A proposed new clinical staging system for patients with mucosal leishmaniasis

Abstract

Mucosal leishmaniasis occurs mainly in areas where Leishmania braziliensis is transmitted. It affects predominantly the nasal mucosa and, in more severe forms, can lead to significant tissue destruction. There is no standard method for grading the severity of disease. We categorised 50 patients with mucosal leishmaniasis according to a proposed clinical staging system. Their age ranged from 10 to 86 y (mean ± SD: 36 ± 16 y) and 43 (86%) patients were male. The different degrees of evolution of mucosal disease, from the initial stage to the more severe long-term cases, enabled mucosal leishmaniasis to be graded into five stages. Stage I is characterised by nodular lesions of the mucosa without ulcerations. Stage II is represented by superficial mucosal ulcerations with concomitant fine granular lesions. Stage III is characterised by deep mucosal ulcerations with granular tissue formation. In stage IV there are irreversible lesions leading to perforation of the cartilaginous nasal septum with necrosis. In stage V the nasal pyramid is compromised with alterations of facial features as a consequence of severe tissue destruction. These stages may be useful in characterising the severity of the lesion and optimising the therapeutic outcome.

ThreeLeishmania/L.species –L. infantum,L. major,L. tropica– as causative agents of mucosal leishmaniasis in Iran

“…Severity of the lesions was classified and scored based on the clinical appearance of the lesion. 9 In five cases with oral and one case with lower lip involvement, scraping from the lesions was performed by a scalpel. A cytobrush was used in one case of nasal mucosa and both cases of laryngeal ML.…”

“…In this PCR method we amplified all constant and variable regions of L. major, L. infantum, and L. tropica kDNA with 560, 680, and 720 bp size, respectively, using CSB2 primers. 9 The external primers CSB2XR…”

Correlation between presence of Leishmania RNA virus 1 and clinical characteristics of nasal mucosal leishmaniosis

“…At the initial stage, there is edema and anterior septal mucosa hyperemia, presence of nodules, and subsequent formation of a granulomatous lesion, which can evolve to septal perforation, nasal edema with skin thickening, nasal septum collapse (tapir nose), and bulky nasal pyramid. 8,10 More than 90% of mucosal injuries affect only the anterior nasal septum. 8,9,11 This condition can severely compromise the nose, palate, gums, pharynx, and larynx, causing deformities that impair phonation, breathing, swallowing, and self-esteem.…”

“…8,9,11 This condition can severely compromise the nose, palate, gums, pharynx, and larynx, causing deformities that impair phonation, breathing, swallowing, and self-esteem. 8,10,11 Factors related to the parasite, host, and magnitude of the immune response are relevant to mucosal damage. Metastases of the parasite to the upper aerodigestive tract mucosa can occur through lymphatic or hematogenous routes.…”

Detection of Leishmania RNA Virus in Leishmania Parasites

“…In South America, CL patients mainly infected by L. braziliensis , L. panamensis and L. guyanensis are at risk for developing mucosal (ML) or disseminated cutaneous leishmaniasis (DCL) [3], [4], [5], [6], which are complications of CL involving dissemination of parasites from primary lesions to secondary sites, with or without mucosal involvement, and causing lesions that are often associated with a highly destructive inflammatory response [7], [8], [9], [10]. Mucosal disease is notorious for its poor response to commonly used treatments, such as antimony, and is often complicated by secondary bacterial or fungal infections.…”