Oral Manifestations in the American Tegumentary Leishmaniasis

Abstract

IntroductionAmerican tegumentary leishmaniasis (ATL) can affect the skin or mucosa (mucocutaneous leishmaniasis – MCL) including the oral cavity. MCL oral lesions are often confused with other oral diseases, delaying diagnosis and specific treatment, and increasing the likelihood of sequelae. Thus, increasing the knowledge of the evolution of ATL oral lesions can facilitate its early diagnosis improving the prognosis of healing.ObjectivesEvaluate the frequency of ATL oral lesion and describe its clinical, laboratory and therapeutic peculiarities.MethodsA descriptive transversal study was carried out, using data from medical records of 206 patients with MCL examined at the outpatient clinics-IPEC-Fiocruz between 1989 and 2013. Proportions were calculated for the categorical variables and the association among them was assessed by the Pearson's chi-square test. Measures of central tendency and dispersion were used for the continuous variables and their differences were assessed by both parametric (t test) and non parametric (Mann-Whitney) tests. P-values <0.05 were considered as significant.ResultsThe most affected site was the nose, followed by the mouth, pharynx and larynx. Seventy eight (37.9%) have oral lesions and the disease presented a lower median of the evolution time than in other mucous sites as well as an increased time to heal. The presence of oral lesion was associated with: the presence of lesions in the other three mucosal sites; a smaller median of the leishmanin skin test values; a longer healing time of the mucosal lesions; a higher recurrence frequency; and a smaller frequency of treatment finishing and healing. When the oral lesion was isolated, it was associated with an age 20 years lower than when the oral lesion was associated with other mucosal sites.ConclusionConsidering the worst therapy results associated with the presence of oral lesions, we suggest that lesions in this location represent a factor of worse prognosis for MCL.

Low dose systemic or intralesional meglumine antimoniate treatment for American tegumentary leishmaniasis results in low lethality, low incidence of relapse, and low late mucosal involvement in a referral centre in Rio de Janeiro, Brazil (2001-2013)

“…Despite that, only 0.25% of the patients initially treated for CL developed ML. At NIID, all ATL patients, regardless of mucous membranes complaint, are systematically evaluated by endoscopic methods that allow early diagnosis and treatment of mucosal lesions, including patients erroneously referred to initially as CL cases ( Costa et al 2014 ). This may explain why the concomitant form (simultaneous presence of cutaneous and mucosal lesions) is the most common form of ML at NIID and consequently, in Rio de Janeiro State.…”

Factors Associated with Clinical and Topographical Features of Laryngeal Tuberculosis

“…Probably this symptom is undervalued by sick people who take longer to seek for medical attention. On the other hand, we observed that symptoms such as odynophagia occur with greater discomfort, decreased food intake and consequent weight loss which can reduce the time for seeking for medical help [ 26 , 27 ]. In the same manner, the lack of specific symptoms [ 3 ] and the insidious nature of LTB, together with the difficult access of patients to medical attention and specialized exams [ 14 ], may delay diagnosis.…”

“…However, similarly to Wang et al (2007), we found no evidence that the delay in the diagnosis predisposes the patient to larger laryngeal lesions [ 16 ]. It is possible that the extent of the laryngeal lesion is not necessarily part of the natural history of the disease, but a more serious outcome in some patients [ 26 ].…”

American tegumentary leishmaniasis: diagnostic and treatment challenges in a clinical case

“…This form is usually secondary to the cutaneous one when it is not correctly treated or is lef untreated, but, in rare cases, it can be primary 2 . In comparison with other mucosal sites, the mouth has a shorter evolution time 3 .…”