title: Species diversity causing human cutaneous leishmaniasis in Rio Branco, state of Acre, Brazil.
abstract: OBJECTIVE
  Information on Leishmania species diversity in western Brazilian Amazon and the clinical picture of human cutaneous leishmaniasis it causes is scarce. We describe clinical findings, diagnostic procedures and identification of Leishmania species in patients from that region.
  
  
  METHODS
  The sample consisted of 50 patients, prospectively evaluated for epidemiological and clinical characteristics by means of a structured questionnaire. Conventional and molecular tools were applied to confirm the parasitological diagnosis and identify the species responsible for the disease.
  
  
  RESULTS
  Patients were predominantly male (76.5%) and living in rural areas. Median average age was 18 years and median average disease evolution was 8 weeks. For the diagnostic procedures of leishmanin skin test, direct visualization of amastigotes in dermal scrapings and parasite culture of aspirates of the ulcer border were positive for 98%, 52% and 34%, respectively. Molecular methods applied to DNA extracted from skin biopsies of the 50 patients yielded 100%, 82% and 44% positivity by PCR minicircle kDNA, PCR-RFLP ITS1rDNA and PCR-glucose-6-phosphate (G6P), respectively. Fourteen samples from 13 patients were successfully isolated and identified. Multilocus enzyme electrophoresis, PCR-RFLP ITS1rDNA and PCR-G6P permitted identification of the Leishmania species responsible for the aetiology of American tegumentary leishmaniasis in 60% of the examined patients: 16 Leishmania (Viannia) braziliensis, 12 Leishmania (Viannia) lainsoni, 1 Leishmania (Viannia) guyanensis and 1 putative hybrid of Leishmania (Viannia) naiffi and L. (V.) lainsoni.
  
  
  CONCLUSIONS
  The clinical and epidemiological behaviour of cutaneous leishmaniasis in Acre, Brazil, is similar to other Amazon scenarios previously described; however Acre's complex parasite diversity may be contributed to the concomitant circulation of at least three distinct Leishmania species. The implementation of control interventions in the studied area must take into consideration the possibility of various expected phlebotomine vectors and reservoirs.
authors.affiliation: Núcleo de Medicina Tropical, Universidade de Brasília, Campus Darcy Ribeiro, Brasília, DF, and Serviço de Imunologia, Hospital Universitário Professor Edgar Santos, Salvador, Brazil.
authors.forename: Anna Christina
authors.initials: AC
authors.lastname: Tojal da Silva
authors.forename: Elisa
authors.initials: E
authors.lastname: Cupolillo
authors.forename: Angela Cristina
authors.initials: AC
authors.lastname: Volpini
authors.forename: Roque
authors.initials: R
authors.lastname: Almeida
authors.forename: Gustavo Adolfo Sierra
authors.initials: GA
authors.lastname: Romero
mesh_terms: D000293:Adolescent; D000328:Adult; D000818:Animals; D001938:Brazil / Q000453:epidemiology; D002648:Child; D016054:DNA, Protozoan / Q000032:analysis; D004275:DNA, Ribosomal / Q000032:analysis; D004586:Electrophoresis / Q000379:methods; D005260:Female; D014644:Genetic Variation / Q000235:genetics; D006801:Humans; D007891:Leishmania / Q000235:genetics / Q000302:isolation & purification*; D007892:Leishmania braziliensis / Q000235:genetics / Q000302:isolation & purification; D018334:Leishmania guyanensis / Q000235:genetics / Q000302:isolation & purification; D016773:Leishmaniasis, Cutaneous / Q000453:epidemiology / Q000235:genetics / Q000469:parasitology*; D008297:Male; D016133:Polymerase Chain Reaction / Q000379:methods; D012150:Polymorphism, Restriction Fragment Length; D011446:Prospective Studies; D012423:Rural Health; D012882:Skin Tests
chemical_list: D016054:DNA, Protozoan; D004275:DNA, Ribosomal