ABSTRACT Introduction. The Toll-like receptor (TLR) interacting with the promastigote of Leishmania spp. determines the cellular activation pathway. Objective. To determine the transcriptional expression of TLR-3, TLR-4, TLR-9, IL-12 and TNF-α in macrophages infected with a native strain of L. braziliensis (Lbn). Materials and Methods. Identification of Lbn was performed by qPCR for kinetoplast DNA sequences. Mouse peritoneal macrophages were infected with promastigotes (MI) and nitric oxide (NO) production was measured; transcript levels for TLRs and cytokines were quantified by qRT-PCR. Results. Lbn showed 96% homology to L. braziliensis. High ON production was observed in IMs at 2 h; significant transcriptional expression especially of TLR-3 and TLR-9, which corresponded with expression for cytokines. Conclusions. Lbn strongly activated macrophages via endosomal TLRs, which can be applied in the design of agonists to treat the disease.

RESUMEN Introducción. El receptor de tipo Toll (TLR) que interactúe con el promastigote de Leishmania spp. determina la vía de activación celular. Objetivo. Identificar la expresión transcripcional de TLR-3, TLR-4, TLR-9, IL-12 y TNF-α en macrófagos infectados con una cepa nativa de L. braziliensis (Lbn). Métodos. La identificación de Lbn se hizo empleando qPCR para secuencias del DNA del cinetoplasto. Los macrófagos peritoneales de ratones fueron infectados con promastigotes y se midieron la producción de óxido nítrico (ON). Se cuantificaron los niveles transcripcionales para TLRs y citoquinas empleando qRT-PCR. Resultados. Lbn presentó 96% de homología con L. braziliensis. En los infectados con promastigotes se observó elevada producción de ON a las 2 h; significativa expresión transcripcional especialmente de TLR-3 y TLR-9 que se correspondió con la expresión para citoquinas. Conclusión. Lbn activó fuertemente a los macrófagos mediante los TLRs endosomales lo cual puede ser aplicado en el diseño de agonistas para tratar la enfermedad.

Resumo O estudo transversal atual foi realizado entre setembro de 2019 e janeiro de 2020 no Departamento de Patologia Mardan Medical Complex (MMC), Mardan, e no District Headquarter Hospital North Waziristan, Khyber Pakhtunkhwa (KP), Paquistão. Os objetivos do presente estudo foram determinar a prevalência da leishmaniose e seus fatores de risco associados em distritos selecionados da província de KP, Paquistão. Ao todo, 374 (n = 374) pacientes com leishmaniose foram incluídos no presente estudo. Amostras de pele da borda da úlcera foram coletadas. As lâminas foram coradas pelo corante Giemsa e examinadas quanto à presença de amastigotas. As prevalências de pacientes infectados por leishmania em diferentes regiões de KP foram as seguintes: região do Waziristão Norte 53,7 (n = 201), distrito Mardan 34,7% (n = 130); distrito Nowshera 6,7% (n = 25), distrito Swabi 1,1% (n = 4) e outros distritos, ou seja, Dir, Malakand, Buner e Bajawarr foram 3,7% (n = 14). A frequência de leishmaniose foi maior no sexo masculino e a maioria dos pacientes infectados estava na faixa etária < 10 anos. Entre n = 374 pacientes, 95,7% (n = 358) tinham leishmaniose cutânea enquanto 3% (n = 11) tinham infecção do tipo mucocutâneo e 1,3% (n = 5) pacientes tinham infecção cutânea e mucocutânea. Após tratamento com estibogluconato de sódio (SSG), 97% (n = 362) apresentaram sinais clínicos de recuperação completa ou parcial de suas lesões cutâneas. Conclusivamente, a maior incidência de infecção por leishmania ocorreu durante o curto período de estudo e a maioria dos casos apresentou resposta positiva ao tratamento.

