Cutaneous Leishmaniasis: An Overlooked Etiology of Midfacial Destructive Lesions

Abstract

BackgroundMidline destructive lesions of the face (MDL) have a wide range of etiologies. Cutaneous Leishmaniasis (CL) is rarely reported as a possible cause.MethodsFifteen patients with solitary nasal lesions caused by CL were studied. The clinical data, biopsies/scrapings and PCR were collected/performed. Ridley’s Pattern (RP) and Parasitic Index (PI) were documented.ResultsPatients’ age ranged from 1 to 60 years including 7 males and 8 females. The duration of the observed lesions ranged from 1 to 18 months. Clinically, the lesions showed 6 patterns varying from dermal erythematous papulonodular with no epidermal changes to destructive erythematous plaque with massive central hemorrhagic crust. The clinical impression ranged from neoplastic to inflammatory processes. RP varied among the cases [RP 3 (n = 6), RP 4 (n = 3), RP 5 (n = 6)]. All cases show low PI [PI 0 (n = 7), PI 1 (n = 6), PI 2 (n = 1), and PI 3 (n = 1)]. Higher PI was noted in the pediatric group [average age 24 years for PI 0–1 vs. 6.5 years for PI 2–3]. Molecular speciation showed Leishmania tropica (n = 13) and Leishmania major (n = 2). All the patients received Meglumine Antimoniate (Glucantine) injections and had initial cure defined as complete scarring and disappearance of inflammatory signs within 3 months.ConclusionLeishmaniasis may cause MDL especially in endemic areas. PCR is instrumental in confirming the diagnosis. MDL caused by CL showed wide spectrum of clinical and microscopic presentation.

Clinico-Epidemiological Patterns of Cutaneous Leishmaniasis Patients Attending the Anuradhapura Teaching Hospital, Sri Lanka

“…Dry type CL lesions were common in this study group, in agreement with previous studies conducted in Sri Lanka [12], India [30], Libya [31], and in Syria [32]. However, females had more wet lesions than males.…”

Socioeconomic, demographic and landscape factors associated with cutaneous leishmaniasis in Kurunegala District, Sri Lanka

“…Furthermore, the results of previous studies in Sri Lanka have indicated that P. argentipes is more likely to transmit the parasite to humans as outdoor bites [6]. As observed in the present study and previous studies [27,40,44], housewives are at risk of receiving infection. This may be due to their outside routine activities such as picking firewood, cleaning home gardens, washing clothes and bathing at outdoor water sources.…”

Cutaneous leishmaniasis: an evolving disease with ancient roots

“…On the other hand, some infections produced large lesions, invariably leaving the patient permanently scarred, a stigma probably causing serious social prejudice. We thus support the need to keep a high index for CL suspicion when faced with midline destructive lesions in endemic areas . This is crucial since nearly half of the cases affect patients under 18 years.…”

“…We thus support the need to keep a high index for CL suspicion when faced with midline destructive lesions in endemic areas. 20 This is crucial since nearly half of the cases affect patients under 18 years. Moreover, the condition's predilection to head and neck places it in proximity to vital sensory organs, threatening the patient with serious disability.…”