Final diagnosis of 86 cases included in differential diagnosis of American tegumentary leishmaniasis in a Brazilian sample: a retrospective cross-sectional study

Abstract

BackgroundCutaneous leishmaniasis is distributed worldwide, including Brazil. Its several clinical forms need to be distinguished from other dermatoses. Clinical similarities and lack of a gold standard diagnostic tool make leishmaniasis-like lesions a challenging diagnosis.Objectives.To report the final diagnosis of patients primarily suspected of having American tegumentary leishmaniasis (ATL).Methods.A retrospective cross-sectional study was conducted on the basis of medical records of 437 patients with clinical suspicion of ATL, registered in electronic hospital system between 1980 and 2013. Demographic, clinical, and laboratory data were compiled.Results.Analysis of 86 cases (19.7%) registered as ATL in one of the hypothesis revealed a different final diagnosis; 55 (63.9%) and 31 cases (36.1%) had skin and mucosal lesions, respectively. In 58 cases (67.4%), the requested PCR did not identify Leishmania sp. In 28 cases (32.5%), biopsies established the diagnosis and confirmed tumors, mycobacteriosis, and subcutaneous or systemic mycosis. Overall, 27% of the cases had inflammatory etiology, mainly nasal nonspecific inflammatory processes; 27% had infectious etiology, especially paracoccidioidomycosis and leprosy; 20% had neoplastic etiology, mainly basal and squamous cell carcinoma; 15% had miscellaneous etiology, including neuropathic ulcer, traumatic ulcers, idiopathic ulcer; 11% missed the follow-up.Study limitationsSome cases had no final diagnosis due to loss of follow-up.Conclusion.ATL can be confused with several differential diagnoses, especially inflammatory and infectious granulomatous diseases as well as non-melanoma skin cancers. Clinicians working in tropical areas should be aware of the main differential diagnosis of leishmaniasis-like lesions.

Differentiation of mucosal lesions in mucocutaneous leishmaniasis and paracoccidioidomycosis

“…The injury in mucosa may result in sequelae due to fibrosis, leading to anatomic and functional alterations in the affected sites [ 4 , 8 ]. A study performed in Brazil indicated that paracoccidioidomycosis was the main differential diagnosis of infectious etiology for leishmaniasis [ 9 ]. Therefore, the establishment of a correct and timely diagnosis is essential to avoid complications in both diseases.…”

Accuracy of diagnostic tests for American tegumentary leishmaniasis: a systematic literature review with meta‐analyses

“…The same can occur with cases of VL and Leprosy [60] and with the adoption of IFR and cytometry. Thus, it is essential that specific antigens be developed and that, in the case of application of these tests in clinical practice, a differential diagnosis be made [7]. In relation to cytometry, although the technique has also shown high sensitivity and specificity and presents advantages over other enzyme immunoassays [61], it is costly and requires specialised technicians to perform the cytofluorometric method.…”

“…Regarding smear slide and histopathology, their low sensitivity values can be attributed to lesion chronicity, in which macrophages tend to reduce their load or disappear. Moreover, there may also be an observation bias in the examiner of the material to be analysed [7,62]. The direct examination technique is widely used by the Brazilian public health service because of its low cost and for being widely available in endemic areas.…”

“…The lesions may not be evident, or may spread affecting the skin and mucous membranes [6]. The diagnosis of ATL is complex and must consider the epidemiological context and the need for differentiation from granulomatous dermatoses [7]. In laboratory analysis, the main diagnostic methods use detection of cellular or humoral immune responses to Leishmania infection, in addition to the presence of the parasite or its genetic material.…”

Economic impact of localized cutaneous leishmaniasis on adult patients of a referral service in Belo Horizonte, Minas Gerais State, Brazil

“…Health managers should pay special attention to professionals inability in performing CL diagnostic exams, especially in the primary health care centers 20 . The differential diagnosis of CL are still challenging for physicians because of the wide number of dermatological diseases with similar clinical manifestations 21 and the lack of access to material and technical resources (including the Montenegro test, surgical material, and resources for biopsy and parasitological examination). Moreover, the scarcity of electrocardiogram and laboratory equipment to perform the necessary tests for monitoring toxicity hampers patients' treatment near their home.…”