Abstract
BackgroundSkin ulcers in American cutaneous leishmaniasis (ACL) may heal spontaneously after months/years. However, few cases may present quick heal even during diagnosis procedure (early spontaneous healing- ESH). The main objective of this study was to compare ESH patients with cases requiring specific treatment [non-ESH (NESH)].MethodsA historical cohort study of ACL patients (n = 445) were divided into 2 groups: ESH – spontaneously healed patients (n = 13; 2.90%), and NESH- treated patients (n = 432; 97.10%). We compared clinical and laboratorial findings at diagnosis, including the lesion healing process.ResultsESH patients had a higher percentage of single lesions (p = 0.027), epithelialized lesion on initial examination (p = 0.001), lesions located in the dorsal trunk (p = 0.017), besides earlier healing (p < 0.001). NESH presents higher frequency of ulcerated lesions (p = 0.002), amastigotes identified in histopathology exams (p = 0.005), positive cultures (p = 0.001), and higher positivity in ≥3 parasitological exams (p = 0.030). All ESH cases were positive in only a single exam, especially in PCR.ConclusionsESH group apparently presented a lower parasitic load evidenced by the difficulty of parasitological confirmation and its positivity only by PCR method. The absence or deficiency of specific treatment is commonly identified as predisposing factors for recurrence and metastasis in ACL. However, due to the drugs toxicity, the treatment of cases which progress to early spontaneous healing is controversial. ESH patients were followed for up to 5 years after cure, with no evidence of recrudescence, therefore suggesting that not treating these patients is justifiable, but periodic dermatological and otorhinolaryngological examinations are advisable to detect a possible relapse.
Highlights
Skin ulcers in American cutaneous leishmaniasis (ACL) may heal spontaneously after months/years
Patients under 18 had the informed consent form signed by parents or guardians who accompanied them during all procedures
The presence of ulcers was prevalent at diagnosis (n = 394; 88.50%), but in 9 cases epithelialized lesions were observed in the initial clinical examination (2.00%)
Summary
Skin ulcers in American cutaneous leishmaniasis (ACL) may heal spontaneously after months/years. Leishmaniasis comprises a group of infectious diseases that may occur with cutaneous or visceral involvement. They are caused by protozoa of the genus Leishmania transmitted to humans by infected female sandflies. The typical cutaneous lesion is an ulcer (usually a single one) with infiltrated borders in exposed areas of the body, but clinical presentation may vary depending on the immune status of the host, the parasite load, and the involved Leishmania species [1]. Some patients have early spontaneous resolution of the disease; they are diagnosed according to clinical and laboratory criteria and, before the start of drug therapy, the lesions begin the process of clinical cure, and may not require treatment [10, 11]
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