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Am. J. Trop. Med. Hyg., 44(5), 1991, pp. 536-546
Copyright © 1991 by The American Society of Tropical Medicine and Hygiene

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Leishmaniasis in Bahia, Brazil: Evidence that Leishmania amazonensis Produces a Wide Spectrum of Clinical Disease

Aldina Barral, Diana Pedral-Sampaio, Gabriel Grimaldi, Jr., Hooman Momen, Diane McMahon-Pratt, Amelia Ribeiro de Jesus, Roque Almeida, Roberto Badaro, Manoel Barral-Netto, Edgar M. Carvalho AND Warren D. Johnson, Jr.
Hospital Prof. Edgard Santos, Universidade Federal da Bahia, Salvador, Brazil; Instituto Oswaldo Cruz, Rio de Janeiro, Brazil; Yale University School of Medicine, New Haven, Connecticut; Cornell University Medical College, New York, New York

One hundred fourteen Leishmania isolates from patients with different clinical forms of leishmaniasis in the State of Bahia, Brazil, were characterized by indirect radioimmune binding assay using specific monoclonal antibodies (serodeme analysis). Seventy-five of these isolates were also analyzed by enzyme electrophoresis, based on 11 enzyme loci; parasite species were compared, according to their characteristic zymodemes, to those of WHO Leishmania reference strains. All isolates could be classified into one of three species: Leishmania amazonensis (n = 40), L. braziliensis (n = 39) or L. chagasi (n = 35). The most interesting information obtained from this study is the realization that L. amazonensis is capable of producing a wide spectrum of disease in humans. Infection with this parasite was associated with many different clinical presentations, including cutaneous leishmaniasis [CL] (20/49 cases), mucocutaneous leishmaniasis [MCL] (5/13 cases) and, of special note, visceral leishmaniasis [VL] (11/46 cases), as well as four cases of post kala-azar dermal leishmaniasis [PKDL]. In situ tissue parasite characterization, by immunoperoxidase assay and employing anti-L. amazonensis amastigote monoclonal antibodies, confirmed the infection with this species in two cases of CL, one case of DCL, one case of MCL and one case of PKDL. Our results also demonstrate the difficulty of parasite differentiation based on clinical grounds, since at least L. amazonensis infection can be associated with all types of leishmanial diseases, and different Leishmania species may be associated with indistinguishable clinical presentations. Since leishmanial parasites may vary in their biological behavior or in their response to treatment, it is important that their identification be made by reliable methods.




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Copyright © 1991 by the American Society of Tropical Medicine and Hygiene.