R ev ist a d a S o c ie d ad e B r as ile ir a d e M e d ic in a T r o p ic al 2 9 ( 3 ) :2 2 9 - 2 3 2 , m ai- ju n , 1 9 9 6 .
PLA N TS USED IN TH E TREA TM EN T O F LEISHM A N IA L
ULCERS D UE TO
L EISH M A N IA (V L A N N IA ) B R A Z IU E N SISIN A N EN D EM IC A REA O F BA HIA , BRA ZIL
Flávio França, Ednaldo L. Lago and Philip D. M arsden
T his p a p e r r e c o r d s t h e p lan t s u s e d in t h e t r e at m e n t o f c u t an e o u s le is h m an ias is d u e to Leishmania (Viannia) braziliensis ( L( V ) b) am o n g t he r u r al p o p u lat io n o f a c o c o a -p r o d u c i n g c o as t al a r e a o f B a h i a st at e, B r az il. A n e n q u ir y c o n d u c t e d am o n g a h u n d r e d p at ie n t s id e n t ifie d 4 9 p l a n t s p e c ie s u s e d t o t r e at s kin u lc e r at io n c a u s e d by this L e is h m a n i a s p e c ie s . T he p r i n c i p a l p l a n t s u s e d a r e c a j u - b r a n c o (A nacardium o ccid entale- A nacardiaceaej), u s e d by 6 5 % o f t he p o p u lat io n , fo l h a - f o g o (Clidemia hirta- M elasto m ataceae) 39 % , alfav ac a- g r o s s a (Plectranthus am bo inicus - L a m ia c e a e ) 33% , m as t r u z (Cheno p o d ium ambro sio ides - C h e n o p o d iac e ae ) 31 % , e r v a- d e - s an t a- m ar ia
(So latiu m am ericanu m - S o l a n a c e a e ) ( 2 5 % ) a n d t r a n s a g e m (Plantag o m ajo r -
P lan t ag in ac e ae .) 2% .
K e y - w o r d s : C u t an e o u s le i s h m a n i a s i s . Leishm ania (V iannia) b raz iliensis. P l a n t t reat m en t .
Três Braço s (Crav o lând ia, BA ) and Co rte d e Ped ra (Tancred o N ev es, BA ) are in an end em ic area o f teg um entary leishm aniasis cau sed b y Leishm ania (V iannia) braziliensis (L(V )b)5 7 18. The p rincip al treatm ent used is the p entav alent antim o nial g lucantim e1. This drug is inco v enient to use, sinc e has m any to xic effects and is no t alw ays av ailable.
Rep o rts o f the u se o f lo cal p lants fo r treatm ent are scarce in the literature. M elo et alIG cited C e p h ae lis i p e c a c u a n h a (Bro t.) A. Rich. (Ru biaceae) and M aced o 9 cites f a c a r a n d a
b r a s i l i a n a Piers (Big n o n iaceae). N etto et al16 rep o rted that m any lesio ns in o u r stud y area w ere treated w ith p lant p ro d ucts by lo cal ap p licatio n. This rep o rt is an extensio n o f this w o rk. In v iew o f the p aucity o f alternativ e therap y to p entav alent antim o nials such an inv estig atio n is relevant.
M A TERIA L A N D M ET H O D S
The stud y area is c o m p o sed o f tw o v illages, Três Braç o s and C o rte d e Ped ra, w ith surro und ing farm s. O f the 15 farm s stud ied in Três Braço s fo r ten y ears, the fo u r w hich p resented the hig hest incid ence o f leishm aniasis
S up p orted in p art b y N IH /G rant A l - 16282
A d d r e s s taProf . Philip D . M arsden. N ú cleo de M edicina T ro p ical e N utrição . U niversid ade d e Brasília. C P: 04 - 6 7 1 . Brasília-D F, Brasil.
R eceb id o p ara p u b licação e m 1 7 / 1 0 / 9 4 .
w ere selected , nam ely So brad inho , Risad a, N o va Esp erança II and Baixinha. Fro m the 8 farm s surro und ing Co rte d e Ped ra a further fo ur w ere selected in a sim ilar m anner, nam ely Ju lião I, Ju lião II, Recô ncav o and Pataxó I. This selectio n w as influ enced b y data relating to d isease incid ence5 7 reco rd ed in p rev io us y ears.
