With approximately 1.3 million infections and more than 50,000 deaths every year, leishmaniasis is an important infectious disease that has an endemic status in the majority of Latin America, countries of the Mediterranean basin, the Middle East, and certain areas of Africa and Asia [1] [2] [3] [4] [5] [6]. The protozoan parasite Leishmania, the causative agent of leishmaniasis, is transmitted to the human host by the sand fly vector from a number of animal hosts (or other human hosts that are already infected, in which case the term anthroponotic leishmaniasis is used) [1] [3]. Mucocutaneous leishmaniasis is one of the three clinical forms (in addition to visceral and cutaneous) of this parasitic infection, distinguished by the onset of lesions on the skin and on mucous membranes as well [1] [2] [3] [4] [7] [8]. Certain Leishmania species (L. braziliensis, L. major, L. panamensis, L. guyanensis, L. infantum, and L. donovani) are known for their propensity to produce mucocutaneous forms that start with the development of an erythematous papule at the site of the sand fly bite [1] [3]. The face and the extremities are usually the locations of the initial lesion, which can appear weeks or even years after the bite [1] [3]. Over time, the papule increases in size and eventually breaks, leading to the formation of a painless, well-demarcated ulcer [1] [3]. Spontaneous resolution within a few months is seen in the majority of cases, but new lesions might appear at various sites on the body [1] [3]. The distinguishing feature of mucocutaneous leishmaniasis is the mucosal involvement, predominantly in the oral cavity and the nasopharynx [2] [8].

• Generalized Lymphadenopathy

  Exfoliative dermatitis, nodular dermatitis, ulcerative dermatitis generalized particularly involving extremities. [leishmaniasis.info]

  Other manifestations may include generalized lymphadenopathy; hyperpigmented skin of the forehead, abdomen, hands, and feet in light-skinned persons; skin lesions in dark-skinned persons; signs of bleeding (petechiae, epistaxis, bleeding gums); jaundice [wynman.com]

• Fever

  The main side effects were headache and fever (7 cases), together with leucopenia and eosinophilia (4 cases). [ncbi.nlm.nih.gov]

  [Dunglison1855] The Low Fever Typhus Mitior in Latin. [Hooper1822] Low Continued Fever Typhoid Fever, Febricula, Little Fever. [Symptom, Nature, etc. of the Febricula or Little Fever, Manningham, 1746]. [antiquusmorbus.com]

  Rickettsia Rickettsii and Other Spotted Fever Group Rickettsiae (Rocky Mountain Spotted Fever and Other Spotted Fevers) 188. Rickettsia Akari (Rickettsialpox) 189. Coxiella Burnetii (Q Fever) 190. [euro-libris.ro]

  Symptoms include fever (often 2 fever spikes per day), enlargement of the spleen and liver, weakness, and progressive emaciation. The disease is often fatal without treatment, but survivors often develop immunity. [msu.edu]

  It is characterized by irregular bouts of fever, substantial weight loss, swelling of the spleen and liver, and anaemia. [the-travel-doctor.com]

• Collapse

  Spikes of violence, isolation, closure of supply routes, and the near-collapse of the health system created obstacles to obtaining medical care. [msf.org]

  Collapse all Expand all Contexte Sur le continent américain, les leishmanioses cutanée et cutanéo‐muqueuse (LC et LCM) sont des maladies associées à l'infection par plusieurs espèces de parasites Leishmania. [cochranelibrary.com]

• Chronic Fatigue Syndrome

  Miscellaneous Syndromes 132. Chronic Fatigue Syndrome Part III Infectious Diseases and Their Etiologic Agents Section A. Viral Diseases 133. Biology of Viruses and Viral Diseases 134. [euro-libris.ro]

• Pneumonia

  [Webster1913] Lung Fever Catarrh, pneumonia. [Dunglison1868]. Lobar Pneumonia; Croupous Pneumonia. [The American Illustrated Medical Dictionary 1914]. Croupous pneumonia. [Gould1916]. [antiquusmorbus.com]

  Dis., 5, ‎ Seite 488 - C., and Gibert, C., Nosocomial pneumonia in patients receiving continuous mechanical ventilation: prospective analysis of 52 episodes with use of a protected specimen brush and quantitative culture techniques, Am. Rev. [books.google.de]

  Chlamydia Pneumoniae 184. Mycoplasma Pneumoniae and Atypical Pneumonia Section D. Mycoplasma Diseases 185. Genital Mycoplasmas: Mycoplasma genitalium, Mycoplasma hominis, and Ureaplasma Species Section E. [euro-libris.ro]

  There are no specific radiological findings: the severe mucosal and cartilaginous destruction and secondary infection may give rise to inhalation pneumonia. [isradiology.org]

