Mucosal leishmaniasis: A Retrospective Study of 327 Cases from an Endemic Area of Leishmania (Viannia) braziliensis

Abstract

Mucosal leishmaniasis (ML) is observed only in about 3% of patients with American tegumentary leishmaniasis (ATL) but has a high potential for destructive, disfiguring, and disabling sequelae. Prior reports of clinical and epidemiologic features of ML are limited by small numbers of cases. In this study, we evaluated changes in the demographic features and clinical presentation of ML in an endemic area of transmission over a period of 20 years. The charts of 327 patients with ML diagnosed between 1995 and 2014 were reviewed. The majority of patients (67%) were male. Age ranged from 8 months to 103 years, with a median age of 38.5 years (interquartile range: 22-58 years). The greatest number of patients was between 19 and 39 years (31%). Over the study period, there was an increase in patients with ML more than 60 years of age, an increase in ML with concomitant cutaneous lesions, a decrease in the period of time between the documentation of cutaneous lesions and the diagnosis of mucosal disease, and an increase in the frequency of patients presenting with stage I and V of ML. Moreover, there was a positive correlation between severity of mucosal disease and both age and the period of time between cutaneous lesion and mucosal disease. Response to therapy of ML remained similar over a period of 20 years. Despite the improvement in medical care during the study period, the prevalence of ML did not change and severe disease continues to be a major challenge for the management of these patients.

Differentiation of mucosal lesions in mucocutaneous leishmaniasis and paracoccidioidomycosis

“…Leishmaniasis was associated with lesions affecting the nasal region, a common finding in previous studies as well [ 6 , 7 , 17 , 18 , 19 ]. It appears that a lower temperature in this area favors the local installation of the parasite [ 3 ] and diminishes the potential of macrophages to perform phagocytosis [ 7 ], contributing to the high frequency of injuries in the external nose.…”

Successful treatment by adding thalidomide to meglumine antimoniate in a case of refractory anthroponotic mucocutaneous leishmaniasis

“…Leishmaniasis in Iran is mainly caused by three species; L. major , L. tropica and L. infantum . L. major and L. tropica are associated with cutaneous leishmaniasis (CL) whereas L. infantum can cause visceral leishmaniasis (VL) (Cincurá et al, 2017). Mucosal leishmaniasis (ML) is mostly associated with L. brazilliens (Cincurá et al, 2017).…”

Case Report: Mucosal Leishmaniasis in New York City

“…[1][2][3][4][5][6] Among at least four New World species capable of involving the nasal, oropharyngeal, and/or laryngeal mucosa, L. (V.) braziliensis has been best studied and is particularly well recognized for involving the nasal mucosa (in > 90% of cases). 15 Isolated involvement of the uvula and surrounding soft palate or subsequently the larynx alone, as in Patient 2, is unusual. 15 Similar to Patient 2, the majority of those with New World ML have evidence of prior or concomitant cutaneous infection; however, as many as 20% do not, 15 raising the possibility of inapparent skin infection caused by parasite strains with particular tropism for mucosal sites.…”

“…15 Isolated involvement of the uvula and surrounding soft palate or subsequently the larynx alone, as in Patient 2, is unusual. 15 Similar to Patient 2, the majority of those with New World ML have evidence of prior or concomitant cutaneous infection; however, as many as 20% do not, 15 raising the possibility of inapparent skin infection caused by parasite strains with particular tropism for mucosal sites. In addition and like Patient 2's experience, having received prior pentavalent antimony treatment for CL does not necessarily prevent the subsequent development of ML.…”