Interv iew s am o ng the p o p ulatio n u se a p ro to co l d esig ned after co nsulting rep o rts o f v ario us p rev io us w o rkers3617. D ata regard ing a histo ry o f leishm aniasis w as co nfirm ed fo r each family.
If a p lant w as b eing reco m m end ed fo r therap y its id entity and m o d e o f ap p licatio n w as reco rd ed . These interview s w ere p erfo rm ed in a cum ulativ e m anner in Ju ly 1989, Janu ary 1990 and Ju ly 1990. Su b jects w ere selected w ho had a histo ry o f leishm aniasis and w ere o v er 15 y ears o f ag e. O nly the senio r autho r co llected and analy sed all data.
RESULTS
O f 100 subjects interv iew ed 55 u sed p lants to treat the skin lesio ns. In o ne co m m unity (Co rte d e Ped ra) significantly m o re p eo p le u sed p lants than in the o ther v illag e (Três Braç o s) (p < 0.15). O ld er p eo p le (o v er .55 y ears o f ag e) tend ed to u se sig nificantly m o re (p < 0.05). As regard s sex bo th m en and w o m en utilised plants but the m en sig nificantly m o re (p < 0.05). The u se o f p lants w as linked to m ultip le lesio n o ccu rrence (p < 0.05). The leg s
F r a n ç a F, L ag o EL, M ar s d e n P D . P lan t s u s e d in t h e t r e at m e n t o f le is h m an ial u lc ers d u e to Leishm ania (V iannia) Braz iliensis in a n e n d e m ic a r e a o f B ah ia, B r az il. R ev ist a d a S o c ie d ad e B r as ile ir a d e M e d ic in a T r o p ic al 2 9 :2 2 9 - 2 3 2 , m ai- ju n , 1 9 9 6 .
w ere the m o st affected p art (66% ). Fifty p ercent o f p atients ab and o ned p lant therap y w hen g luncantim e b ecam e av aiable. Fo rty- nine c o m m o n nam es o f p lants u sed in leishm ania therap y w ere id entified in this study. Tab le 1 d etails the six m o st co m m o n plants reco m m end ed b y m o re than 20% o f the 55 p lant users. Tab le 2 d etails the m anner o f u se o f these sp ecies.
In b o th areas m o re than 10% o f p o p ulatio n in te rv ie w e d c ite d th e fo llo w in g p lan ts: cajueiro -branco (A n a c a r d i u m o c c i d e n t a l e L.), fo lha-fo g o (C lid e m ia h ir t a L.), alfav aca-gro ssa (.P le c t r an t h u s a m b o i n i c u s (Lo ur.) Sp reng .), mastruz (C h e n o p o d iu m a m b r o s io id e s L.), erv a- d e-santa-m aria ( S o lat iu m a m e r i c a n u m Mill.) and transag em (P la n t a g o m a j o r L.). In Três Braço s co có -brav o (X an t h o s o m a c f. m a x im ilian i
T ab le 1 - S p e c ie s u s e d b y m o r e t h a n 2 0 % o f 5 5 p l a n t u sers.
Sp ecies Co mmo n Pacients w ho cited
nam e the plants
_____________ ne %
A n a c a r d iu m o c c id e n t a le cajueiro branco 34 65.4
C lid e m ia h ir a fo lha fo g o 20 38.5
P le c t r an t r an t h u s a m b o in ic u s alfavaca gro ssa 17 32.7
C h e n o p o d iu m a m b r o s io id e s mastruz 16 30.8
S o lan u m a m e r ic a n u m erva de santa maria 13 25.0
P lan t ag o m a j o r transagem 12 23.1
T ab le 2 - M an n e r o f u s e o f p l a n t d e r iv at iv e s a t s it e o f le sio n .
M anner o f lo cal use Species*
A .o. C. h. P. a. C. a. S. a. P. m.