  Advanced untreated visceral leishmaniasis can be fatal, particularly if other pre-existing conditions such as tuberculosis, pneumonia, and dysentry are present. Prevention Avoid outdoor activities from dusk to dawn. [iamat.org]

• Nasal Ulcer

  A 55-year-old man presented with a nasal ulcer of four years' duration. He had been treated for borderline lepromatous (BL) leprosy 25 years earlier. Differential diagnoses of MCL, lupus vulgaris, and subcutaneous mycosis were considered. [ncbi.nlm.nih.gov]

• Nasal Congestion

  A 35-year-old man with nasal congestion, swelling, and pain. N Engl J Med 2005;352:609-15. 3. Vera LA, Macedo JL, Ciuffo IA, Santos CG, Santos JB. [ijdvl.com]

• Pleural Effusion

  Empyema and Pleural Effusion 70. Lung Abscess 71. Chronic Pneumonia 72. Cystic Fibrosis Section D. Urinary Tract Infections 73. Urinary Tract Infections Section E. Sepsis 74. Sepsis, Severe Sepsis, and Septic Shock Section F. [euro-libris.ro]

• Jaundice

  Other manifestations may include generalized lymphadenopathy; hyperpigmented skin of the forehead, abdomen, hands, and feet in light-skinned persons; skin lesions in dark-skinned persons; signs of bleeding (petechiae, epistaxis, bleeding gums); jaundice [wynman.com]

• Arthralgia

  Myalgias, arthralgias, anorexia, nausea, and headache were the common adverse effects. [cochranelibrary.com]

  Chemical pancreatitis, nausea and abdominal pain, arthralgia and fatigue are common. ECG changes may occur. [patient.info]

  […] well as the pentad of fever, weight loss, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia Viscerotropic leishmaniasis: Nonspecific abdominal tenderness; fever, rigors, fatigue, malaise, nonproductive cough, intermittent diarrhea, headache, arthralgias [emedicine.medscape.com]

  Patients treated with nitric oxide releasing patch presented a significant lower proportion of non-serious adverse events such as fever, headache, myalgia, and arthralgia while those treated with meglumine antimoniate had a significant lower proportion [journals.plos.org]

  Treatment may have to be interrupted because of severe thrombocytopenia (very rare), increase of liver enzyme or amylase levels to more than 5 times normal values (rare), QTc prolongation and dysrhythmias (rare) or severe arthralgia. [antimicrobe.org]

• Skin Lesion

  The helper/suppressor (H/S) ratio in the skin lesions was 1.6 +/- 0.5 and in the nasal lesions of mucosal leishmaniasis was 1.7 +/- 0.8. [ncbi.nlm.nih.gov]

  Leishmaniasis Recidivans This term is used to define the recurrence of a skin lesion years after the initial lesion healed. [rarediseases.org]

  Sometimes lymphadenopathy is noticed, before skin lesions develop. Back To Top Ulcerative skin lesion, with a raised outer border, on a Guatemalan patient who has cutaneous leishmaniasis. (Credit: MERTU, Guatemala; courtesy of B. [cdc.gov]

• Skin Disease

  Mucocutaneous disease is due to extension of local skin disease into the mucosal tissue via direct extension, bloodstream or lymphatics. Lesions interest mainly the oral and nasal mucosa and occasionally the laryngeal and pharyngeal mucosa. [ncbi.nlm.nih.gov]

  Old World cutaneous leishmaniasis is a mostly self-limiting skin disease in adults, but depending on the species, infected infants and children can develop the visceral form of the disease. [iamat.org]

  On DermNet NZ Bugs Arthopod bites and stings Tropical skin diseases Other websites Leishmaniasis – pathology Leishmaniasis – Medline Plus Leishmaniasis – World Health Organization (WHO) Leishmaniasis – Medscape Reference Books about skin diseases See [dermnetnz.org]

  Leishmania infection can cause skin disease (called cutaneous leishmaniasis). [the-travel-doctor.com]

  [CancerWEB] Lepra The term lepra was formerly given to various skin diseases, the leprosy of modern authors being Lepra Arabum. [antiquusmorbus.com]

• Skin Ulcer

  Characteristics of both the human host and the parasite species influence the clinical disease manifestations that range from asymptomatic exposure, to self-healing skin ulcers, to life-threatening widespread destructive ulcerations. [ncbi.nlm.nih.gov]

  scaly skin, gray, dark, ashen hair, thinning Cutaneous leishmaniasis Symptoms on the skin include: macule or papule, erythematous skin ulcer, forms at site of original lesion ulcer heals very slowly over a matter of months smaller lesions may form around [the-travel-doctor.com]

