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

Aldina BarralHospital Prof. Edgard Santos, Universidade Federal da Bahia, Instituto Oswaldo Cruz, Yale University School of Medicine, Cornell University Medical College, Salvador, Brazil

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Diana Pedral-SampaioHospital Prof. Edgard Santos, Universidade Federal da Bahia, Instituto Oswaldo Cruz, Yale University School of Medicine, Cornell University Medical College, Salvador, Brazil

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Gabriel Grimaldi Jr.Hospital Prof. Edgard Santos, Universidade Federal da Bahia, Instituto Oswaldo Cruz, Yale University School of Medicine, Cornell University Medical College, Salvador, Brazil

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Hooman MomenHospital Prof. Edgard Santos, Universidade Federal da Bahia, Instituto Oswaldo Cruz, Yale University School of Medicine, Cornell University Medical College, Salvador, Brazil

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Diane McMahon-PrattHospital Prof. Edgard Santos, Universidade Federal da Bahia, Instituto Oswaldo Cruz, Yale University School of Medicine, Cornell University Medical College, Salvador, Brazil

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Amelia Ribeiro de JesusHospital Prof. Edgard Santos, Universidade Federal da Bahia, Instituto Oswaldo Cruz, Yale University School of Medicine, Cornell University Medical College, Salvador, Brazil

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Roque AlmeidaHospital Prof. Edgard Santos, Universidade Federal da Bahia, Instituto Oswaldo Cruz, Yale University School of Medicine, Cornell University Medical College, Salvador, Brazil

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Roberto BadaroHospital Prof. Edgard Santos, Universidade Federal da Bahia, Instituto Oswaldo Cruz, Yale University School of Medicine, Cornell University Medical College, Salvador, Brazil

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Manoel Barral-NettoHospital Prof. Edgard Santos, Universidade Federal da Bahia, Instituto Oswaldo Cruz, Yale University School of Medicine, Cornell University Medical College, Salvador, Brazil

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Edgar M. CarvalhoHospital Prof. Edgard Santos, Universidade Federal da Bahia, Instituto Oswaldo Cruz, Yale University School of Medicine, Cornell University Medical College, Salvador, Brazil

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Warren D. Johnson Jr.Hospital Prof. Edgard Santos, Universidade Federal da Bahia, Instituto Oswaldo Cruz, Yale University School of Medicine, Cornell University Medical College, Salvador, Brazil

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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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