Bathing w ith bo iled leaf extract X X X X X
Dried leaf p o w d er X X X X X
Bathing w ith b o iled bark extract X
D ried bark po w d er X
Po ultice o f raw leav es X X
Po ultice o f leaf extract X
Paste o f fresh leav es X X
* A .o .= A n a c a r d iu m o c c id e n t ale , C.h. = C lid e m ia hir t a: P.a. = P le c t r an t h u s a m b o in ic u s; C.a. = C h e n o p o d iu m am br o s io ides - , S.a. = S o lan u m a m e r ic a n u m , P. m. = P lan t a g o m ajo r.
Scho tt), m alv a-branca C Sida c o r d i f o l i a L.) and pau d ’arco (T a b e b u ia c f. u m b e ll a t a (So nd .) Sand w .) w ere cited b y 10% and in Co rte de Ped ra p inhao -ro xo ( f a t r o p b a g o s s y p fo lia L.), p eq u i (C a r y o c a r e d u l e C asar) and fum o (.N ic o t t a n a t a b a c u m L.).
So m etim es m o re than o n e sp ecies w as used in s a m e a p p l ic a tio n . L o c a l m e th o d s o f ap p licatio n are d etailed in Tab le 2. Sy stem ic treatm ent w as no t no ted .
D ISCU SSIO N
If a p lant co u ld b e fo u nd w ith therap eutic activ ity ag ainst Lvb it w o uld b e useful as current therap y is unsatisfacto ry 1. Ev en if it had o nly lo cal activ ity it w o u ld b e o f v alue since there is ev id ence that the incid ence o f m uco sal m etastatic sp read is lo w 15.
In Três Braço s there w as less herb al use than in Co rte d e Ped ra, w hich is no t sup rising in v iew o f the existence o f a health p o st in this v illage since 1974. Co m p aring the tw o v illag es w e no ted that 36% o f the p lants w ere u sed at b o th sites. In Co rte d e Ped ra a w id er sp ectrum w as no ted altho ug h in 56% o f instances a sing le ind iv id ual reco m m end ed the p lant. O nly 36% o f iso lated citatio ns o ccu rred in Três Braço s w here there w as m o re o f a co nsensu s. N atio n w id e the nu m b er o f su ch rem ed ies m ust b e larg e ind eed .
Since the Três Braço s co m m unity is m o re iso lated 32% o f p eo p le using p lants did no t seek p ro fessio nal help , but in Co rte d e Ped ra w here the health p o st functio n d aily this num b er falls to 7% . H o w ev er 45% o f p atients attend ing the latter p o st u sed p lants as
F r a n ç a F, L ag o EL, M ar s d e n P D . P lan t s u s e d in t he t r e at m e n t o f le is h m an ial u lc e r s d u e to Leishm ania (V iannia) Braz iliensis in a n e n d e m ic a r e a o f B ah ia, B r az il. R ev ist a d a S o c ie d ad e B r as ile ir a d e M e d ic in a T r o p ic al 2 9 :2 2 9 - 2 3 2 , m ai- ju n , 1 9 9 6 .
ad d itio nal treatm ent co m p ared w ith 12% in Três Braço s.
Interv iew d ata rev ealed that the lo ng er the d uratio n o f the lesio n the g reater the u se o f p lants. The sam e ap p lied w hen lesio ns w ere m ultip le and w id ely d istributed o n the bo d y. As sho w n p rev io usly m o re m en that w o m en acquire the d isease7. O ften up to three sp ecies w ere u sed in to p ical treatm ent. W hen subjects chang es o f treatm ent o ccurred , the ap p arent resp o nse w as no t g o o d .
O nly six p lants w ere reco m m end ed by m o re than 20% o f interv iew ed fo r lo cal treatm ent. O f the p lants m entio ned in this p ap er o nly A n a c a r d i u m o c c i d e n t a l s L. and C h e n o p o d iu m a m b r o s io id e s L. hav e b e e n cited fo r u se ag ainst leishm aniasis in the area16. P la n t a g o m a j o r L. is a sp ecies m uch stud ied in Russia and Jap an and used as an astringent, antip y retic e tc 11 and fo r haem o rrho id s2. S o lar iu m a m e r i c a n u m Mill, is used in d iv erse d erm ato ses su ch as ecz em a, p so riasis and skin traum a o r infectio ns14. C lid e m ia h ir t a L. w as the p lant p referred after cajueiro . Their fruits are ed ible and rich in vitam in C2. C h e n o p o d iu m a m b r o s io id e s L. is a kno w n anthelm inthic v ery effectiv e ag ainst ascariasis d ue to its hig h co ntent o f ascarid o l11. It is also u sed as an abo rtificant and fo r d igestiv e effects2.
