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An increase in mucocutaneous leishmaniasis (ML) cases in northern (Brazil) motivated this study. In 44 ML patients with clinical diagnosis, only 13 parasitologically confirmed cases exhibited mucosal lesion suggestive of ML. Other conditions involving nasal manifestations are frequently confounded with ML. Therefore, otorhinolaryngologic examination is important in the clinical management of ML.

The mutilant nature of the mucosal form of leishmaniasis can cause alterations in personal relations. To identify the level of understanding of leishmaniasis and the psychological reaction to it patients and houseowners in an endemic area of Bahia were interviewed. Several false beliefs were identified and there was a strong tendency to reject mutilated patients among the population for a false fear of contagion. Possibly future clarification of the real nature of leishmaniasis could change such a negative attitude among the resident population.

We have characterized the T-lymphocytes in the skin lesions of 10 patients with cutaneous leishmaniasis and in the nasal lesions of seven patients with mucosal leishmaniasis, with the immunoperoxidase and monoclonal antibody techniques. There was predominance of cells with helper phenotype (Leu 3A+ 3B) over suppressor phenotype (Leu 2a) in the lesions of both groups. The helper/suppressor (H/S) ratio in the skin lesions was 1.6 +/- 0.5 and in the nasal lesions of mucosal leishmaniasis was 1.7 +/- 0.8. The H/S ratios in the peripheral blood of patients with cutaneous leishmaniasis (2.1 +/- 0.8) and in patients with mucosal leishmaniasis (1.6 +/- 0.8) were comparable and similar to the ratios in the skin and nasal biopsies. The percentage of T-cells and macrophages expressing the Dr antigen in the cutaneous group (69.5 +/- 13.7) was not significantly different from the mucosal patients (90.3 +/- 5.7). We conclude that the immunopathology of the skin lesions in cutaneous leishmaniasis is similar to the nasal lesions of mucosal leishmaniasis.

We used instrumental neutron activation analysis (INAA) to determine antimony in small quantities of hair from individuals living in an area of endemic leishmaniasis. The groups studied were 12 patients undergoing treatment with N-methylglucamine antimoniate, 34 patients who had received such treatment a year ago, and 17 control subjects (untreated) who were living in the same area. Patients receiving treatment showed mean and median (12.13, 2.9 micrograms/g) values for antimony in hair that significantly exceeded those in either controls (1.01, 0.4 microgram/g) or patients one year after treatment (1.54, 1.0 microgram/g). We conclude that INAA can be useful in monitoring and differentiating such exposure to antimony in patients under treatment.