title: Failure of early treatment of cutaneous leishmaniasis in preventing the development of an ulcer.
abstract: The clinical characteristics and treatment outcome were determined for 26 patients who presented with early-stage cutaneous leishmaniasis. Illness duration ranged from 8 to 20 days, and the commonest clinical presentation was the presence of a papule with small central crust on a lower extremity. Prominent regional adenopathy was found in 22 (85%) of 26 patients. The results of an intradermal skin test for Leishmania were positive for 96% of those patients, and results of serologic testing were positive for 61% of patients tested. Ten (46%) of 22 patients for whom follow-up data were available developed enlargement and ulceration of the lesion despite early antimony therapy and required additional courses of treatment. Histopathological studies of samples from the lesions of 3 patients showed vasculitis. These data show that early therapy for cutaneous leishmaniasis does not prevent the development of an ulcer in one-half of patients. This unfavorable outcome underlines the relevance of local exacerbated inflammatory and immune response in the pathogenesis of the disease.
authors.affiliation: Serviço de Imunologia, Hospital Universitário Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Bahia, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Machado
authors.forename: Cibele
authors.initials: C
authors.lastname: Araújo
authors.forename: Andréa T
authors.initials: AT
authors.lastname: Da Silva
authors.forename: Roque P
authors.initials: RP
authors.lastname: Almeida
authors.forename: Argemiro
authors.initials: A
authors.lastname: D'Oliveira Jr
authors.forename: Achiléa
authors.initials: A
authors.lastname: Bittencourt
authors.forename: Edgar M
authors.initials: EM
authors.lastname: Carvalho
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D002648:Child; D005260:Female; D006801:Humans; D007892:Leishmania braziliensis / Q000302:isolation & purification*; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy* / Q000469:parasitology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017211:Treatment Failure; D014456:Ulcer / Q000209:etiology / Q000469:parasitology / Q000517:prevention & control*