A n a c a r d i u m o c c i d e n t a l e L. nut extract w as the m o st w id ely used . It co ntains co rro siv e su b stan c es and has b e e n u sed in o ther d iseases such as lep ro sy , p so riasis, ecz em a and w arts2 8 13. O ther p arts o f the p lant hav e m ed icinal u ses12.
Elsew here w e p resented o ur results o f testing extracts o f A n a c a r d i u m o c c i d e n t a l e L. bark in lab o rato ry exp erim ents w ith Lvb in
v iv o 4. This extract sho w ed hig h activ ity in the in v it r o m o d el ag ainst p ro m astig o te o f this sp ecies. H o w ev er in the in v iv o m o d el no curativ e activ ity w as o b serv ed in the ham ster.
RESU M O
E st e t r a b a l h o r e l a t a a s p l a n t a s u s a d a s n o t r at am e n t o d a le is h m an io s e c u t ân e a, c a u s a d a p o r
Leishm ania (V iannia) braziliensis ( L( V ) b) , n a p o p u l a ç ã o r u r al d a f a i x a lit o r ân e a p r o d u t o r a d e c a c a u d o e s t ad o d a B ah ia, B ras il. U m in qu é r it o r e a l i z a d o e n t r e 1 0 0 p a c ie n t e s , id e n t ific o u 4 9 e s p é c ie s d e p la n t a s u s ad as p a r a t r at ar ú lc e r as d e p e l e c a u s a d a s p o r e s t a e s p é c ie d e L e is h m ân ia. A s p r in c ip a is p la n t a s u s ad as f o r a m o c aj u e ir o - b r an c o
(A nacardium o ccid entale - A n a c a r d i a c e a e ) u s ad o p o r 6 5 % d a p o p u la ç ão , a f o l h a - f o g o (Clidemia hirta
- M e l a s t o m a t a c e a e ) 3 9 % , a a l f a v a c a - g r o s s a
(Plectranthu s am b o inicu s - L a m i a c e a e ) 3 3 % , o m a s t r u z ( C h e n o p o d iu m a m b ro s io id e s -
h e n o p o d i a c e a e ) 3 1% , a e r v a - d e - s a n t a - m a r i a
(So lanum americanum - S o la n a c e a e ) 2 5 % e a t r an s ag e m (Plantago majo r - P lan t ag in ac e ae ) 2% .
P a l a v r a s - c h a v e s : L e i s h m a n i o s e c u t â n e a .
Leishmania (Viannia) braziliensis. T r at am e n t o c o m p lan t as .
REFEREN CES
1. Berm an JD . C hem otherapy for leishmaniasis, biochem ical m ecanism s, clinical efficacy and future strategies. Reviews o f Infectious D iseases
1 0 :5 6 0 - 5 8 6 ,1 9 8 0 .
2. Correa PM. D iccionário das plantas úteis e das
exóticas cultivadas. M inistério da A gricultura/ IBGE (6 vol.). Rio de Janeiro. 1929.
3. D e Smet PAGM, Rivier L. A general outlook on e t h n o p h a r m a c o l o g y . Jo u r n a l o f
Ethnopharmacology 2 5 :1 2 7 - 1 3 8 ,1 9 8 9 .
4. França F, Cuba CAC, M oreira EA, M iguel O, A lmeida MD, V irgens ML, M arsden PD. A valiação do efeito do extrato de casca de cajueiro-branco (A n ac ar d iu m o c c id e n t ale L.) sobre a infecção por L e is h m an ia ( V ian n ia) b r az ilie n s is . Revista da Sociedade Brasileira de M edicina Tropical 26:
151- 155,1993.
