Peripheral Nerve Involvement in Cutaneous Leishmaniasis (Old World)

Kubba, Raj; Elhassan, Ahmed M.; Al-Gindan, Yussuf; Omer, Awad; Bushra, Mehmoud; Kutty, Methil Kannan

doi:10.1111/j.1365-4362.1987.tb02295.x

Cited by 35 publications

(29 citation statements)

References 9 publications

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“…[6][7][8]12 In the present case, the lesion was macroscopically detectable as a granuloma. Histological examination showed free amastigotes inside the granuloma and many macrophages infected with leishmania amastigotes were well recognizable.…”

mentioning

confidence: 66%

Paraparesis Caused by Vertebral Canal Leishmaniotic Granuloma in a Dog

Cauduro¹,

Favole²,

Lorenzo³

et al. 2011

Veterinary Internal Medicne

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A 7-year-old male Shih Tzu was examined because of acute onset of abnormal gait in pelvic limbs. Physical examination revealed pain at the level of the lumbar spine, paraparesis, ataxia, and decreased postural reactions in pelvic limbs. Muscle tone was normal. Normal patellar and cranial tibial reflexes were normal but flexor reflex was mildly reduced in the left pelvic limb. The neuroanatomic diagnosis was a focal or diffuse lesion between T 3 -L 3 . Hematologic and serum biochemical analysis revealed severe anemia (RBC 3.9, HB, HCT 27.5,, and on the following day paraparesis and ataxia increased.Bone marrow biopsy performed under general anesthesia at the level of humerus head revealed a leishmaniasis infection, with a high presence of amastigotes. Bone marrow plasmacytosis was present and numerous histiocytes containing Leishmania spp. were evident. Leishmania spp. were detected extracellulary microscopically. IFA titre for Leishmania was 4320. PCR for Ehrlichia and Borrelia spp. were negative.An MRI study was performed with an open permanent magnet operating in 0.2 T (ESAOTE). The study included T1-weighted spin echo (SE) sequences [800/26/ 3; repetition time (TR) echo time (TE)], T2-weighted SE sequences (3000/100/1; TR/TE), gadoliniumdimeglumide (0.5 mmol/mL, GE Healthcare Omniscan, Paderno Dugnano, Milan, Italy) enhanced T1-weighted SE sequences (gadolinium chelate dose was 0.1 mmol/kg, IV), in the 3 orthogonal planes, and Gradient echo STIR sequences (1490/25/1; TR/TE/IR).The MRI revealed the presence of an extradural mass ventral to the spinal cord and lateralized to the left localized on the L 4 -L 5 intervertebral disk to the midbody of L 5 , displacing the spinal cord. The lesion was hyperintense on T1-weighted, T2-weighted, and STIR images, and had heterogeneous postconstrast enhancement (Fig 1).As neurological signs were rapidly progressing, surgery was performed to decompress the spinal cord by means of a left L 4 -L 5 hemilaminectomy, an ill-defined extradural mass, located ventrolaterally, was identified. The mass was yellow and hardly distinguishable from the epidural fat, neither encapsulated nor adhesive and with friable appearance. The diseased tissue was then removed and fixed in 10% buffered formalin.After surgery, cephalosporine (20 mg/kg PO q12h for 10 days) and prednisolone (0.5 mg/kg PO q12h for 5 days) were administered.The surgically removed tissue consisted of epidural fat tissue heavily infiltrated by macrophages, lymphocytes, plasma cells, and neutrophils. Proliferation of capillaries and scattered hemorrhages were also seen. The cytoplasm of many foamy macrophages contained multiple Leishmania amastigotes (Fig 2). The parasites were also identified free within the interstitium. The organisms were strongly labeled by immunohistochemical staining by the streptavidin-biotin immunohistochemical method with canine hyperimmune serum as the primary antibody.

