title: American tegumentary leishmaniasis: correlations among immunological, histopathological and clinical parameters.
abstract: BACKGROUND
  American tegumentary leishmaniasis has an annual incidence of 1 to 1.5 million cases. In some cases, the patient's immune response can eliminate the parasite, and the lesion spontaneously resolves. However, when this does not occur, patients develop the disseminated form of the disease.
  
  
  OBJECTIVE
  To investigate the association between clinical, laboratory and pathological findings in cases of American tegumentary leishmaniasis.
  
  
  METHODS
  A retrospective study of the medical records of 47 patients with American cutaneous leishmaniasis. Clinical, laboratory and epidemiological data were collected, and semi-quantitative histopathological analyses were performed using the Spearman correlation coefficient (p <0.05).
  
  
  RESULTS
  Mean patient age was 40.5 years. A total of 29.7% individuals were female and 70.2% were male, and 40.4% of the patients were farmers. The ulcerative form was found in 53.2% of patients, of whom 59.6% had lesions in the limbs. The average time to diagnosis was 22.3 months. The following positive correlations were significant: age and duration of the disease, Montenegro reaction, degree of granulomatous transformation and epithelioid cell count; duration of disease, Montenegro reaction and number of lymphocytes; epithelial hyperplasia and edema, hemorrhaging, and epithelial aggression; number of plasmocytes and number of parasites. The main negative correlations found were as follows: age and serology; time and parasite load; epithelial hyperplasia and degree of granulomatous transformation.
  
  
  CONCLUSIONS
  The long duration of the disease could be explained by the fact that lesions were relatively asymptomatic, and therefore ignored by patients with low literacy levels. Individuals may have simply waited for spontaneous healing, which proved to be dependent on the activation of hypersensitivity mechanisms.
authors.affiliation: Lauro de Souza Lima Institute, São PauloSP, Brasil, Dermatologist - Residency preceptor, Lauro de Souza Lima Institute (ILSL). Private medical practitioner - São Paulo (SP), Brasil.
authors.forename: Ana Luiza Grizzo Peres
authors.initials: AL
authors.lastname: Martins
authors.affiliation: São Paulo University, Lauro de Souza Lima Institute, epidemiology department, São PauloSP, Brazil, Doctor in Dermatology at the São Paulo University (Universidade de São Paulo; USP) - Head of the epidemiology department of the Lauro de Souza Lima Institute (ILSL) - São Paulo (SP), Brazil.
authors.forename: Jaison Antonio
authors.initials: JA
authors.lastname: Barreto
authors.affiliation: São Paulo University, Bauru School of Odontology, São PauloSP, Brazil, Doctor in Science at the São Paulo University (Universidade de São Paulo; USP) - Associate Professor at the Bauru School of Odontology of the São Paulo University (FOB-USP) - São Paulo (SP), Brazil.
authors.forename: José Roberto Pereira
authors.initials: JR
authors.lastname: Lauris
authors.affiliation: São Paulo University, Clinical Hospital, School of Medical Sciences, São PauloSP, Brazil, Physician, Santos School of Medical Sciences - Dermatology Resident at the Clinical Hospital of the São Paulo University (HC-USP) - São Paulo (SP), Brazil.
authors.forename: Ana Claudia Grizzo Peres
authors.initials: AC
authors.lastname: Martins
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D001706:Biopsy; D002648:Child; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D006099:Granuloma / Q000473:pathology; D006801:Humans; D006965:Hyperplasia / Q000473:pathology; D016773:Leishmaniasis, Cutaneous / Q000276:immunology* / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012867:Skin / Q000473:pathology*; D018709:Statistics, Nonparametric; D013997:Time Factors; D055815:Young Adult