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Scientific letter
Leishmaniasis: Clinical characteristics of 22 cases
Leishmaniasis: características clínicas de 22 casos
Sergio Santos Alarcón
Corresponding author
ssantosalarcon@gmail.com

Corresponding author.
, María Isabel García-Briz, Almudena Mateu-Puchades
Servicio de Dermatología, Hospital Universitario Doctor Peset, Valencia, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Leishmaniasis is a parasitosis with a complex immunomodulatory response to infection&#46; This response depends on the Leishmania species&#44; the transmission vector and the host&#46; The result is a wide clinical spectrum of polymorphic intermediate syndromic forms&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Currently&#44; atypical cases of multifocal cutaneous leishmaniasis &#40;MCL&#41; have been described in the literature&#44;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">2&#8211;4</span></a> which encompass cases of localized CL&#44; with a form of presentation that includes multiple lesions&#44; smaller than the well-known &#8220;Middle East button&#8221;&#46; Some authors have suggested that these atypical cases are associated with immunosuppression or malnutrition&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In order to analyze their characteristics&#44; we performed a case-series retrospective observational study of leishmaniasis diagnosed in our department&#46; Patients diagnosed in our service from 1st January 2008 to 31st October 2016&#44; with at least one confirmatory method &#40;histological&#44; microbiological or molecular biology&#41; were selected&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Twenty-two cases of leishmaniasis were collected&#46; Three cases were excluded&#44; as they only had a clinical diagnosis&#46; Of the 19 patients&#44; 12 &#40;63&#37;&#41; were males and 7 &#40;37&#37;&#41; were females&#46; The median age was 40 years&#44; range&#58; 1&#8211;83 years&#59; 18 cases were autochthonous and one case was imported Leishmania &#40;Equatorial Guinea&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Analyzing the initial presentation&#44; there were 9 cases of papular lesions&#44; 5 cases of nodular lesions&#44; 4 cases with ulcers and one plaque-shaped case&#46; The single-element lesion was found in 13 cases&#44; while 6 patients had multiple lesions&#46; Topographically&#44; there were 11 lesions in the region of the upper limbs&#44; 10 in the cephalic region&#44; 3 in the lower limbs and one lesion in the thorax&#44; abdomen and back&#44; respectively&#46; Thirteen of our cases were immunocompetent patients and 6 immunocompromised patients &#40;2 cases of diabetes mellitus&#44; one in combination with golimumab for psoriatic arthropathy&#44; one case of Crohn&#39;s disease treated with adalimumab&#44; one case of Takayasu arteritis treated with methotrexate&#44; one case of human immunodeficiency virus infection &#91;HIV&#93;&#44; and one case of hepatitis C virus&#41;&#46; Excluding the HIV case&#44; 60&#37; of cases involved multiple lesions&#44; compared to 40&#37; in patients classified as immunocompromised&#59; and 23&#37; of multiple lesions&#44; compared to 77&#37; in immunocompetent patients &#40;p&#58; 0&#46;26&#41;&#46; There was only one case of visceral leishmaniasis &#40;VL&#41;&#44; our HIV patient from Equatorial Guinea&#44; who was treated with intravenous liposomal amphotericin B &#40;3<span class="elsevierStyleHsp" style=""></span>mg&#47;kg for 10 days&#41;&#46; VL was clinically ruled out with abdominal ultrasound and lab tests in the remaining immunosuppressed patients&#44; and in selected cases&#44; through polymerase chain reaction &#40;PCR&#41; detection in peripheral blood&#46; The diagnosis was reached in 16 cases by histological techniques &#40;including Giemsa&#41;&#44; and in 3 cases by PCR of the lesion&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Fifteen patients were treated with intralesional meglumine antimoniate &#40;MA&#41;&#44; with an average dose of 0&#46;5&#8211;1<span class="elsevierStyleHsp" style=""></span>cm&#47;lesion&#44; and a median of 2 infiltrations&#46; A complete response rate of 80&#37; was obtained&#44; with the remaining patients pending completion of treatment&#44; with partial response&#46; Of the remaining cases&#44; 2 cases underwent local surgery&#44; achieving recovery&#46; One case was lost to follow-up&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The single papular lesion was the most frequent presentation&#44; predominantly affecting upper limbs and cephalic region&#44; findings similar to those previously described&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> MA was the treatment of choice in our series&#44; both in single and multiple forms&#46; This treatment is the most widely used in our country&#44; especially in the single forms&#46; It is also used in the multiple forms&#44; with results similar to those obtained&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">The proportion of multiple lesions in immunocompromised patients was higher than that of single lesions compared to immunocompetent patients&#44; although this tendency did not reach statistical significance&#46; These immunosuppressed patients &#40;excluding HIV&#41; were treated with MA&#44; with complete response&#46; This finding could demonstrate that&#44; despite finding patients with MCL and some degree of immunosuppression&#44; a systemic treatment would not be necessary&#44; provided VL is ruled out&#44; in order to avoid systemic drug toxicity&#46; A less aggressive therapeutic option&#44; such as the MA used&#44; could control the disease even with multiple lesions&#46; Larger studies are needed in order to test this hypothesis&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Santos Alarc&#243;n S&#44; Garc&#237;a-Briz MI&#44; Mateu-Puchades A&#46; Leishmaniasis&#58; caracter&#237;sticas cl&#237;nicas de 22 casos&#46; Med Clin &#40;Barc&#41; 2017&#59;148&#58;524&#46;</p>"
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Original language: English
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