Abstract Current cross-sectional study was carried out between September 2019 to January 2020 at the Department of Pathology, Mardan Medical Complex (MMC), Mardan, and District Headquarter Hospital North Waziristan, Khyber Pakhtunkhwa (KP), Pakistan. The objectives of the current study were to determine the prevalence of leishmaniasis and its associated risk factors in selected districts of KP province, Pakistan. Altogether, three hundred and seventy-four (n=374) leishmaniosis patients were included in the current study. Skin specimen from the ulcer border were collected. The slides were stained by Giemsa stain and examined for the presence of amastigote. The prevalence of leishmania infected patients in different region of KP were as follows: North Waziristan region 53.7 (n=201) District Mardan 34.7% (n=130); District Nowshera 6.7% (n=25), District Swabi 1.1% (n=4) and other Districts i.e. Dir, Malakand, Buner and Bajawarr were 3.7% (n=14). The frequency of leishmaniasis were more in male and majority of the infected patients were in the age group of <10 years. Among n=374 patients 95.7% (n= 358) had cutaneous leishmaniasis while 3% (n= 11) had mucocutaneous type of infection and 1.3% (n= 5) patients had both cutaneous and mucocutaneous infection. Upon treatment by Sodium stibogluconate (SSG) 97% (n=362) showed clinical signs of complete or partial recovery of their skin lesions. Conclusively, highest incidence of leishmania infection occurred during short study period and majority of the cases showed positive response to treatment.

BACKGROUND Eosinophils are granulocytes that rapidly increase frequency in the bloodstream during helminthic infections and allergic responses. They are found in tissue infected by Leishmania during early disease, but their role during infection is not entirely understood. OBJECTIVES We aim to compare the disease due to Leishmania amazonensis in BALB/c and Δdbl-GATA1 mice, which lack eosinophils. METHODS BALB/c and Δdbl-GATA1 mice infected with L. amazonensis were observed for several weeks. The parasite load and dissemination pattern were assessed. FINDINGS The Δdbl-GATA1 mice developed an anticipated dissemination of L. amazonensis and a worsening disease. No differences were found in the lesion development or the parasite load in the footpad among Δdbl-GATA1 mice and BALB/c eight weeks after infection. However, nine weeks after infection, massive growth of metastatic lesions appeared in several parts of the skin in Δdbl-GATA1 mice, weeks earlier than BALB/c. We observed increased parasites in the bloodstream, probably an essential dissemination route. Thirteen weeks after infection, metastatic lesions were found in all Δdbl-GATA1 mice. MAIN CONCLUSION These results suggest a protective role of eosinophils in delaying the disease caused by L. amazonensis, although several limitations of this mice strain must be considered.

ABSTRACT Drug repositioning seeks to discover new applications for a drug that has already been approved in the market, resulting in faster and lower cost solutions, generally used for diseases that receive little investment, such as cutaneous leishmaniasis. In this context, hesperidin, commercially approved as Daflon®, is a flavonoid that belongs to the chalcones group, a class that has antileishmanial potential. The present study evaluated the in vitro and in vivo antileishmanial activity of commercial hesperidin. Hesperidin (9 to 0.56 mg mL-1) was tested against promastigote and amastigote forms of four dermotropic species of Leishmania, namely L. (L.) amazonensis, L. (V.) guyanensis, L. (V.) braziliensis and L. (V.) naiffi. For the in vivo tests, hamsters were infected in the snout and the lesions were treated with intralesional hesperidin. The treatment effectiveness was assessed by measuring the total volume of the lesion on the snout and determining the parasitic load. The in vitro results showed moderate toxicity in murine macrophages, with higher efficacy in L. (L.) amazonensis when compared to the other species tested. The in vivo results showed that hesperidin was able to gradually reduce the size of lesions by L. (L.) amazonensis, although it did not induce clinical and parasitological cure. Thus, hesperidin showed potential in in vitro tests against L. (L.) amazonensis and further studies with new formulations and experimental treatment schemes should be carried out.

