Bubonic leishmaniasis: a common manifestation of Leishmania (Viannia) braziliensis infection in Ceara, Brazil
Sousa, A.de.Q.; Parise, M.E.; Pompeu, M.M.; Coehlo Filho, J.M.; Vasconcelos, I.A.; Lima, J.W.; Oliveira, E.G.; Vasconcelos, A.W.; David, J.R.; Maguire, J.H.
American Journal of Tropical Medicine and Hygiene 53(4): 380-385
1995
ISSN/ISBN: 0002-9637 PMID: 7485690 Document Number: 450930
Enlarged regional lymph nodes have been reported to accompany the cutaneous lesions of Leishmania braziliensis. A survey in Ceara State, Brazil, between 1989 and 1992 indicated that 77% of persons (456 of 595) with parasitologically confirmed cutaneous leishmaniasis reported lymphadenopathy in addition to skin lesions. A group of 169 persons with recently diagnosed leishmaniasis and lymph nodes measuring >= 2 cm in diameter (mean = 3.6 cm, maximum = 10.5 cm) underwent detailed clinical examination. Lymphadenopathy preceded the skin lesions in more than two-thirds of these, on the average by 2 weeks. Cultures of lymph node aspirates yielded Leishmania more frequently (86%) than cultures of aspirates of skin (53%) or biopsies of skin (74%). Parasites were isolated from the peripheral blood of one patient. Persons with lymphadenopathy gave a history of fever and had enlarged livers or spleens more often than a comparison group of 50 persons with cutaneous lesions but no lymphadenopathy. Persons with lymphadenopathy had more intense leishmanin skin reactions and lymphocyte proliferation following stimulation with specific antigens, whereas persons without lymphadenopathy had a higher frequency of previous infection. Isolates of parasites from both groups were identified as L. braziliensis. These data demonstrate the early spread of L. braziliensis beyond the skin and suggest differences in host immunity between persons with and without lymphadenopathy. It is recommended that L. braziliensis should be considered in cases of unexplained lymphadenopathy in endemic areas.