Case Report: Mucosal Leishmaniasis in New York City

Murray, Henry W.; Eiras, Daniel P.; Kirkman, Laura A.; Chai, Raymond L.; Caplivski, Daniel

doi:10.4269/ajtmh.19-0861

Cited by 6 publications

(4 citation statements)

References 21 publications

(52 reference statements)

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“…panamensis [12]. A number of case reports have also demonstrated the efficacy of treating ML and CL, including cases in the United States [12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

“…After miltefosine and pentavalent antimony, the last remaining treatment option for ML is Amphotericin B, which is typically reserved for refractory cases to meglumine antimoniate and miltefosine treatment [ 6 , 13 ]. This medication is known for a more severe side effect profile, specifically nephrotoxicity, anemia, and electrolyte disturbance [ 2 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical Diagnosis and Management of Mucosal Leishmaniasis in the Context of a Global Pandemic: A Case Report

Carotenuto¹,

Albers²,

Hankins³

et al. 2022

Cureus

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Mucosal leishmaniasis (ML) is a rare metastatic complication of Leishmania infection. It has a high potential for destructive and disfiguring complications, namely destruction of nasal architecture and airway compromise. ML is difficult to treat for a variety of reasons, including variable antimicrobial resistance rates between species, as well as between endemic areas geographically. There are several treatment options available, which are discussed here. In the majority of cases, a nuanced approach to treatment is required based on speciation and geography. Importantly, the treatment of ML requires a multi-disciplinary approach. We present a patient with a history of cutaneous leishmaniasis who presented with signs and symptoms concerning ML, but due to the COVID-19 global pandemic diagnostic testing was not possible, was treated empirically under clinical suspicion of ML with good results.

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“…panamensis [12]. A number of case reports have also demonstrated the efficacy of treating ML and CL, including cases in the United States [12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Clinical Diagnosis and Management of Mucosal Leishmaniasis in the Context of a Global Pandemic: A Case Report

Carotenuto¹,

Albers²,

Hankins³

et al. 2022

Cureus

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“…A relook at the previously developed clinical scoring system [ 14 ] may be now worthwhile based on regional differences. Though the possibility of visceralization or mucosal tissue localization was not indicated in this focus [ 46 – 48 ], this risk cannot be completely disregarded at least in a minority. Adequate patient follow-up is desirable.…”

Section: Discussionmentioning

confidence: 99%

First Evidence from Sri Lanka for Subphenotypic Diversity within L. donovani-Induced Classical Cutaneous Leishmaniasis

Siriwardana

Deepachandi

Weerasinghe

et al. 2021

BioMed Research International

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Sri Lanka reports a large focus of Leishmania donovani-induced cutaneous leishmaniasis (CL) with CL as the main clinical entity. Two independent, long existed, and clinicoepidemiologically different transmission foci in the northern region (NR) and southern region (SR) were recently reported. Current project is an extension to this previous study. Clinical diversity within a profile of classical cutaneous leishmaniasis (CCL) in a focus of L. donovani-induced CL is described for the first time. Patients with laboratory confirmed CCL ( n = 550 ) from NF and SF were evaluated. Lesions in both foci were found to have all classical developmental stages (small and large nodules, ulcerating nodules, and ulcers) and other identified changes (multiplication, ulceration, and enlargement). Main difference was in the proportions of lesions progressing in to each different stages, proportions of lesion undergoing the main changes, and in timing of these changes during the course of a lesion. Northern focus reported a smaller proportion of lesions showing enlargement and ulceration, and a longer period of time was also required for these changes when compared to same in southern focus. In northern focus, most lesions remained small and nonulcerating and showed a higher tendency to multiply while most lesions reported in southern focus enlarged and ulcerated rapidly and remained single. Current study also evidenced a wider spectrum in the rate and pattern of progression of a skin lesion and high individual variation which could mask these region-based differences. Parasitic, vector-related, or a host etiology is suggested. Slow progressing nonulcerating infections in North may be the result of a well-adopted parasite strain that coevolved with its host for a long period while inducing only a minimal host response. This could be one among many reasons for previously observed silent expansion in northern focus while southern focus remained more confined and stable over time. Small nonprogressive, nondisturbing lesions can play a major role as silent parasite reservoirs in a community. In addition, the laboratory detection rate declined significantly when lesions multiplied and enlarged indicating the need for early laboratory confirmation. Usefulness of identified features in clinical screening and management needs to be considered.

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“…The most common destinations associated with a subsequent leishmaniasis diagnosis were Bolivia 156 (18%), Costa Rica 97 (11%), Afghanistan 60 (7%), Spain 54 (6%), and Peru 49 (6%); for mucosal leishmaniasis (ML), travel to Bolivia and Peru was associated with most ML cases and mainly seen in tourists as demonstrated in 29 cases (72.5%) [ 49 ]. A recent case series and review of mucosal leishmaniasis in the U.S. involved eight civilians and three military personnel; it is most certainly an underestimate, but an important reminder that ML can occur in travelers even remotely following the presumed period of exposure [ 50 ].…”

Section: Human Leishmaniasis: Epidemiology In the United Statesmentioning

confidence: 99%

Leishmaniasis in the United States: Emerging Issues in a Region of Low Endemicity

Curtin

Aronson

2021

Microorganisms

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Leishmaniasis, a chronic and persistent intracellular protozoal infection caused by many different species within the genus Leishmania, is an unfamiliar disease to most North American providers. Clinical presentations may include asymptomatic and symptomatic visceral leishmaniasis (so-called Kala-azar), as well as cutaneous or mucosal disease. Although cutaneous leishmaniasis (caused by Leishmania mexicana in the United States) is endemic in some southwest states, other causes for concern include reactivation of imported visceral leishmaniasis remotely in time from the initial infection, and the possible long-term complications of chronic inflammation from asymptomatic infection. Climate change, the identification of competent vectors and reservoirs, a highly mobile populace, significant population groups with proven exposure history, HIV, and widespread use of immunosuppressive medications and organ transplant all create the potential for increased frequency of leishmaniasis in the U.S. Together, these factors could contribute to leishmaniasis emerging as a health threat in the U.S., including the possibility of sustained autochthonous spread of newly introduced visceral disease. We summarize recent data examining the epidemiology and major risk factors for acquisition of cutaneous and visceral leishmaniasis, with a special focus on implications for the United States, as well as discuss key emerging issues affecting the management of visceral leishmaniasis.

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Case Report: Mucosal Leishmaniasis in New York City

Cited by 6 publications

References 21 publications

Clinical Diagnosis and Management of Mucosal Leishmaniasis in the Context of a Global Pandemic: A Case Report

Clinical Diagnosis and Management of Mucosal Leishmaniasis in the Context of a Global Pandemic: A Case Report

First Evidence from Sri Lanka for Subphenotypic Diversity within L. donovani-Induced Classical Cutaneous Leishmaniasis

Leishmaniasis in the United States: Emerging Issues in a Region of Low Endemicity

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