DISSEMINATED AMERICAN CUTANEOUS LEISHMANIASIS

Background. While studying cutaneous leishmaniasis in the central part of western Venezuela, we found four cases of disseminated American cu taneous leishmaniasis, three from the Lara State and one from Portugue sa State. Methods. A clinical history was taken for each of these pati ents, followed by microscopic examination of the Giemsa-stained smears from their cutaneous lesions and by a Montenegro skin test. Serum fro m a skin lesion were grown in Novy-MacNeal-Nicolle medium (NNN). Hamst ers were inoculated with suspension of tissues taken from the patient' s lesions. Biopsies were taken for histopathologic examination. Isolat es from cultures on NNN medium and from hamsters were subcultured in S chneider's medium for parasite identification, using molecular techniq ues. Treatment with injections of N-methyl glucamine antimonate, 25 mg /kg/day was precribed for each patient for 20 consecutive days and, af ter a week of rest, a second course of injections was administered. Re sults. Patients had disseminated papular, ulcerous, nodular, and ulcer onodular lesions on the skin. Smears of the skin lesions from all of t he patients showed abundant amastigotes within histiocytes or free in the tissues. The skin test was negative in two patients. On histopatho logic examination of skin lesions, mainly numerous vacuolated histiocy tes filled with amastigotes were observed. Isolates from all the patie nts were identified as Leishmania venezuelensis. One of the patients h ealed after treatment with N-methyl glucamine antimonate. The others w ere resistant to this therapy. Conclusions. Diffuse cutaneous leishman iasis can be caused also by Leishmania venezuelensis. Patients with no dular lesions who presented a negative Montenegro skin test were more resistant to treatment with specific pentavalent antimonials.