RESUMO O reposicionamento de medicamentos busca descobrir novas aplicações para um medicamento já aprovado no mercado, resultando em soluções mais rápidas e de menor custo, geralmente utilizadas para doenças que recebem pouco investimento, como a leishmaniose tegumentar. Nesse contexto, a hesperidina, aprovada comercialmente como Daflon®, tem despertado interesse científico por ser um flavonoide pertencente ao grupo das chalconas, classe que possui potencial antileishmania. O presente estudo avaliou a atividade antileishmania in vitro e in vivo da hesperidina comercial. A hesperidina (9 a 0,56 mg mL-1) foi testada contra as formas promastigota e amastigota de quatro espécies dermotrópicas de Leishmania, sendo elas L. (L.) amazonensis, L. (V.) guyanensis, L. (V.) braziliensis e L. (V.) naiffi. Para os testes, os hamsters foram infectados no focinho e as lesões tratadas com hesperidina intralesional, cuja eficácia foi avaliada através da aferição do volume total da lesão no focinho e a determinação da carga parasitária. Os resultados in vitro demonstraram toxicidade moderada em macrófagos murinos e melhor eficácia em Leishmania (L.) amazonensis quando comparados às demais espécies testadas. Os resultados in vivo mostraram que a hesperidina foi capaz de reduzir gradativamente o tamanho das lesões causadas por L. (L.) amazonensis, embora não tenha induzido a cura clínica e parasitológica. Assim, a hesperidina mostrou-se promissora em estudos in vitro contra Leishmania (L.) amazonensis e novos estudos com novas formulações e esquemas de tratamento experimental devem ser realizados.

ABSTRACT In the Amazon region, andiroba (Carapa guianensis) oil is among the most used products by the local population due to its medicinal properties. Previously, our group described the leishmanicidal activity of three limonoid-rich fractions from andiroba oil. This work aimed to evaluate the antioxidant activity and ultrastructural changes in Leishmania amazonensis treated with these limonoid-rich fractions from andiroba oil: 6α,11β-diacetoxygedunin; 11β-hydroxygedunin; and a fraction with both 6α,11β-diacetoxygedunin +11β-hydroxygedunin. The antioxidant activity was evaluated by the DPPH method and ultrastructural changes were evaluated by transmission electron microscopy. The fraction with both 6α,11β-diacetoxygedunin + 11β-hydroxygedunin displayed the best antioxidant activity (IC50 330.35 ± 8.60 µg mL-1; p=0.0022) compared to the 6α,11β-diacetoxygedunin fraction. The three fractions induced structural changes to mitochondria and kinetoplasts of L. amazonensis, in addition to lipid bodies, vacuolization, and vesicles in the flagellar pocket, indicating that the limonoid-rich fractions from andiroba oil can induce structural damage to Leishmania.

RESUMO Na região Amazônica, o óleo de andiroba (Carapa guianensis) é um dos produtos mais utilizados pela população local devido às suas propriedades medicinais. Anteriormente, nosso grupo descreveu a atividade leishmanicida de três frações do óleo de andiroba ricas em limonóides. Este trabalho objetivou avaliar a atividade antioxidante e alterações ultraestruturais em Leishmania amazonensis tratadas com essas frações ricas em limonóides do óleo de andiroba: 6α,11β-diacetoxigedunina; 11β-hidroxigedunina; e uma fração com ambas 6α,11β-diacetoxigedunina + 11β-hidroxigedunina. A atividade antioxidante foi avaliada pelo método DPPH, e alterações ultraestruturais foram avaliadas por microscopia eletrônica de transmissão. A fração com ambas 6α,11β-diacetoxigedunina + 11β-hidroxigedunina exibiu a melhor atividade antioxidante (IC50 = 330,35 ± 8,60 µg mL-1; p = 0.0022) comparado com a fração 6α,11β-diacetoxigedunina. As três frações induziram alterações estruturais nas mitocôndrias e cinetoplasto de L. amazonensis, além de corpúsculos lipídicos, vacuolizações e vesículas na bolsa flagelar, indicando que as frações ricas em limonóides do óleo de andiroba podem induzir dano estrutural a Leishmania.

Resumen: La leishmaniosis visceral ocasionada por Leishmania infantum se ha extendido hacia el sur de la región y el perro infectado con o sin manifestaciones clínicas constituye el principal reservorio. Los signos clínicos mayormente encontrados en perros de la ciudad de Salto, Uruguay fueron lesiones cutáneas, adelgazamiento, mucosas pálidas y linfadenomegalia. En la paraclínica se mencionan alteraciones hematológicas y bioquímicas relacionadas con la infección y en consecuencia resulta importante analizarlas en la situación epidemiológica actual de la enfermedad. El objetivo del trabajo fue describir los perfiles hematológicos, hepáticos y renales en perros naturalmente infectados con L. infantum en la ciudad de Salto, Uruguay y comparar con valores de referencia. En una subpoblación de perros con anticuerpos anti-L. infantum se determinaron valores del hemograma y de la bioquímica hepática y renal. Se detectó significativa disminución de eritrocitos, hemoglobina, hematocrito, índices hematimétricos, plaquetas, eosinófilos, albúmina e índice albúmina/globulinas, así como aumento de proteínas totales, globulinas, la mayoría de las enzimas hepáticas y de urea. Los perros con leishmaniosis visceral presentan una afección multisistémica al constatar alteraciones hematológicas, hepáticas y renales. Las modificaciones en los indicadores, principalmente del perfil proteico en plasma, en un contexto epidemiológico compatible orientan a la sospecha de infección por L. infantum.