5. França F, Lago EL, Tada MS, Costa JM L, Vale K, O liveira J, Costa MA, Osaki N, C heever L, N etto EM, Barreto AC, Johnson W D , M arsden PD. A n outbreak o f hum an L e is h m a n i a ( V i a n n ia ) b r a z i l i e n s i s (LV b). M em órias do In stitu to O swaldo Cruz 8 6 :1 6 9 - 1 7 4 ,1 9 9 1 .
6. Friedman J, Yaniv Z, Dafni A, Palewitch D. A preliminary classification o f the healing potential of medicinal plants, based on a rational analysis of an ethnopharm acological field survey among bedouin in the negev D esert, Israel. Journal of Ethnopharmacology 16: 275- 2 8 7 ,1 9 8 6 .
7. Jones TC, Johnson Jr W D , Barreto AC, Lago E, Badaró R, Cerf B, Reed SG, N etto EM, Tada MS,
França F, W iese K, G olightly L, Fikrig E, Costa JM L, Cuba CC, M arsden PD. Epidemiology of am erican cutaneous leishmaniasis due to L e is h m a n i a ( V ian n ia) b r az ilie n s is .T h e Journal of Infectious D iseases 1 5 6 :7 3 - 8 3 ,1 9 8 7 .
8. Léon J. Botânica de los cultivos tropicales. IICA,
San José, 1987.
F r a n ç a F, L ag o EL, M ar s d e n P D . P lan t s u s e d in t he t r e at m e n t o f le is h m an ial u lc ers d u e t o Leishm ania (V iannia) Braz iliensis in a n e n d e m ic a r e a o f B ah ia, B r az il. R ev ist a d a S o c ie d ad e B r as ile ir a d e M e d ic in a T r o p ic al 2 9 :2 2 9 - 2 3 2 , m ai- ju n , 1 9 9 6 .
9. M acêdo FEA. Proposta alternativa de terapia para leishmaniose tegumentar americana. Universidade Federal da Paraíba. M imeographed document, Jo ão Pessoa, 1986.
10. M ello MOA, Costa CF, Barbosa MS, Oliveira EL. Catálogo de plantas medicinais do Estado da Bahia. Boletim do Instituto Biológico da Bahia 10:
3 9 - 66,1971.
11. M enezes AI. Flora da Bahia. Companhia Editora N acional, São Paulo, 1949.
12. M itchell DJ, M ori SA.The cashew and its relatives
( A n ac ar d iu m : A nacardiaceae). M emoirs o f the N ew York Botanical G arden 4 2 :1 - 7 6 ,1 9 8 7 .
13. M orais MO. O óleo de caju na lepra. Revista Brasileira de Farmácia 2 6 :1 7 - 2 0 ,1 9 4 5 .
14. N aw w ar MAM. Q uercetin 3-glycosides from the leaves o f S o lan u m n ig ru m . Phytochem istry 28:
1 755- 1758,1989.
15- N etto EM, M arsden PD, Llanos-Cuentas EA, Costa JM , Cuba CC, Barreto AC, Badaró R, Johnson W D,
Jones TC. Long term follow up o f patients w ith
L e is h m an ia ( V ian n ia) b r az ilie n s is infection and treated w ith glucantime. Transactions o f Royal Society ofTropical M edicine and H ygiene 8 4 :3 6 7 -3 7 0 ,1 9 9 0
16. N etto EM ,Tada MS, G olightly L, K alter DC, Lago E, Barreto AC, M arsden PD. C onceitos de uma pop ulação local a respeito da leishm aniose m ucocutânea em uma área endêm ica. Revista Brasileira de M edicina tropical 18: 3 3 - 37,1985.
17. Rizzini CT. Coleta e preparo de material vegetal para estudos químicos e farm acológicos .A rquivos do Jardim Botânico do Rio de Janeiro 30:179- 190,
1981.
18. RosaA C, Cuba CC,V exenat A, Barreto AC, M arsden PD. Predom inance o f L e is h m an ia b r az ilie n s is b r az ilie n s is in the regions o f Três Braços and C orte de Pedra, Bahia, Brazil. Transactions of the Royal Society ofTropical M edicine and Hygiene 8 2 :4 0 9 - 4 1 0 ,1 9 8 8 .
