Individual clothing prophylaxis of cutaneous leishmaniasis in the Amazonian area.
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Biomedical subjects
Publications and source records attributed to R Pradinaud.
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Thirty three cases of donovanosis have been observed at the Dermatology Department of Cayenne's Hospital between 1970 and 1982, only in black people. The high frequency of rectal lesions of passive homosexual patients and the vagina contamination in women without sexual intercourse postulate for the intestinal reservoir of the bacteria, and the possibility of auto-inoculation. There is probably a cellular immune deficit. Donovanosis is often associated with other diseases, and in our practice in French Guyana, with leprosy. The skin of the genitalia is the most frequently infected, the mucosa generally resistant. The intracellular life of the "Donovan bodies" "Calymmatobacterium granulomatosis"--in the cytoplasm of large mononuclear cells seems an argument for an anergic disease.
The authors report the two first proven cases of cutaneous leishmaniasis due to Leishmania mexicana amazonensis in French Guiana. They present some observations on the situation of cutaneous leishmaniasis epidemiology in this country.
The observation in French Guyana of pemphigus foliaceus having long mimicked eczema or psoriasis and turning 5 year later as an exudative erythroderma, points out the clinical polymorphism of the disease. Several clinical features are analysed that might support the hypothesis of autonomy of the Brazilian type: such as for example joint involvement. But the main point concerns epidemiology since this disease seems to spread out from the classical endemic Brazilian provinces to northern countries as socio-economical conditions improve in the south.
Clinical studies by Dr R. Pradinaud (Cayenne) has given prominence to the symptoms of "papillonite": its primary and secondary cutaneous lesions, their localisation and evolution as well as its accompanying symptoms such as respiratory pathology. Epidemiologic survey shows a parallelism between the occurrence of papillonite and the presence of the moth Hylesia urticans. The urticant apparatus of this moth was studied with the scanning electron microscope. "Arrow" (fléchettes) were found and they more or less resemble the urticant apparatus of Thaumetopoea pityocampa Schiff caterpillar. The mechanism of action has been studied in the animal and in humans. Extracts prepared from the "arrows" have been rested in vivo guinea-pigs (bleu Evans, Liacopoulos et al.). The findings seem to incriminate an histamino-liberation.
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In French Guayana, climatic and geographic conditions enhance development of numerous fungal, parasitic and microbial skin diseases. The most particular infectious diseases of this French department are lobomycosis, chromomycosis (Phialophora pedrosoi), creeping disease, cutaneous leishmaniasis, tungiasis, mycobacterial ulcus (Mycobacterium ulcerans) and papular dermatitis caused by nettling hairs of lepidoptera (Hylesia urticans). The occurence of these skin diseases is demonstrative of pathological ecology of the Amazonian country.
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A follow-up study of 219 patients infected with parasitologically confirmed cutaneous leishmaniasis in French Guiana was made between 1981 and 1987. Cutaneous leishmaniasis appeared to be common in young male adults entering the forest for professional activities (84.2% of the cases). The lesions were generally of the classical ulcerative type. They were limited to the skin and preferentially located on the legs and forearms (20.7% and 19.8% respectively). Most of the cases (86.6%) represented primary infections, but 6.8% had a recurrent lesion at the site of an old, previously cured lesion.
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