Abstract: Visceral leishmaniasis caused by Leishmania infantum has spread to the south of the region and the infected dog with or without clinical manifestations constitutes the main reservoir. The most common clinical signs in dogs from Salto city, Uruguay were skin lesions, weight loss, pale mucous membranes and lymphadenomegaly. In the paraclinical, haematological and biochemical alterations related to the infection are mentioned and, consequently, it is important to analyze them in the current epidemiological situation of the disease. The objective of the work was to describe the haematological, hepatic and renal profiles in dogs naturally infected with L. infantum in the city of Salto, Uruguay, and to compare them with reference values. In a subpopulation of dogs with anti-L. infantum antibodies, haemogram values and liver and kidney biochemistry were determined. A significant decrease in erythrocytes, haemoglobin, haematocrit, haematometric indices, platelets, eosinophils, albumin and albumin/globulin ratio was detected as well as increased in total proteins, globulins, most liver enzymes and urea. Dogs with visceral leishmaniasis present a multisystem condition when verifying haematoloical, hepatic and renal alterations. Changes in the indicators, mainly the plasma protein profile, in a compatible epidemiological context, lead to the suspicion of L. infantum infection.

Resumo: A leishmaniose visceral causada por Leishmania infantum se espalhou para o sul da região e o cão infectado com ou sem manifestações clínicas é o principal reservatório. Os sinais clínicos mais comuns encontrados em cães da cidade de Salto, Uruguai foram lesões cutâneas, perda de peso, mucosas pálidas e linfadenomegalia. Na paraclínica, são mencionadas alterações hematológicas e bioquímicas relacionadas à infecção e, consequentemente, é importante analisá-las na atual situação epidemiológica da doença. O objetivo do trabalho foi descrever os perfis hematológico, hepático e renal em cães naturalmente infectados com L. infantum na cidade de Salto, Uruguai, e compará-los com valores de referência. Em uma subpopulacão de cães com anticorpos anti-L. infantum, foram determinados valores de hemograma e bioquímica hepática e renal. Foi detectada diminuicão significativa de eritrócitos, hemoglobina, hematócrito, índices hematométricos, plaquetas, eosinófilos, albumina e relação albumina/globulina, além de aumento das proteínas totais, globulinas, maioria das enzimas hepáticas e uréia. Cães com leishmaniose visceral apresentam um cuadro multissistêmico ao verificar alterações hematológicas, hepáticas e renais. Alterações dos indicadores, principalmente do perfil protéico plasmático, em contexto epidemiológico compatível levam à suspeita de infecção por L. infantum.

ABSTRACT Cutaneous leishmaniasis, caused by protozoa of the genus Leishmania, presents diverse clinical manifestations, and current therapeutic options have limitations, including long treatment periods, potential hospitalization, and excessive pain during treatment. Methyl gallate, a phenolic compound found in plants such as Libidibia ferrea, presents promising antileishmanial activity. Combining this compound with existing leishmaniasis medications could lead to reduced dosages and the minimization of side effects. This study aimed to assess the efficacy of a microemulsion containing methyl gallate, either on its own or in combination with Glucantime®, for the experimental treatment of cutaneous leishmaniasis in a 30-day in vivo assay using golden hamsters infected with Leishmania (Leishmania) amazonensis. The control groups included an untreated positive control and an uninfected, untreated negative control. After treatment, we evaluated clinical, parasitological, and biochemical parameters. While none of the treatments achieved clinical or parasitological cure, notable improvements were observed in the combined group, with significant reductions in snout skin lesions and parasite load when compared to the control. Biochemical parameters such as creatinine, CK-MB, GOT, and GPT remained unchanged, but urea and CPK levels significantly increased in all the experimental groups relative to the control. In conclusion, the integration of a topical methyl gallate microemulsion with intralesional Glucantime® showed potential as an effective treatment for cutaneous leishmaniasis. Further investigations into optimal dosages and therapeutic schemes are warranted in order to enhance treatment outcomes.

