title: Intestinal helminth coinfection is associated with mucosal lesions and poor response to therapy in American tegumentary leishmaniasis.
abstract: The most severe clinical form of American tegumentary leishmaniasis (ATL) due to Leishmania braziliensis is mucosal leishmaniasis (ML), characterized by destructive lesions in the facial mucosa. We performed a retrospective cohort study of 109 ATL patients from Rio de Janeiro State, Brazil, where ATL is caused by L. braziliensis, to evaluate the influence of intestinal parasite coinfections in the clinical course of ATL. Parasitological stool examination (PSE) was performed with samples from all patients by the sedimentation, Kato-Katz and Baermann-Moraes methods. The diagnosis of ATL was made from lesion biopsies by direct observation of amastigotes in Giemsa-stained imprints, isolation of Leishmania promastigotes or histopathological examination. All patients were treated with meglumine antimoniate. Patients with positive PSE had a frequency of mucosal lesions significantly higher than those with negative PSE (p<0.005). The same was observed for infections with helminths in general (p<0.05), with nematodes (p<0.05) and with Ascaris lumbricoides (p<0.05), but not for protozoan infections. Patients with intestinal parasites had poor response to therapy (therapeutic failure or relapse) significantly more frequently than the patients with negative stool examination (p<0.005). A similar difference (p<0.005) was observed between patients with positive and negative results for intestinal helminths, but not for intestinal protozoa. Patients with positive PSE took significantly longer to heal than those with negative PSE (p<0.005). A similar difference was observed for intestinal helminth infections (p<0.005), but not for protozoan infections. Our results indicate a deleterious influence of intestinal helminth infections in the clinical course of ATL and evidence for the first time an association between ML and these coinfections, particularly with nematodes and A. lumbricoides.
authors.affiliation: Secretaria Municipal de Saúde, Rua Afonso Cavalcanti, 455-Cidade Nova, 20211-110 Rio de Janeiro, Brazil.
authors.forename: Rilza Beatriz G
authors.initials: RB
authors.lastname: Azeredo-Coutinho
authors.affiliation: Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365-Manguinhos, 21040-900 Rio de Janeiro, Brazil.
authors.forename: Maria Inês
authors.initials: MI
authors.lastname: Pimentel
authors.affiliation: Serviço de Parasitologia, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365-Manguinhos, 21040-900 Rio de Janeiro, Brazil.
authors.forename: Graziela Maria
authors.initials: GM
authors.lastname: Zanini
authors.affiliation: Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365-Manguinhos, 21040-900 Rio de Janeiro, Brazil.
authors.forename: Maria F
authors.initials: MF
authors.lastname: Madeira
authors.affiliation: Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365-Manguinhos, 21040-900 Rio de Janeiro, Brazil.
authors.forename: Jamyra Iglesias
authors.initials: JI
authors.lastname: Cataldo
authors.affiliation: Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365-Manguinhos, 21040-900 Rio de Janeiro, Brazil.
authors.forename: Armando O
authors.initials: AO
authors.lastname: Schubach
authors.affiliation: Serviço de Anatomia Patológica, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365-Manguinhos, 21040-900 Rio de Janeiro, Brazil.
authors.forename: Leonardo Pereira
authors.initials: LP
authors.lastname: Quintella
authors.affiliation: Laboratório de Pesquisa Clínica e Vigilância em Leishmanioses, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av. Brasil 4365-Manguinhos, 21040-900 Rio de Janeiro, Brazil.
authors.forename: Cintia Xavier
authors.initials: CX
authors.lastname: de Mello
authors.affiliation: Laboratório de Imunoparasitologia, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Av. Brasil 4365-Manguinhos, 21040-360 Rio de Janeiro, Brazil. Electronic address: mendonca@ioc.fiocruz.br.
authors.forename: Sergio C F
authors.initials: SC
authors.lastname: Mendonça
mesh_terms: D000328:Adult; D000818:Animals; D015331:Cohort Studies; D060085:Coinfection / Q000188:drug therapy*; D005243:Feces / Q000469:parasitology; D005260:Female; D006801:Humans; D007411:Intestinal Diseases, Parasitic / Q000188:drug therapy*; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy*; D007897:Leishmaniasis, Mucocutaneous; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Ascaris lumbricoides; Coinfection; Helminths; Leishmania (Viannia) braziliensis; Mucocutaneous leishmaniasis; Nematodes