Ocular Leishmaniasis - A systematic review

Abstract

The incidence of leishmaniasis is reported to be up to 1 million per year. To date, there has been no comprehensive review describing the diversity of clinical presentations of ocular leishmaniasis (OL) and its treatment. This systematic review aims to address this knowledge gap and provide a summary of the clinical presentation, natural course, and treatment options for OL. Our study identified a total of 57 published articles as describing cases of OL involving: adnexa ( n = 26), orbit ( n = 1), retina ( n = 7), uvea ( n = 18) and cornea ( n = 6). Though well described and easily treated, palpebral leishmaniasis is often misdiagnosed and may lead to chronic issues if untreated. The retinal manifestations of Leishmaniasis consist of self-resolving hemorrhages secondary to thrombocytopenia. Two main uveitis etiologies have been identified: uveitis in the context of active Leishmanial infection (associated with immunosuppression) and uveitis occurring as an immune reconstitution syndrome. Corneal involvement in most geographic areas generally follows an aggressive course, most often ending in corneal perforation if left untreated. In the Americas, a chronic indolent interstitial keratitis may also occur. Topical steroids are of little use in keratitis (systemic antileishmanials being the cornerstone of treatment). However, these are essential in cases of uveitis, with or without concomitant systemic antileishmanial therapy. In conclusion, though ocular involvement in Leishmaniasis is rare, severe sight-threatening consequences follow if left untreated. Early diagnosis, enthusiastic follow-up and aggressive treatment are essential for good outcomes.

Unusual Observations in Leishmaniasis—An Overview

“…Chronic and erosive ulcerations are suspected to be capable of leading to the development of diseases including chalazion, tuberculosis, syphilis, sarcoidosis and basal cell carcinoma [ 146 ]. The differential diagnosis for ocular leishmaniasis includes pterygium, chronic blepharitis, cell carcinoma, impetigo and histoplasmosis [ 147 ]. The haired and bald scalp and palm are other unusual sites that can be affected by CL [ 148 , 149 ].…”

The roles of autophagy and mitophagy in corneal pathology: current knowledge and future perspectives

“…Ocular manifestations of Leishmaniasis, known as Kala-Azar, mainly affects the retina (198). In cutaneous Leishmaniasis caused by bite near the eyelid, blepharoconjunctivitis, dacryocystitis, and even keratitis can develop (199,200). In the case of corneal disease, if not adequately (201).…”

Leishmaniose Ocular Canina: Uma Revisão Das Manifestações Clínicas, Diagnóstico E Tratamento

“…Atualmente estimase que mais de 1 bilhão de pessoas estejam sob o risco de infecções em áreas endêmicas (WHO, 2021). Apesar de ser considerada multifatorial, estando atribuída a ocorrência de lesões cutâneas e ao comprometimento visceral grave, recentemente tem sido revelado novas particularidades clínicas dessa doença (OLIVEIRA et al, 2010;SANTOS et al, 2017;MACHADO et al, 2019;MIGNOT et al, 2021). em seres humanos e animais, acometendo de 20 a 81% dos pacientes (MAUDE et al, 2014;DOWER et al, 2020).…”

“…Como consequência, os hospedeiros infectados podem apresentar alterações oculares (Figuras 1, 2 e 3) como blefarospasmo, blefarite, uveíte, ceratite, ceratouveíte, ceratoconjuntivites, granulação e edema corneal, erosões epiteliais, úlceras, neovascularização, hiperemia conjuntival, secreção ocular, descamação e alopecia periocular (GONTIJO et al, 2002;DOWER et al, 2020;RICCI, 2018). O diagnóstico dessa enfermidade geralmente é realizado através dos achados clínicos, atrelados a técnicas convencionais de sorologia, imunologia e biologia molecular ( VAN et al, 2015;DI PIETRO et al, 2016;MIGNOT et al, 2021). Contudo, recebem um enfoque maior a associação de procedimentos que permitem a detecção direta das amastigotas de Leishmania sp.…”