiro, no período compreendido entre 01 de janeiro de 1989 e 31 de dezembro de 2004. Todos os pacientes foram diagnosticados e acompanhados por médicos especialistas em Otorrinolaringologia equipados com fibras ópticas Hopkins com angulações de 0° e 70°. O diagnóstico foi estabelecido com base em critérios epidemiológicos, clínicos e laboratoriais, incluindo resposta à intradermorreação de Montenegro (IDRM), sorologia para LTA, histopatologia e cultura. Do total de pacientes, 68,2% eram do sexo masculino e a média de idade foi de 51 anos. À época do primeiro atendimento no IPEC, 59,1% dos pacientes residiam em área urbana e 39,6% exerciam ocupações diversas, não relacionadas epidemiologicamente à LTA. À época provável da infecção, 86% residiam na Região Sudeste, especialmente no Rio de Janeiro, e 44,8% também exerciam ocupações diversas. As cavidades nasais foram acometidas em 92,4% dos casos
O aspecto mais freqüente das lesões foi a infiltração das mucosas. A úlcera foi a lesão cutânea ativa predominante na forma cutâneo-mucosa. Dos pacientes que realizaram IDRM, 97,4% apresentaram forte reação. Os títulos da sorologia por imunofluorescência indireta declinaram progressivamente ao longo de dois anos pós-tratamento. Na histopatologia, o aspecto predominante foi o infiltrado inflamatório crônico granulomatoso, sem a presença de amastigotas. Os pacientes estudados foram tratados com antimoniato de meglumina e/ou anfotericina B em doses e esquemas variados. Destes, 19,2% necessitaram re-tratamento por diferentes motivos: recidiva, abandono de tratamento inicial e falha terapêutica. Os eventos adversos mais encontrados, com ambas as drogas, foram: artralgia, mialgia, astenia, febre e aumento de creatinina. Todos os pacientes que mantiveram o acompanhamento ambulatorial pós-tratamento obtiveram cura clínica. 55% dos pacientes não evoluíram com seqüelas. O diagnóstico e acompanhamento das lesões mucosas de LTA por médico especialista em Otorrinolaringologia permitiu a instituição de terapia adequada o mais precoce possível e, conseqüentemente, a prevenção de sequelas / We studied 132 cases of American muco
-
cutaneous leishmaniasis and mucosal
leishmaniasis, admitted to Otorrhinolaryngology Service of Evandro Chagas Research
Institute, Fiocruz, Rio de Janeiro (Brasil) from January, 1989 up to December, 2004 wi
th
the objective of tracing a profile of the epidemiological, clinical, laboratorial, therapeutic
and evolutive (including sequels) patterns of the mucosal forms of American Tegumentary
Leishmaniasis. All the patients selected to this study had their mucos
al lesions diagnosed
and clinically evaluated by physicians that were specialists in Otorrhinolaryngology. The
mucosal forms of American leishmaniasis were confirmed by epidemiological, clinical and
laboratorial findings, including the Montenegro test, ser
ological tests, histopathological
findings and cultures. Of the total of patients, 68,2% were males, and the mean age was 51
years. When they were admitted to our service, 59,1% were residents in urban areas, and
39,6% worked in different employments, not
epidemiologically related to leishmaniasis.
When these patients were probably infected, 86% lived at Southeast Region, especially at
Rio de Janeiro, and 44,6% worked in different employments too. When the mucosal
damage was evaluated, the nose was implicat
ed at 92,4% of the total of cases. The most
common morphological aspect of the mucosal lesions was the infiltrative type, irrespective
of the involved organ. When considered the muco
-
cutaneous forms, the most common
active cutaneous lesion was the ulcerati
ve type. Considering the mucosal patients that were
submitted to the Montenegro’s skin test, 97,4% were strongly positive. The indirect
immunofluorescence test showed progressive decreasing during the period of two years
after the treatment; and the most c
ommon histopathological finding was a chronic
granulomatous inflammatory process without the finding of amastigotes. The patients
selected to this study were treated with glucantime ® and/or amphoterycin, used in
differents doses and schedules (continuous
or in series); some of them were submitted to
more than one treatment. The motives of them were relapses, treatment abandonment or
therapeutic failure. The most common adverse effects due the treatments, either with
glucantime ® or with amphoterycin, were,
clinically, general adverse effects (arthralgic
pain, myalgia, asthenia and fever), and concerning laboratory findings, the increasing of
creatinine levels. At the final phase of the treatments, all the attended patients were
clinically healed. After the
treatment, more than 55% of the patients with mucosal lesions
didn’t present sequelae. The diagnose of the mucosal lesions caused by American
leishmaniasis realized by the physicians specialists in Otorrhinolaryngology allows the
earlier treatment of this
disease, and the attendance of these lesions by these professionals
prevents the appearance of sequelae
| Identifer | oai:union.ndltd.org:IBICT/oai:www.arca.fiocruz.br:icict/11917 |
| Date | January 2007 |
| Creators | Meneses, Andréa Morais de |
| Contributors | Silva, Fátima da Conceição, Pimentel, Maria Inês Fernandes, Santos, Ginelza Peres Leme dos, Schubach, Armando de Oliveira, Valete-Rosalino, Cláudia Maria |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Source | reponame:Repositório Institucional da FIOCRUZ, instname:Fundação Oswaldo Cruz, instacron:FIOCRUZ |
| Rights | info:eu-repo/semantics/openAccess |
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