Eighteen patients from the northeastern Brazilian State of Ceara with proven kala-azar were studied for evidence of skin parasitism: two had ulcerative or papular skin lesions and 16 had clinically normal skin. Punch biopsies (3 mm) of intact paraspinal subscapular skin were performed on all patients; in those with papular or ulcerative lesions biopsies also were taken from an active site. One of each of the subscapsular biopsies and half of each biopsy from an active lesion were studied; the other specimens were seeded on NNN Difco Blood Agar Base Medium for parasite culture. The biopsies revealed a discrete to intense mononuclear inflammatory infiltrate, predominantly perivascular in nature. No amastigotes were observed in any tissue sections but 7 of the 18 patients yielded promastigotes on skin culture identified by monoclonal antibodies and by enzyme electrophoresis as Leishmania (Leishmania) chagasi [L. (L.) chagasi]. The isolation of Leishmania (Leishmania) chagasi, the recognized aetiologic agent of visceral leishmaniasis in the New World, from the skin of nearly 40% of 18 AVL patients proves dermatotropism of L. (L.) chagasi occurs and may be frequent in neotropical human visceral leishmaniasis (AVL.). Infected persons with skin parasites could act as a reservoir of infection and allow human to human transmission.
Adolescent Adult