Cutaneous leishmaniasis with atypical clinical manifestations: Case report

Neitzke-Abreu, Herintha Coeto; Venazzi, Mateus Sabaini; Scodro, Regiane Bertin de Lima; Zanzarini, Paulo Donizeti; Fernandes, Andréa Claudia Bekner da Silva; Aristides, Sandra Mara Alessi; Silveira, Thaís Gomes Verzignassi; Lonardoni, Maria Valdrinez Campana

doi:10.1016/j.idcr.2014.07.003

Cited by 13 publications

(5 citation statements)

References 10 publications

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“…NEITZKE-ABREU et al . 16 have also reported a case of CL with atypical clinical manifestations due to L. (V.) braziliensis. SANDOVAL-JUAREZ et al .…”

Section: Discussionmentioning

confidence: 94%

American Cutaneous Leishmaniasis With Unusual Clinical Presentation and Response to Treatment

Fernandes

Pedroso

Venazzi

et al. 2016

Rev. Inst. Med. trop. S. Paulo

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The clinical manifestations and prognosis of cutaneous leishmaniasis (CL) can be influenced by the immune response of the patient and the species of the parasite. A case of atypical clinical presentation of CL, with development of non-characteristic lesions, poor response to therapy, and a long time to resolution is reported. Confirmatory laboratory tests included parasite detection, indirect immunofluorescence, Montenegro skin test, polymerase chain reaction, and parasite identification by multilocus enzyme electrophoresis. The parasite was identified as Leishmaniabraziliensis. The lesion was unresponsive to three complete courses of N-methylglucamine antimoniate intramuscular, and to treatment with pentamidine. The patient did not tolerate amphotericin B. The lesion finally receded after treatment with intravenous N-methylglucamine antimoniate. It is essential to ensure the accuracy of diagnosis and the appropriate treatment, which can include the use a second choice drug or a different route of administration.

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“…NEITZKE-ABREU et al . 16 have also reported a case of CL with atypical clinical manifestations due to L. (V.) braziliensis. SANDOVAL-JUAREZ et al .…”

Section: Discussionmentioning

confidence: 94%

American Cutaneous Leishmaniasis With Unusual Clinical Presentation and Response to Treatment

Fernandes

Pedroso

Venazzi

et al. 2016

Rev. Inst. Med. trop. S. Paulo

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“…In general, atypical skin lesions may include erythematous volcanic ulcers; diffuse, eczematous, lupoid, verrucous, dry, zosteriform, and nodular lesions; or erysipeloid, sporotrichoid, annular (resembling a ringworm infection), paronychial, palmoplantar, genital chancriform, and psoriatic forms. Leishmaniasis recidivans, characterized by small nodules that develop around a healed scar, has also been reported [72][73][74].…”

Section: Cutaneous Leishmaniasis In Transplant Candidates and Recipiementioning

confidence: 97%

Leishmaniasis in Transplant Candidates and Recipients: Diagnosis and Management

Clemente¹,

Mourão²

2020

Emerging Transplant Infections

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Leishmaniasis is a rare disease in both solid-organ and hematopoietic stem cell transplantation. Additionally, the frequency of disease is likely related to the leishmaniasis prevalence in the general population. Although cutaneous leishmaniasis (CL) presentation is more prevalent than that of visceral leishmaniasis (VL) in the general population, the opposite occurs in transplant patients. The current available knowledge is based on small series, case reports, or extrapolations from studies conducted in the general population or in immunocompromised subjects. Therefore, recommendations for disease management are based on the opinion of experts. Leishmania transmission through organ grafts has not been conclusively demonstrated, and there are relatively low rates of transfusion-transmitted leishmaniasis (TTL). To date, compulsory screening for VL in organ donors and the deferral criteria have still not been established. In the context of transplant recipients, diagnosis and management remain a challenge. Delayed diagnosis frequently occurs because of low clinical suspicion and atypical disease presentation. Liposomal amphotericin is the drug of choice and the most commonly used therapy. However, patient profile, Leishmania species, disease extent, drug availability or toxicity, presence of concomitant infections, and especially response can influence this choice. Immunosuppression dose reduction is often recommended, but such decisions must be taken on an individual basis. The main challenges include donor screening and organ deferral, duration of therapy, secondary prophylaxis, and follow-up.

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“…Specific approaches to treat CL patients have to take in consideration the etiologic agent, patient immune competence, clinical features, and arising complications in the course of Leishmania infection [11, 19]. Atypical infections may require an accurate differential diagnosis with other possible coexisting infections, such as leprosy, tuberculosis, fungal infections, ecthyma, furuncle, carbuncle, North American blastomycosis, paracocciomycosis, yaws, prototheca infection, condyloma acuminate, sporotrichosis, syphilis, lupus vulgaris, cutaneous furuncular myiasis, tungiasis, xanthoma tuberosum, sarcoidosis, pyoderma gangrenosum, and neoplasm [107]. Conventionally, the prompt CL diagnosis is obtained by the identification of amastigotes forms (round intracellular forms with 1.5 μ m to 3 μ m) of Leishmania in biopsy samples of skin lesion (gold standard) by optical microscopic observation [1].…”

Section: Challenges Of Prevention Diagnosis and Treatment Of Cutmentioning

confidence: 99%

Cutaneous Leishmaniasis: The Complexity of Host’s Effective Immune Response against a Polymorphic Parasitic Disease

Gabriel

Valério-Bolas

Palma-Marques

et al. 2019

Journal of Immunology Research

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This review is aimed at providing a comprehensive outline of the immune response displayed against cutaneous leishmaniasis (CL), the more common zoonotic infection caused by protozoan parasites of the genus Leishmania. Although of polymorphic clinical presentation, classically CL is characterized by leishmaniotic lesions on the face and extremities of the patients, which can be ulcerative, and even after healing can lead to permanent injuries and disfigurement, affecting significantly their psychological, social, and economic well-being. According a report released by the World Health Organization, the disability-adjusted life years (DALYs) lost due to leishmaniasis are close to 2.4 million, annually there are 1.0–1.5 million new cases of CL, and a numerous population is at risk in the endemic areas. Despite its increasing worldwide incidence, it is one of the so-called neglected tropical diseases. Furthermore, this review provides an overview of the existing knowledge of the host innate and acquired immune response to cutaneous species of Leishmania. The use of animal models and of in vitro studies has improved the understanding of parasite-host interplay and the complexity of immune mechanisms involved. The importance of diagnosis accuracy associated with effective patient management in CL reduction is highlighted. However, the multiple factors involved in CL epizoology associated with the unavailability of vaccines or drugs to prevent infection make difficult to formulate an effective strategy for CL control.

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Cutaneous leishmaniasis with atypical clinical manifestations: Case report

Cited by 13 publications

References 10 publications

American Cutaneous Leishmaniasis With Unusual Clinical Presentation and Response to Treatment

American Cutaneous Leishmaniasis With Unusual Clinical Presentation and Response to Treatment

Leishmaniasis in Transplant Candidates and Recipients: Diagnosis and Management

Cutaneous Leishmaniasis: The Complexity of Host’s Effective Immune Response against a Polymorphic Parasitic Disease

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