Abstract
We present a review of current knowledge about mucosal leishmaniasis (ML). Although involvement of mucous membranes is classically admitted in New World leishmaniasis, particularly occurring in infection by Leishmania (L.) braziliensis species complex, ML is also a possible presentation of Old World leishmaniasis, in either L. donovani or L. major species complex infections. Thus, ML has to be considered not only as a Latin American disease but as an Old and New World disease. We describe ML epidemiology, pathogenesis, clinics, diagnosis, and therapy. Considering both its highly disfiguring lesions and its possible lethal outcome, ML should not be underestimated by physicians. Moreover, leishmaniasis is expected to increase its burden in many countries as sandfly vector distribution is widespreading towards non-endemic areas. Finally, the lack of clear understanding of ML pathogenesis and the absence of effective human vaccines strongly claim for more research.
Highlights
Leishmaniasis is a vector-borne disease caused by Leishmania protozoa, which is transmitted by sandflies of Phlebotomus and Lutzomyia species [1]. 1.6 millions of new cases per year are estimated to occur worldwide, but only 600,000 are recorded [2]
Old World leishmaniasis includes two clinical presentations: cutaneous leishmaniasis (CL), which is confined to skin, and visceral leishmaniasis (VL), which involves bloodstream and inner organs
Two New World Leishmania species complexes are constituted by L. mexicana complex and L. braziliensis complex, whereas two Old World Leishmania complexes are L. major complex and L. donovani complex [3, 28]
Summary
Leishmaniasis is a vector-borne disease caused by Leishmania protozoa (order Kinetoplastida), which is transmitted by sandflies of Phlebotomus and Lutzomyia species [1]. 1.6 millions of new cases per year are estimated to occur worldwide, but only 600,000 are recorded [2]. Old World leishmaniasis includes two clinical presentations: cutaneous leishmaniasis (CL), which is confined to skin, and visceral leishmaniasis (VL), which involves bloodstream and inner organs. New World leishmaniasis clinical presentations are CL and mucocutaneous leishmaniasis (MCL), which involves mucous membranes in addition to the skin [2, 3]. Together with CL and diffuse cutaneous leishmaniasis (DCL), MCL is one of the typical presentations of leishmaniasis in South America, characterizing the so-called american tegumentary leishmaniasis (ATL) [5]. Outside the South American continent, ML can exist with different and less defined clinical presentations than MCL. These clinical presentations are caused by Leishmania donovani complex species, commonly L. infantum [4]. Our purpose is to sum up the clinical, epidemiologic, diagnostic, and therapeutic aspects of ML
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