RESUMO A leishmaniose cutânea, causada por protozoários do gênero Leishmania, apresenta diversas manifestações clínicas e as opções terapêuticas atuais têm limitações, incluindo longos períodos de tratamento, possível hospitalização e dor excessiva durante o tratamento. O galato de metila, um composto fenólico encontrado em plantas como Libidibia ferrea, mostra atividade antileishmania promissora. A combinação deste composto com os medicamentos existentes para leishmaniose pode levar a dosagens reduzidas e à minimização dos efeitos colaterais. Este estudo teve como objetivo avaliar a eficácia de uma microemulsão contendo galato de metila, isoladamente ou em combinação com Glucantime®, no tratamento experimental da leishmaniose cutânea em um ensaio in vivo de 30 dias em hamsters sírios infectados com Leishmania (Leishmania) amazonensis. Os grupos de controle incluíram um controle positivo não tratado e um controle negativo não infectado e não tratado. Após o tratamento, avaliamos parâmetros clínicos, parasitológicos e bioquímicos. Embora nenhum dos tratamentos tenha alcançado cura clínica ou parasitológica, melhorias notáveis foram observadas no grupo combinado, com redução significativa nas lesões cutâneas do focinho e na carga parasitária em comparação com o controle. Parâmetros bioquímicos como creatinina, CK-MB, TGO e TGP permaneceram inalterados, os níveis de ureia e CPK aumentaram significativamente em todos os grupos experimentais em relação ao controle. Em conclusão, a integração da microemulsão tópica de galato de metila com Glucantime® intralesional mostrou potencial como um tratamento eficaz para a leishmaniose cutânea. Mais investigações sobre dosagens ideais e esquemas terapêuticos são necessárias para melhorar os resultados do tratamento.

This work describes a green synthesis, the characterization, and biological evaluation of silver nanoparticles (AgNPs). The AgNPs suspension was synthesized using aqueous leaf extract of Eucalyptus grandis, which presented a characteristic band at 407 nm in the UV-Vis spectrum. The AgNPs presented a spherical shape and size of 9.7 ± 0.3 nm. The nanoparticles were stable over a month, indicating that E. grandis’ extract is suitable for their preparation and stabilization. The X-ray analysis showed that the crystallinity of AgNPs corresponded to the centered face phase of silver. The antibacterial and leishmanicidal activities of AgNPs were evaluated. The AgNPs presented antibacterial activity on the Gram-negative bacteria Escherichia coli at 53.9 µg mL-1. The leishmanicidal activity evaluation against promastigote forms of Leishmania infantum, Leishmania amazonensis, and Leishmania braziliensis showed that the biological response is dependent on the volume of AgNP suspension. It was demonstrated that L. infantum was more sensitive to the nanoparticle’s treatment than L. amazonensis and L. braziliensis. The treatment of L infantum promastigotes with 150 µL of AgNP suspension reduced parasite growth by 67.9%, a result which was similar to the treatment with 1 (66.7%) or 2 µL (70.6%) of amphotericin B used as a positive control.

ABSTRACT Microalgae have proven to have multiple applications in the biotechnology industry. Porphyridium cruentum is a microalgae that exhibits a wide content of polysaccharides and proteins with potential pharmacological activity. This work evaluates the antimicrobial activity of the P. cruentum biomass against the parasites Leishmania infantum, Trypanosoma rhodesiense, Trypanosoma cruzi, and Trypanosoma brucei through the microdilution method in plates, as well as the cytotoxicity in leukocyte cell lines, using as a drug reference Tamoxifen. The biomass showed inhibitory activity against the parasites T. brucei, T. rhodesiensis, and T. cruzi. The study also demonstrated that the biomass does not exert cytotoxic activity on THP-1 human monocytes and RAW 264.7 murine macrophages. The results obtained indicate that the active compounds present in Porphyridium cruentum could be considered as possible antimicrobial candidates.

