Leishmaniasis tegumentaria americana en brotes epidérmicos familiares diagnóstico y terapèutica

Describir y evaluar cinco brotes epidemicos de leishmaniasis tegumentaria americana (LTA) en grupos familiares de los estados Miranda y Aragua y de la Republica de Colombia. Trece pacientes de grupos familiares diferentes acudieron al Instituto de Medicina Tropical por lesiones ulcerosas en regiones anatomicas expuestas; siete del sexo masculino en edades entre 2 y 66 anos. La leishmanina, los anticuerpos fluorescentes anti-leishmania y los frotis por aposicion de segmentos de piel de las ulceras revelaron la presencia del parasito leishmania spp. Se efectuaron examenes bioanaliticos y cardiovasculares recomendados para el tratamiento con antimoniatos pentavalentes. Siete pacietes fueron tratados ambulatoriamente con meglumina intramuscular a la dosis de 3000 mg/dia en series terapeuticas de 10 dias con una segunda serie luego del reposo de 10 dias. Una paciente adulta recibio tres series de AM, la ultima de ellas de 4500 mg/kg/dia 10 dias en hospitalizacion. Cinco ninos fueron hospitalizados y recibieron AM a la dosis de 70 mg/dia/10 dias con reposo intermedio y una segunda serie. Los pacientes respondieron adecuadamente a la terapia empleada con la cicatrizacion completa de los procesos ulcerosos. La LTA siguen adquiriendola pobladores y viajeros de las areas rurales de Venezuela y Colombia y frecuentemente se presenta como brotes epidemicos familiares, lo cual facilita el diagnostico presuntivo. El caso indice permite el diagnostico de la enfermedad entre otros familiares. Los casos tratados comprueban una vez mas las ventajas terapeuticas de la meglumina en LTA. Leishmaniasis is an infectious disease acquired with relative frequency in the rural areas of Venezuela and Colombia. When there is the antecedent of another member of the family with a similar symptom "at home there is somebody with a similar ulcer" is a frequent statement that facilitates the diagnosis. To describe and evaluate five epidemic autbreaks of cutaneous leishmaniasis of the New World (CLNW) in family groups of Miranda and Aragua states in Venezuela and North Santander Department in Colombia, including diagnosis and treatment with meglumine. This disease is relatively frequently acquired by inhabitants and travelers to these geographical regions. Thirteen patients of different family groups, attended to the "Instituto de Medicina Tropical" (IMT) and to the "Hospital Universitario de Caracas" (HUC) presenting an ulcerative lesion on an exposed area of skin, compatible with the clinical diagnosis of this parasitic disease. Seven patients were females with age between 2 and 66 years. Laboratory diagnostic exams included the intradermal reaction test "leishmanina" serology tests for determination of antibodies anti-leismania and apposition smear from the ulcers stained by the Giemsa method, resulted positive for the infection produced by parasites of the species Leishmania spp. Six patients adults received treatment as outpatients with two series of the pentavalent antimony meglumine at a dose of 3000 mg/day during 10 days, one patient received the dose of 4500 mg/day as a last series of treatment. Children were given a dose of meglumine of 70 mg/kg/day, in series of treatment with their respective rest period. All patients responded adequately. Once again, we can demonstrate the advantages of the treatment of CLNW with the pentavalent antimony meglumine.