Mucosal leishmaniasis (ML) is observed only in about 3% of patients with American tegumentary leishmaniasis (ATL) but has a high potential for destructive, disfiguring, and disabling sequelae. Prior reports of clinical and epidemiologic features of ML are limited by small numbers of cases. In this study, we evaluated changes in the demographic features and clinical presentation of ML in an endemic area of Leishmania braziliensis transmission over a period of 20 years. The charts of 327 patients with ML diagnosed between 1995 and 2014 were reviewed. The majority of patients (67%) were male. Age ranged from 8 months to 103 years, with a median age of 38.5 years (interquartile range: 22–58 years). The greatest number of patients was between 19 and 39 years (31%). Over the study period, there was an increase in patients with ML more than 60 years of age, an increase in ML with concomitant cutaneous lesions, a decrease in the period of time between the documentation of cutaneous lesions and the diagnosis of mucosal disease, and an increase in the frequency of patients presenting with stage I and V of ML. Moreover, there was a positive correlation between severity of mucosal disease and both age and the period of time between cutaneous lesion and mucosal disease. Response to therapy of ML remained similar over a period of 20 years. Despite the improvement in medical care during the study period, the prevalence of ML did not change and severe disease continues to be a major challenge for the management of these patients.

Mucosal leishmaniasis (ML) is a severe form of tegumentary leishmaniasis associated with a persistent inflammatory response. High levels of TNF, IFN-γ, CXCL9 and CXCL10 are found in ML patients, and the association of pentoxifylline with antimony is more effective in decreasing the healing time in ML patients when compared to antimony alone. The present study aimed to investigate the existence of a correlation between cytokine and chemokine production and ML severity and evaluate the potential value of cytokine and chemokine production as marker of therapeutic response in ML patients. This prospective study included 86 subjects in an area of endemic Leishmania braziliensis transmission. Patients diagnosed with ML were classified into clinical stages ranging from I to V according to disease severity. TNF, IFN-γ, CXCL9 and CXCL10 levels were quantified in the supernatant of the mononuclear cell cultures by ELISA before and after treatment with antimony alone or antimony plus pentoxifylline. The median TNF level in the group with mild disease (Stages I–II) was 1064 pg/mL (142–3738 pg/mL), while, in the group with moderate or severe disease (Stages III–V), it was 1941 pg/mL (529–5294 pg/mL) (p = 0.008). A direct correlation was observed between ML clinical severity and levels of TNF production (r = 0.44, p = 0.007). Patients who were treated with antimony and pentoxifylline healed significantly faster than those treated with antimony alone (52 vs. 77 days, hazard ratio = 0.60; 95% confidence interval = 0.38–0.95, p = 0.013). Therapeutic failure was higher in the group that received antimony alone (25% vs. 7%; p = 0.041). There was a significant decrease in CXCL9 after therapy of ML in both groups (p = 0.013; p = 0.043). TNF levels are associated with the severity of mucosal diseases, and pentoxifylline associated with antimony should be the recommended therapy for ML in countries where liposomal amphotericin B is not available.

A Apneia Obstrutiva do Sono é um distúrbio do sono muito prevalente e um fator de risco independente para doenças cardiovasculares, como a Insuficiência Cardíaca. O seu rastreamento na Atenção Primária à Saúde por ferramentas simples pode contribuir para um adequado manejo. Sendo assim, o objetivo deste estudo é avaliar a associação entre o risco de Apneia Obstrutiva do Sono, quantificado pelo Questionário STOP-Bang, e alterações cardiovasculares incipientes no ecocardiograma em pacientes sem sintomas clínicos de Insuficiência Cardíaca, contribuindo para gerar estratégias de identificação precoce e terapêutica adequada. Trata-se de estudo transversal analítico com 51 pacientes da atenção primária de Porto Seguro-BA, os quais realizaram exame clínico, preencheram o Questionário STOP-Bang e foram submetidos ao Ecocardiograma Doppler Tecidual. Os dados foram analisados pelos testes Exato de Fisher e t de Student, considerando p ≤ 0,05 como significativo. A amostra foi predominantemente masculina (52,9%), com idade média de 43,8 anos (± 8,76); 64,7% apresentaram baixo risco para Apneia Obstrutiva do Sono e 35,3%, risco intermediário-alto. O grupo de maior risco evidenciou aumento significativo no volume do átrio esquerdo indexado, enquanto outros parâmetros de função diastólica e sistólica estavam preservados. Conclui-se que o risco aumentado de Apneia Obstrutiva do Sono está associado com o incremento de um importante marcador de disfunção diastólica precoce. Além disso, o Questionário STOP-Bang mostrou-se uma ferramenta útil para rastrear esse distúrbio do sono na atenção primária.