ThreeLeishmania/L.species –L. infantum,L. major,L. tropica– as causative agents of mucosal leishmaniasis in Iran

Abstract

Cases of human oro-mucosal leishmaniasis are mainly reported in areas where Leishmania (Viannia) braziliensis perpetuates and the damages are mainly located at the cartilaginous nasal septum and frontal portions of the nasal fossa. In Iran, an area free of any L.(V) braziliensis, three Leishmania species are known to perpetuate through distinct (i) blood-feeding sand flies and (ii) rodents or (iii) canidae. Thus while establishing the diagnosis of any human oro-mucosal lesions, three Leishmania species -L. infantum, L. major, and L. tropica -must be considered as potential etiological agents of these damages. With these objectives in mind, features such as localization, extent, severity of oro-mucosal lesions, and duration of symptoms at the time of diagnosis were recorded from 11 patients with respect to the presence or absence of cutaneous lesions in other body parts. The biopsy samples were collected from the oromucosal and cutaneous lesions and were processed for further identification of the Leishmania species. The lesions ranged from mucosal nodules without ulceration, nodules with erosion, and shallow to deep ulcerations. Leishmania major was isolated from six (55%) cases showing lesions or scars. The scars were restricted to upper and lower extremities. For the other five patients who did not display any signs of former or active cutaneous leishmaniasis, L. major, L. tropica, and L. infantum were isolated from their lesions. In conclusion L. major, L. infantum, and L. tropica, regardless of common tropism, can be seen in mucosal tissues. However, L. major was the predominant species detected from the lesions in the nasal, gingival, and hard and soft palates, and L. tropica was isolated from the gingival and lower lip lesions. Leishmania infantum was isolated from two severe cases of deep mucosal damage displayed by the epiglottis, cricoarytenoid muscle, and laryngeal mucosa. One important finding was the association of L. major with active or scarred skin lesions.

Lip Leishmaniasis in Saudi Arabia: A Typical Presentation of Cutaneous Leishmaniasis

“…The causative agent was typed biochemically and proved to be Leishmania tropica. A study conducted in Iran revealed that, L. tropica was detected from the lesions present in the gingiva and lower lip of two cases having mucosal nodules and erosion (Shirian et al, 2013).…”

A Case- Study of Mucosal Leishmaniasis in the Lip

“…Lip lesion is seldom mentioned as presentation of cutaneous leishmaniasis in Iran (5,6). Leishmaniasis may have various presentations, and factors affecting the disease spectrum include species and number of parasites, site of bite, and also nutritional status of the patient and the immune status (5,6).…”

“…Leishmaniasis may have various presentations, and factors affecting the disease spectrum include species and number of parasites, site of bite, and also nutritional status of the patient and the immune status (5,6). Leishmaniasis of the skin may occur anywhere on the body but the usual sites are the exposed parts.…”

“…Traditionally, the term mucosal leishmaniasis refers to a potentially disfiguring sequel of the New World (America) cutaneous leishmaniasis those results from dissemination of parasites from the skin to the naso-oropharyngeal mucosa (3,4). Leishmaniasis is endemic in Iran (Old World diseases) that usually affects only the skin and mucosal involvement is rare (1,(4)(5)(6).…”

Progressive Perforation of the Nasal Septum Due to Leishmania major: A Case of Mucosal Leishmaniasis in a Traveler

“…There are reports about ML caused by Leishmania donovani, 2 Leishmania infantum, 3 Leishmania tropica, or Leishmania major. [4][5][6] So far only few cases of ML caused by L. major have been reported. One report described a case of ML of the lips in a young boy from Iran.…”