  Cutaneous leishmaniasis Cutaneous ulcers will often heal without treatment. However, treatment can speed healing, reduce scarring, and decrease risk of further disease. Any skin ulcers that cause disfigurement may require plastic surgery. [healthline.com]

  cutaneous is characterized by development of single or multiple localized lesions on exposed areas of skin that typically ulcerate. [fpnotebook.com]

• Cutaneous Manifestation

  Yet the infrequency of mucocutaneous disease compared with cutaneous manifestations, and the difficulty of isolating parasites from mucocutaneous lesions have restricted the study of the organisms involved. [ajtmh.org]

  Therefore, these lesions can be confused with those found in Wegener's granulomatosis (which is also marked by cutaneous manifestations and can involve the nasal mucosa), leprosy, and tuberculosis. (9) Cultures and recombinant immunoenzymatic testing [the-medical-dictionary.com]

  Leishmania causes a spectrum of inflammatory cutaneous disease manifestations. [mdpi.com]

  The disease can be subacute, acute, or chronic, and can manifest in patients who are immunocompromised years after they have left endemic regions. [emedicine.medscape.com]

  Clinical manifestations Clinical manifestations of cutaneous leishmaniasis offer a wide spectrum of lesions, from a few small non‐ulcerated nodules observed in people in Central America due to L. [cochranelibrary.com]

• Disfiguring Scar

  Whether through medical treatment or through spontaneous resolution, skin ulcerations generally result in disfiguring scars with significant social and economic impact. [ncbi.nlm.nih.gov]

  Ulcerated lesions may lead to scarring and tissue destruction that can be disfiguring. [medicinenet.com]

  However, disease resolution can take several months and leave disfiguring scars [ 3 ]. In 2013, the World Health Organization (WHO) reported an estimated one million cases of LCL within the previous five years [ 1 ]. [mdpi.com]

  The scarring process could leave disfiguring sequelae. This could be extremely relevant for people with facial lesions, potentially affecting their quality of life. [cochranelibrary.com]

• Epistaxis

  Nasal obstruction and epistaxis are frequent presenting symptoms. [icd10data.com]

  Onychogryposis Muscular atrophy Ocular lesions: Keratitis Uveitis Chorioretinitis Corneal edema Glaucoma Epistaxis Polyarthritis – intermittent lameness. [leishmaniasis.info]

  […] erythematous skin ulcer, forms at site of original lesion ulcer heals very slowly over a matter of months smaller lesions may form around the ulcer (satellite lesions) Symptoms mucocutaneous L.include: nasal stuffiness runny nose (coryza) nosebleed ( epistaxis [the-travel-doctor.com]

  […] mucosa is the most commonly affected area and involvement of other mucosal sites is rare. [1] In patients with nasal mucosal involvement, the disease can begin with non-specific symptoms such as persistent nasal stuffiness, discharge, discomfort or epistaxis [ijdvl.com]

  Other manifestations may include generalized lymphadenopathy; hyperpigmented skin of the forehead, abdomen, hands, and feet in light-skinned persons; skin lesions in dark-skinned persons; signs of bleeding (petechiae, epistaxis, bleeding gums); jaundice [wynman.com]

A thorough clinical approach is necessary in order to make the diagnosis of mucocutaneous leishmaniasis. A meticulously obtained patient history should be the first step, during which the physician must bear in mind the country of residence and travel to endemic areas in the past several years, whereas a history of sand fly bites might be assessed as well. A properly conducted physical examination, with an emphasis on the inspection of the skin and the oral cavity, may be even more important for identifying the lesions seen in mucocutaneous leishmaniasis. To solidify clinical suspicion, however, several microbiological tests can be employed. Scrapings from the lesions are used for microscopic smear examination or cultivation, the former being a superior method due to the longer turnaround time of cultures (up to 10 days are necessary for Leishmania to grow on standard media) [3] [4]. A histological examination of a biopsy sample (using hematoxylin-eosin staining) can be carried out, but the introduction of serological and molecular studies have greatly improved the overall rate of diagnosis [3] [4]. The Montenegro's test, comprised of inoculating Leishmania antigen into the forearm, can yield conclusive results after 72 hours [3] [4] [8]. Polymerase chain reaction (PCR), although being expensive and more sophisticated compared to the previously mentioned methods, should be implemented whenever possible, primarily because of its very high sensitivity/specificity rates [3] [4] [9].