RESUMEN Actualmente, existe una creciente preocupación por el aumento de la resistencia microbiana de numerosos agentes patógenos. Las microalgas han demostrado tener múltiples aplicaciones en la industria biotecnológica. Porphyridium cruentum es una microalga que exhibe un amplio contenido de polisacáridos y proteínas con potencial actividad farmacológica. Este trabajo evalúa la actividad antimicrobiana de la biomasa P. cruentum frente a los parásitos Leishmania infantum, Trypanosoma rhodesiense, Trypanosoma cruzi, y Trypanosoma brucei a través del método de microdilución en placas, así como la citotoxicidad en líneas celulares de leucocitos, utilizando como fármaco de referencia el Tamoxifeno. La biomasa mostró actividad inhibitoria frente a los parásitos T. brucei, T. rhodesiensis, y T. cruzi. El estudio demostró, además, que la biomasa no ejerce actividad citotóxica sobre monocitos humanos THP-1 y macrófagos murinos RAW 264.7. Los resultados obtenidos apuntan que los compuestos activos presentes en Porphyridium cruentum podrían ser considerados como posibles candidatos antimicrobianos.

RESUMEN Se presenta un caso de leishmaniasis selvática cutánea diseminada con manifestación extensa en una paciente pediátrica con síndrome de Down. El caso se confirmó a través de estudios parasitológicos e inmunológicos, mientras que la identificación se realizó mediante la técnica de reacción en cadena de la polimerasa-polimorfismos de longitud de fragmentos de restricción (PCR-RFLP, por sus siglas en inglés), determinándose la especie como Leishmania (Viannia) braziliensis. La manifestación clínica agresiva y prolongada con poca respuesta a estibogluconato y anfotericina desoxicolato pueden deberse al déficit inmunológico que se presenta como parte del síndrome de Down. La paciente eventualmente recibió tratamiento con anfotericina B liposomal y al término de la terapia, mostró mejoría clínica de las lesiones. El presente reporte ilustra los desafíos tanto de diagnóstico como tratamiento de leishmaniasis cutánea en pacientes pediátricos inmunosuprimidos, especialmente en un entorno de difícil acceso social, económico y geográfico, a los servicios de salud. Se recomienda considerar a la leishmaniasis en el diagnóstico diferencial cuando se atienda ulceras crónicas dermatológicas atípicas; así como tener en cuenta el uso de anfotericina liposomal en pacientes inmunocomprometidos.

ABSTRACT We present a case of disseminated cutaneous leishmaniasis with extensive manifestation in a pediatric patient with Down syndrome. The case was confirmed by parasitological and immunological tests. The species was identified as Leishmania (Viannia) braziliensis by polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP). The immune deficit that occurs as part of Down syndrome may have been the reason for the aggressive and prolonged clinical manifestations as well as the poor response to stibogluconate and deoxycholate amphotericin. The patient was treated with liposomal amphotericin B and at the end of therapy, showed clinical improvement of the lesions. This report highlights the challenges of the diagnosis and treatment of cutaneous leishmaniasis in immunosuppressed pediatric patients, especially under difficult social, economic and geographic conditions. Leishmaniasis should be considered as a differential diagnosis when treating atypical chronic dermatologic ulcers; the use of liposomal amphotericin in immunocompromised patients should also be considered in these cases.

ABSTRACT Introduction: Visceral leishmaniasis is a zoonotic disease transmitted by vectors of the Lutzomyia genus, distributed in 98 countries, including Colombia, which can cause a serious clinical picture that, in the absence of treatment, can be fatal. Objective: To determine the knowledge, attitudes, and practices (KAP) acquired on vectors and reservoirs, as well as the characteristics of visceral Leishmaniasis in communes 8, 9 and 10 of the city of Neiva in 2019. Material and Methods: A descriptive cross-sectional study was carried out from June to December 2019. Three communes (8, 9 y 10) were sampled from a total of 30 neighborhoods of the city of Neiva - Huila. In addition, 385 CAP-type surveys were applied, with a margin of error of 5% and a reliability of 95%. People aged 18 years or older (267 women and 117 men) who voluntarily wished to participate, with prior informed consent, were included. Results: According to the analyzed information, it was determined that the majority of the surveyed population did not know about visceral leishmaniasis (77%), did not identify it as a zoonotic disease (52%), nor did they know who the causative agent is (82%); furthermore, they were not clear about the symptoms that occur in humans, nor the treatment used to manage them. Conclusions: Although preventive campaigns have been carried out in the affected communes, the level of knowledge about the disease, the vector, the reservoir, and the specific preventive practices to counteract visceral leishmaniasis are little known in the study population, despite the fact that the identified practices and attitudes are positive.