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mentioning

confidence: 66%

Paraparesis Caused by Vertebral Canal Leishmaniotic Granuloma in a Dog

Cauduro¹,

Favole²,

Lorenzo³

et al. 2011

Veterinary Internal Medicne

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“…In addition, amastigotes were found in dermal nerves in 3 out 12 active lesions in which the neural pattern was detected. These findings could be related to the fact that cutaneous ulcer is painless (Kubba et al 1987, Satti et al 1989. Neural structures were not found in the dense connective tissue of scar lesions.…”

Section: Discussionmentioning

confidence: 89%

Leishmanial antigens in the diagnosis of active lesions and ancient scars of American tegumentary leishmaniasis patients

Schubach

Cuzzi-Maya

Oliveira

et al. 2001

Mem. Inst. Oswaldo Cruz

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Cutaneous biopsies (n = 94) obtained from 88 patients with American tegumentary leishmaniasis were studied by conventional and immunohistochemical techniques. Specimens were distributed as active lesions of cutaneous leishmaniasis (n = 53) (Group I), cicatricial lesions of cutaneous leishmaniasis (n = 35) (Group II) and suggestive scars of healed mucosal leishmaniasis patients (n = 6) (Group III). In addition, active cutaneous lesions of other etiology (n = 24) (Group C1) and cutaneous scars not related to leishmaniasis (n = 10) (Group C2) were also included in the protocol. Amastigotes in

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“…Regarding cutaneous leishmaniasis (CL), a report investigating associated distal nerve involvement in cutaneous lesion biopsy specimens in the 14 affected biopsies described an overallperineural inflammatory cell infiltrate consisting of either lymphocytes or a mixture of lymphocytes, plasma cells, and macrophages [25]. In this report, four patients had inflammatory cell invasion of the nerves (neuritis), and in one of them the inflammation was granulomatous and associated with nerve destruction.…”

Section: Historical Case Reports Of Neurologic Manifestations During mentioning

confidence: 85%

“…Amastigotes were seen inside the perineural sheath in two patients. Sensory testing of 50 consecutive patients with cutaneous leishmaniasis identified two patients with diminished sensations in the area of their CL lesions [25]. A study of hyperesthetic CL patients with follow-up mechanistic studies using L. major infection in BALB/c mice, nerve sheath inflammation and parasites within the perineural space occurred with some frequency, though nerve inflammation did not correlate with persistence of the cutaneous lesion [46].…”

Section: Historical Case Reports Of Neurologic Manifestations During mentioning

confidence: 99%

“…There are historical [5] and recent reports [1] of both CNS and ocular alterations with visceral leishmaniasis (VL), particularly. In addition to CNS manifestations, there have been studies indicating localized peripheral nerve deficits with cutaneous leishmaniasis [25]. On the whole, neurologic manifestations may occur with Leishmania infection much more frequently than discussed in overview descriptions of this complex infectious disease process.…”

Section: Introductionmentioning

confidence: 99%

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Neurologic Manifestations ofLeishmania spp.Infection

Petersen¹,

Greenlee²

2011

J. Neuroparasitolog.

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When listing common clinical signs of the spectra of Leishmania-derived diseases, neurologic malfunctions are not commonly included. Despite this, there are multiple reported instances both in human and veterinary medicine where neurologic manifestations, whether central or peripheral, are described. In this review, we describe neurologic manifestations seen during infection with Leishmania spp. with some discussion of the implicit effect of inflammation on the blood brain barrier in both medical and veterinary cases. Taken together, the material discussed here suggests that in patients from Leishmania-endemic areas, when observing neurologic symptoms, causation secondary to infection with Leishmania spp. should be highly considered.

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Peripheral Nerve Involvement in Cutaneous Leishmaniasis (Old World)

Cited by 35 publications

References 9 publications

Paraparesis Caused by Vertebral Canal Leishmaniotic Granuloma in a Dog

Paraparesis Caused by Vertebral Canal Leishmaniotic Granuloma in a Dog

Leishmanial antigens in the diagnosis of active lesions and ancient scars of American tegumentary leishmaniasis patients

Neurologic Manifestations ofLeishmania spp.Infection

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