ACCIDENTAL LEISHMANIA-MEXICANA INFECTION IN AN IMMUNOSUPPRESSED LABORATORY TECHNICIAN

A 30 year-old female laboratory technician under immunosuppressive tre atment because of systemic lupus erythematosus (SLE) developed cutaneo us leishmaniasis 8 months after accidental percutaneous inoculation of amastigote culture forms of Leishmania mexicana. Leishmania-specific PCR and restriction analysis patterns were identical for both the labo ratory strain and the clinical specimen. The lesion was resistant to l ocal paromomycin and oral ketoconazole, but responded to local applica tion of meglumine antimonate. No signs of dissemination or visceraliza tion occurred during the 5-month period of observation. However, a fut ure recurrence cannot be excluded since a persistent infection even af ter clinical cure has always to be considered in leishmaniasis. Patien ts under immunosuppressive therapy are possibly at risk of clinical re lapse or disseminating infection although there is no experience with regard to leishmaniasis mexicana. Serious infection may require interf eron gamma as part of the treatment which may contribute to deteriorat ion of concomitant diseases like SLE. In any case, the exposure of imm unodeficient laboratory workers to Leishmania spp. should be avoided.