RESUMEN Introducción: La leishmaniasis visceral es una enfermedad zoonótica, transmitida por vectores del género Lutzomyia, de distribución en 98 países, incluyendo Colombia y que puede ocasionar un cuadro clínico grave, que en ausencia de tratamiento puede ser fatal. Objetivo: Determinar los conocimientos, actitudes y prácticas (CAP) adquiridas sobre vectores, reservorios y características de la Leishmaniasis visceral en las comunas 8, 9 y 10 de Neiva (Huila) en 2019. Materiales y métodos: Se realizó un estudio descriptivo de corte transversal en el período de junio a diciembre de 2019, en el que se muestrearon tres comunas (8, 9 y 10), en un total de 30 barrios de la ciudad de Neiva-Huila. Se aplicaron 385 encuestas tipo CAP, con un margen de error de 5 % y una confiabilidad de 95 %. Se incluyeron personas adultas de 18 años o más (267 mujeres y 117 hombres), que voluntariamente desearon participar, con previo consentimiento informado. Resultados: Según la información analizada, se determinó que 77 % de los encuestados no conoce la leishmaniasis visceral, 52 % no la identifican como una enfermedad zoonótica, 82 % no conocen el agente causal y 44 % no tienen claridad sobre los síntomas que se presentan en humanos. Conclusiones: Aunque se han realizado campañas preventivas en las comunas afectadas, el nivel de conocimiento sobre la enfermedad, el vector, el reservorio y las prácticas preventivas específicas para contrarrestar la leishmaniasis visceral son poco conocidos en la población de estudio, a pesar de que las prácticas y actitudes identificadas son positivas.

ABSTRACT We present a case of disseminated cutaneous leishmaniasis with extensive manifestation in a pediatric patient with Down syndrome. The case was confirmed by parasitological and immunological tests. The species was identified as Leishmania (Viannia) braziliensis by polymerase chain reaction-restriction fragment length polymorphisms (PCR-RFLP). The immune deficit that occurs as part of Down syndrome may have been the reason for the aggressive and prolonged clinical manifestations as well as the poor response to stibogluconate and deoxycholate amphotericin. The patient was treated with liposomal amphotericin B and at the end of therapy, showed clinical improvement of the lesions. This report highlights the challenges of the diagnosis and treatment of cutaneous leishmaniasis in immunosuppressed pediatric patients, especially under difficult social, economic and geographic conditions. Leishmaniasis should be considered as a differential diagnosis when treating atypical chronic dermatologic ulcers; the use of liposomal amphotericin in immunocompromised patients should also be considered in these cases.

RESUMEN Se presenta un caso de leishmaniasis selvática cutánea diseminada con manifestación extensa en una paciente pediátrica con síndrome de Down. El caso se confirmó a través de estudios parasitológicos e inmunológicos, mientras que la identificación se realizó mediante la técnica de reacción en cadena de la polimerasa-polimorfismos de longitud de fragmentos de restricción (PCR-RFLP, por sus siglas en inglés), determinándose la especie como Leishmania (Viannia) braziliensis. La manifestación clínica agresiva y prolongada con poca respuesta a estibogluconato y anfotericina desoxicolato pueden deberse al déficit inmunológico que se presenta como parte del síndrome de Down. La paciente eventualmente recibió tratamiento con anfotericina B liposomal y al término de la terapia, mostró mejoría clínica de las lesiones. El presente reporte ilustra los desafíos tanto de diagnóstico como tratamiento de leishmaniasis cutánea en pacientes pediátricos inmunosuprimidos, especialmente en un entorno de difícil acceso social, económico y geográfico, a los servicios de salud. Se recomienda considerar a la leishmaniasis en el diagnóstico diferencial cuando se atienda ulceras crónicas dermatológicas atípicas; así como tener en cuenta el uso de anfotericina liposomal en pacientes inmunocomprometidos.