Bubonic Leishmaniasis: A Common Manifestation of Leishmania (Viannia) braziliensis Infection in Ceara, Brazil

Anastacio de Q. Sousa Nucleo de Medicina Tropical, Universidade Federal do Ceara, Hospital Sao Jose, Department of Tropical Public Health, Harvard School of Public Health, Division of Infectious Disease, Brigham and Women's Hospital, Fortaleza, Ceara, Brazil

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Monica E. Parise Nucleo de Medicina Tropical, Universidade Federal do Ceara, Hospital Sao Jose, Department of Tropical Public Health, Harvard School of Public Health, Division of Infectious Disease, Brigham and Women's Hospital, Fortaleza, Ceara, Brazil

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Margarida M. L. Pompeu Nucleo de Medicina Tropical, Universidade Federal do Ceara, Hospital Sao Jose, Department of Tropical Public Health, Harvard School of Public Health, Division of Infectious Disease, Brigham and Women's Hospital, Fortaleza, Ceara, Brazil

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Joao Macedo Coehlo Filho Nucleo de Medicina Tropical, Universidade Federal do Ceara, Hospital Sao Jose, Department of Tropical Public Health, Harvard School of Public Health, Division of Infectious Disease, Brigham and Women's Hospital, Fortaleza, Ceara, Brazil

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Isabel A. B. Vasconcelos Nucleo de Medicina Tropical, Universidade Federal do Ceara, Hospital Sao Jose, Department of Tropical Public Health, Harvard School of Public Health, Division of Infectious Disease, Brigham and Women's Hospital, Fortaleza, Ceara, Brazil

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Jose Wellington O. Lima Nucleo de Medicina Tropical, Universidade Federal do Ceara, Hospital Sao Jose, Department of Tropical Public Health, Harvard School of Public Health, Division of Infectious Disease, Brigham and Women's Hospital, Fortaleza, Ceara, Brazil

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Erico G. Oliveira Nucleo de Medicina Tropical, Universidade Federal do Ceara, Hospital Sao Jose, Department of Tropical Public Health, Harvard School of Public Health, Division of Infectious Disease, Brigham and Women's Hospital, Fortaleza, Ceara, Brazil

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Antonio Wilson Vasconcelos Nucleo de Medicina Tropical, Universidade Federal do Ceara, Hospital Sao Jose, Department of Tropical Public Health, Harvard School of Public Health, Division of Infectious Disease, Brigham and Women's Hospital, Fortaleza, Ceara, Brazil

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John R. David Nucleo de Medicina Tropical, Universidade Federal do Ceara, Hospital Sao Jose, Department of Tropical Public Health, Harvard School of Public Health, Division of Infectious Disease, Brigham and Women's Hospital, Fortaleza, Ceara, Brazil

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James H. Maguire Nucleo de Medicina Tropical, Universidade Federal do Ceara, Hospital Sao Jose, Department of Tropical Public Health, Harvard School of Public Health, Division of Infectious Disease, Brigham and Women's Hospital, Fortaleza, Ceara, Brazil

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DOI:
https://doi.org/10.4269/ajtmh.1995.53.380
Volume/Issue:
Volume 53: Issue 4
Page(s):
380–385
Restricted access
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Enlarged regional lymph nodes have been reported to accompany the cutaneous lesions of Leishmania (Viannia) braziliensis (= L. braziliensis). A survey in Ceara State, Brazil indicated that 77% of persons (456 of 595) with parasitologically confirmed cutaneous leishmaniasis reported lymphadenopathy in addition to skin lesions. A group of 169 persons with recently diagnosed leishmaniasis and lymph nodes measuring ≥ 2 cm in diameter (mean = 3.6 cm, maximum = 10.5 cm) underwent detailed clinical examination. Lymphadenopathy preceded the skin lesions in more than two-thirds of these, on the average by two weeks. Cultures of lymph node aspirates yielded Leishmania more frequently (86%) than cultures of aspirates of skin (53%) or biopsies of skin (74%). Parasites were isolated from the peripheral blood of one patient. Persons with lymphadenopathy gave a history of fever and had enlarged livers or spleens more often than a comparison group of 50 persons with cutaneous lesions but no lymphadenopathy. Persons with lymphadenopathy had more intense leishmanin skin reactions and lymphocyte proliferation following stimulation with specific antigens, whereas persons without lymphadenopathy had a higher frequency of previous infection. Isolates of parasites from both groups were identified as L. braziliensis. These data demonstrate the early spread of L. braziliensis beyond the skin and suggest differences in host immunity between persons with and without lymphadenopathy. Leishmaniasis braziliensis should be considered in cases of unexplained lymphadenopathy in endemic areas.

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Copyright:
Copyright © 1995 by The American Society of Tropical Medicine and Hygiene 1995
Published Online:
Oct 1995
Cover The American Journal of Tropical Medicine and Hygiene
The American Journal of Tropical Medicine and Hygiene
Print ISSN:
0002-9637
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