Cutaneous leishmaniasis associated with extensive lymphadenopathy during an epidemic in Ceará State, northeast Brazil

During an epidemic of cutaneous leishmaniais in northeast Brazil a prospective study was conducted in order to assess clinical, parasitological and immunological features of cutaneous leishmaniasis in a representative sample of patients. A general examination was done and demographic and anthropometric data as well as numbers, duration, location, size, consistency and tenderness of enlarged lymph nodes and lesions recorded. Hematologic and biochemical parameters as well as Leishmania-specific antibodies were measured in the blood. Lymph node aspirations were performed to detect Leishmania-specific DNA by PCR. Cellular immunity was assessed by a leishmanin skin test. Ninety-seven patients with cutaneous leishmaniasis presented with a total of 181 lesions and 127 enlarged regional lymph nodes. In 36% the lymph node enlargement had been observed 2 days to 2 months before the development of a lesion. In 59% the lesions were followed by lymphadenopathy by 3 days to 3 months. The skin test was positive in all patients tested. PCR of the lymph node aspirates was positive in 63.2%. No significant correlations were found between positive PCR results, antibody levels or number of lesions. In northeast Brazil cutaneous leishmaniasis due to Leishmania braziliensis is constantly accompanied by an extensive lymphadenopathy. This may help to identify patients when lesions are still small or have not even developed and lymphadenopathy is the only clinical sign.