Localized Mucosal Leishmaniasis due to Leishmania (Leishmania) infantum

Abstract

The clinical and microbiologic characteristics of 31 patients with mucosal leishmaniasis due to Leishmania (Leishmania) infantum are described. Twenty-eight (90%) patients were male. Mean age at presentation was 48 +/- 14 years. Thirteen (42%) patients had no underlying disease, while 18 (58%) patients had several other medical conditions. Fifteen (48%) patients were immunocompromised, 7 patients were infected with human immunodeficiency virus (HIV), and 3 were graft recipients. The primary location of lesions was the larynx in 11 (35%) patients, oral mucosa in 10 (32%) patients, and the nose in 5 (16%) patients. Mucosal lesions were painless in all patients but 2 and consisted of whitish, red, or violaceous nodular swelling or tumorlike masses. Ulceration was reported in 6 patients. Pathologically, the lesions showed a chronic inflammatory infiltrate. Granuloma may be seen. The localization of the lesions determined the symptomatology of the disease. Symptoms included hoarseness, difficulty swallowing, and nasal obstruction. The disease presentation was usually protracted, with a mean time from the onset of symptoms to diagnosis of 13 months (range, 3 wk-4.5 yr), and the clinical diagnosis was usually mistaken for neoplasia of the upper aerodigestive tract. No laboratory abnormalities were found in these patients due to the localized disease, apart from those attributed to underlying diseases. Parasites were easily identified in smears or sections by Giemsa stain or hematoxylin-eosin stain. Leishmania was grown in culture in 12 (60%) patients; culture was negative in 8 (40%) patients. Leishmania (Leishmania) infantum was identified in only 9 instances. The following zymodemes were reported: MON-1 (2 patients), MON-24 (2 patients), MON-27 (1 patient), and MON-34 (1 patient). Serologic test results were known in 25 patients. Serology was usually positive at low titer; 6 (24%) patients had negative serologic test results. Twenty patients were treated with antimonial compounds for between 3 and 36 days. Three patients were given drugs other than antimonial drugs. Five patients were treated only locally, by surgery (3 patients) or topical medical therapy. One patient received no therapy, and treatment was not reported in 2 cases. Patients were cured in 25 (89%) cases, and sequelae were uncommon (14%). Relapse was detected in 2 individuals and 1 patient developed visceral leishmaniasis after treatment. Two HIV-coinfected patients died of causes unrelated to leishmaniasis. The results of the present report stress the clinical importance of searching for the presence of Leishmania in patients with suspected neoplasia of the upper respiratory tract if they have visited or resided in zones endemic for Leishmania (Leishmania) infantum. The treatment of choice for these patients is not established yet, but most patients respond to antimonial compounds given for 28 days or less.

Exclusive Primary Lesion of Oral Leishmaniasis with Immunohistochemical Diagnosis

“…However, in the current review (Table 1), we found that leishmaniasis with exclusive primary involvement of the oral mucosa was more frequent in immunocompetent patients (14 cases, 70.0 %). In immunocompromised patients, we found 6 cases (31.6 %), with 3 (15.8 %) in HIV-positive patients [3,6] and diabetes, kidney transplant, and corticotherapy with one case each [5][6][7]. Interestingly, in all cases that were difficult to diagnosis, the patients were HIV-negative, whereas in HIVpositive patients the parasite was easily visualized in the tissues.…”

“…We found only 19 cases of leishmaniasis, with involvement reported exclusively in the oral area in the English-language literature [3][4][5][6][7][8][9][10][11][12][13], and 6 cases in immunocompromised patients [3,[5][6][7]. These lesions usually appear as erythema and ulceration or as plaque, papules, and/or exophytic nodules, usually affecting the hard or soft palate and tongue.…”

“…These lesions usually appear as erythema and ulceration or as plaque, papules, and/or exophytic nodules, usually affecting the hard or soft palate and tongue. However, they can affect any site such as the lip, uvula, gingiva, tonsil, and retromolar region [5,6,9,11].…”

Leishmaniasis mucosa nasolaringotraqueal en un adolescente

“…13 Los hallazgos endoscópicos de la leishmaniasis laríngea incluyen ulceración transglótica bilateral, edema perilesional, 3 hipertrofia de bandas ventriculares, 1,14 masas exofíticas de apariencia granular, 14 vegetación ulcerada y granulomas en cuerdas vocales. 5,14 En nuestro paciente, se encontró hipertrofia de la epiglotis y edema glótico y ocupación de la vallécula.…”

“…5,6 Se han documentado casos secundarios a la reactivación de la forma visceral por Leishmania donovani e infantum. 7 Hasta el 3% de las formas cutáneas por Leishmania braziliensis afectan las mucosas concomitantemente o después de 2 años de la remisión, como resultado de la diseminación linfohematógena del parásito.…”