Leishmania Bolivia

TRANSACTIONS

OF THE ROYAL SOCIETY OF TROPICAL MEDICINE AND HYGIENE (2002) 96,529-532

Co-infection
by Leishmania amazonensis
and L. infantum/l.
diffuse cutaneous leishmaniasis
in Bolivia

chagasi in a case of

E. Martinez’*,
S. Mollinedo’,
M. Torrez’, M. Muiioz2, A.-L. Baiiuls3 and F. Le Pont4 ‘Instituto National de
Laboratorios de SaludlINLASA,
Unidad de Parasitologia, C.Rafael Zubieta No. 1889, La Paz, Bolivia; zInstituto
Boliviano de Biologia de Altura, Departamento de Enfermedades Tropicales, C. C. Sanjintk, sin, Mirajlores, La Paz, Bolivia;
3Centre d’Etudes sur le Polymorphisme des Micro-organismes (CEPM), UMR CNRS-IRD n”9926, Centre IRD, Montpellier,
France; 41nstitut de Recherche pour le D&veloppement (IRD-La Paz), La Paz, Bolivia
Abstract
We present thefirst report of a co-infection by Leishmania amazonensis and L. infantumll. chagasi isolated
in 1993 from a patient with diffuse cutaneous leishmaniasis (DCL), living in the sub-Andean region of
Bolivia. This is the third reported case of DCL in Bolivia, but the first one with isoenzymatic
identification of the aetiological agents involved and the first one giving evidence for a mixed infectionby
2 Leishmania parasites in the same lesion.
Keywords:
co-infection,

leishmaniasis, diffuse
case report, Bolivia

cutaneous

leishmaniasis,

Leishmania amazonensis, Leishmania injantumichagasi,

Introduction
Visceral and cutaneous leishmaniases are endemic
diseases in Bolivia, occurring at a higher frequency in
the sub-Andean area below 1800 m above sea level (LE
PONT et al.,1992). While visceral leishmaniasis (Leishmania infantumll. chagasz) seems restricted to the Yungas of La Paz Department (1 OOO- 1800 m), as well as
to the eastern lowlands of Santa Cruz Department (LE
PONT et al., 1992), cutaneous and mucocutaneous
leishmaniasis (L. braziliensis) extends from 1800 m to
the lowlands of Beni Department. L. amazonensis may
produce a particular form ofcutaneous leishmaniasis
named ‘diffuse cutaneous leishmaniasis’ (DCL), which
was reported (2 cases) only from the Yungas region but
without formal identification
of the parasite (PRADO
BARRIENTOS, 1948a, 1948b; VALDA, 1980). This latter
species has been identified occasionally in humans
presenting cutaneous leishmaniasis in the Santa Cruz
Department (LA FUENTE et al., 1986; DUJARDIN et al.,1987; GRIMALDI
et al., 1987; DESJEUX, 1991), and
recently a new focus, very active for cutaneous leishmania& due to L. ama.z&nsis, was reported in the
sub-Andean retion of Ia Paz WARTINEZ et al,. 1998).
We present &e third known case of DCL in Bolivia,
the first one with aetiological confirmation (co-infection by L. amazonensis and L. infantumll. chagasz), in a
child living in a settlementlocated in the sub-Andean
region.
Patient and Methods
Clinical histo y
The patient (E.Q.Z.), detected in 1993, was a 5
year-old Aymara girl, born in the colony Unicin Berea
II (Caranavi Province, La Paz Department),
a subtropical mountainous
area located at 900-1000 m,
without evidence of travel to other regions. The disease
began 2 years previously, with an ulcer on the right
arm,followed by infiltrated satellite lesions, some with
superficial ulceration. One month later, lesions appeared on the cheeks, nose and left ear, followed by
multiple and confluent lesions on the thigh, leg, hand,
thorax and abdomen. Some lesions evolved with periods of total or partial healing followed by reactivation.
Three months later a mucocutaneous
nasal lesion
flared up. Topical antibioticsand pentavalent antimonials (meglumine
antimonate)
were previously
administered at an inadequate dose, without any favourable result.
Clinical examination showed multiple infiltrated plaques, scars and seric crusts principally on the face and
left ear, mucocutaneous nasal lesion and facial oedema
(Fig. 1). The patient had scars, hypopigmentation,
*Author

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