The Leishmaniases are a group of diseases whose clinical presentation is in part determined by the infecting species. Until recently, mucosal leishmaniasis was attributed exclusively to Leishmania (Viannia ) braziliensis; however, the capacity of other species of the subgenus Viannia to invade mucosal tissue has been documented. This report examines the clinical characteristics of 23 parasitologically diagnosed patients with mucosal leishmaniasis due to L. (V.) panamensis from the Pacific Coast of Colombia seen at CIDEIM between 1985 and 1996. Most of the mucosal lesions 74% (17 of 23) were mild, with a short time of evolution (median ϭ 2.5 months) and were present concomitantly with an active cutaneous lesion in 61% (14 of 23) of the cases. The simultaneous presentation of mucosal and active cutaneous lesions contrast with classical descriptions of mucosal leishmaniasis caused by L. (V.) braziliensis, and highlights the importance of early diagnosis of mucosal disease by the examination of mucosa in all cases of cutaneous leishmaniasis.

In order to determine the frequency of therapeutic failures to chloroquine (CQ)

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The effect of antimalarials on gametocytes can influence transmission and the spread of drug resistance. In order to further understand this relationship, we determined the proportion of gametocyte carriers over time post-treatment in patients with uncomplicated Plasmodium falciparum malaria who were treated with either chloroquine (CQ) or sulfadoxine/pyrimethamine (SP) In spite of several in vivo and in vitro studies (Hogh et al. 1998, Buckling et al. 1999, Robert et al. 2000, the effect of chloroquine (CQ) and sulfadoxine/pyrimethamine (SP) on gametocytes in patients with Plasmodium falciparum malaria remains unclear. If after treatment a considerable proportion of patients carry gametocytes this would increase transmission. Likewise, if resistant parasites are more likely to develop gametocytes after treatment, the spread of drug resistance would be favoured. The present study examines the effect of these two antimalarials on gametocytaemia and explores the influence of treatment failure on gametocyte carriage. MATERIALS AND METHODSIn 1998, a 14-day in vivo randomized trial of the efficacy of CQ and SP to treat uncomplicated P. falciparum malaria in Quibdó, Colombia was conducted (Osorio et al. 1999). Thick blood film slides from 98 out of 141 patients who had participated in this study were examined for the presence and density of asexual and sexual parasites. Asexual parasitaemia was measured by dividing the number of asexual parasites found in 300 leukocytes by 300 and multiplying by 8,000 (the estimated number of leukocytes per microliter of blood). The presence of gametocytes was evaluated in 1,000 leukocytes (approximately 200 fields), and gametocyte density was estimated by counting the number of sexual forms in 1,000 leukocytes and multiplying by 8. Two laboratory technicians with expertise in malaria microscopy read all slides blinded. Discordant results were evaluated by a qualified third reader, who did not know the results of the previous readers. EPINFO 6.04b (CDC 1997) was used for data analysis. Data was compared using 2 x 2 tables. Continous variables were compared by Kruskal-Wallis test, and categorical data by Chi-squared or Fisher's exact test when required. RESULTSForty-two patients received CQ and 56 SP. As in the original study, in this subset CQ-and SP-treated groups were similar in demographic and malaria characteristics at enrollment but differed in the presence of CQ in urine and treatment failure (Table). The overall proportion of patients with gametocytes at enrollment was 25.5% (25/98). Most patients in the study developed gametocytes over 14 days of follow up, and the proportion of patients carrying gametocytes in blood peaked on day 7 (85.7% in CQtreated and 86% in SP-treated patients) (Figure). Factors such as age, parasite density at enrollment, duration of symptoms (fever) and presence of CQ in urine were not associated with gametocyte carriage at enrollment, nor at follow up.The geometric mean gametocyte density was comparable between groups at enrollment (61 gametocytes/µ...

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