• Leishmania in Tissue

  In MCL, T cell responsiveness to Leishmania antigen further increases towards the hypersensitivity pole, resulting in tissue damage but low parasite burden. [mdpi.com]

• Pleural Effusion

  Empyema and Pleural Effusion 70. Lung Abscess 71. Chronic Pneumonia 72. Cystic Fibrosis Section D. Urinary Tract Infections 73. Urinary Tract Infections Section E. Sepsis 74. Sepsis, Severe Sepsis, and Septic Shock Section F. [euro-libris.ro]

CONCLUSION: Prolonged and high-dose treatment regimens with itraconazole are not effective for the treatment of the majority of patients with MCL. [ncbi.nlm.nih.gov]

CONCLUSION: A classification or staging system enhances the ability to evaluate patients with mucocutaneous leishmaniasis and determine more accurately their prognosis and treatment. [ncbi.nlm.nih.gov]

Restorative surgery may be required for severe cases The prognosis depends upon the promptness in providing appropriate treatment. [dovemed.com]

Clinical observations, with special reference to factors influencing prognosis, Rev. Infect. [books.google.de]

Midline destructive lesions have multiple possible etiologies, which can be grouped into neoplastic, infectious, or vasculitis-associated. [ncbi.nlm.nih.gov]

Individually and collectively, the identifying criteria implicate at least two L. braziliensis subspecies as etiologic agents of mucocutaneous leishmaniasis in Colombia and suggest that a spectrum of intrinsically distinguishable organisms may be involved [ajtmh.org]

S., Kuo, C., Berger, K., Shuster, JR, Overby, LR, Bradley, DW, and Houghton, M., An assay for circulating antibodies to a major etiologic virus of human non-A, non-B hepatitis, Science, 244, 362, 1989. ‎ [books.google.de]

[…] may appear on the tongue, buccal or nasal mucosa, and pharynx; many variants of the disease exist, marked by differences in distribution, vector, epidemiology, and pathology, which suggest that it may in fact be caused by a number of closely related etiologic [medical-dictionary.thefreedictionary.com]

The practical aims are to encourage the application of these and other molecular epidemiological methods in S. [cordis.europa.eu]

Abstract Leishmaniasis is a parasitosis with high prevalence and increasing epidemiologic relevance. [ncbi.nlm.nih.gov]

Jump to: navigation, search Leishmaniasis Microchapters Home Patient Information Overview Historical Perspective Classification Pathophysiology Causes Differentiating Leishmaniasis from other Diseases Epidemiology and Demographics Risk Factors Natural [wikidoc.org]

________________________________________ Pathophysiology • The parasite occurs in the amastigote form in the vertebrate host and in the promastigote form in the sandfly vector and on culture. • The promastigotes inoculated by the sandfly vector enter [leishmaniasis.info]

Pathophysiology Modes of transmission In leishmaniasis, the obligatory intracellular protozoa are transmitted to mammals via the bite of the tiny 2- to 3-mm female sandfly of the genus Phlebotomus in the Old World (Eastern Hemisphere) and Lutzomyia in [emedicine.medscape.com]

The etiology and pathophysiology of post-kala azar dermal leishmaniasis are not elucidated. [antimicrobe.org]

How can Mucocutaneous Leishmaniasis be Prevented? Currently, no vaccination has been discovered to prevent Leishmaniasis. Research is being undertaken to develop a vaccine at the earliest. [dovemed.com]

Research on the immune response has been interesting, and vaccine prevention and treatment are objects of current interest. American leishmaniasis may not always remain a sylvan disease, and urban adaptation is a distressing possibility. [ncbi.nlm.nih.gov]

1. Palumbo E. Treatment strategies for mucocutaneous leishmaniasis. J Glob Infect Dis. 2010;2(2):147-150.
2. Elmahallawy EK, Sampedro Martinez A, Rodriguez-Granger J, et al. Diagnosis of leishmaniasis. J Infect Dev Ctries. 2014;8(8):961-972.
3. Masmoudi A, Hariz W, Marrekchi S, Amouri M, Turki H. Old World cutaneous leishmaniasis: diagnosis and treatment. J Dermatol Case Rep. 2013;7(2):31-41.
4. Davies CR, Kaye P, Croft SL, Sundar S. Leishmaniasis: new approaches to disease control. BMJ. 2003;326(7385):377-382.
5. World Health Organization. The world health report. Geneva: WHO; 2002. Annex 3: Burden of disease in DALYs by cause, sex and mortality stratum in WHO regions, estimates for 2001; pp. 192–197.www.who.int/whr/2002/whr2002_annex3.pdf
6. Alvar J, Vélez ID, Bern C, et al. Leishmaniasis worldwide and global estimates of its incidence. PLoS One. 2012;7:e35671.
7. Savoia D. Recent updates and perspectives on leishmaniasis. J Infect Dev Ctries. 2015;9(6):588-596.
8. Diniz JL, Costa MO, Gonçalves DU. Mucocutaneous Leishmaniasis: clinical markers in presumptive diagnosis. Braz J Otorhinolaryngol. 2011;77(3):380-384.
9. Lemrani M, Hamdi S, Laamrani A, Hassar M. PCR detection of Leishmania in skin biopsies. J Infect Dev Ctries. 2009;3(2):115-122.