Voice disorders in mucosal leishmaniasis.

Ana Cristina Nunes Ruas,Tania Salgado De Sousa Torraca,Márcia Mendonça Lucena,Ananda Dutra Da Costa,Maria Helena De Araújo-Melo,Claudia Maria Valete-Rosalino,Armando De Oliveira Schubach,Benivaldo Ramos Ferreira Terceiro,Jéssica Rafael Vieira

doi:10.1371/journal.pone.0101831

Abstract

IntroductionLeishmaniasis is considered as one of the six most important infectious diseases because of its high detection coefficient and ability to produce deformities. In most cases, mucosal leishmaniasis (ML) occurs as a consequence of cutaneous leishmaniasis. If left untreated, mucosal lesions can leave sequelae, interfering in the swallowing, breathing, voice and speech processes and requiring rehabilitation.ObjectiveTo describe the anatomical characteristics and voice quality of ML patients.Materials and MethodsA descriptive transversal study was conducted in a cohort of ML patients treated at the Laboratory for Leishmaniasis Surveillance of the Evandro Chagas National Institute of Infectious Diseases - Fiocruz, between 2010 and 2013. The patients were submitted to otorhinolaryngologic clinical examination by endoscopy of the upper airways and digestive tract and to speech-language assessment through directed anamnesis, auditory perception, phonation times and vocal acoustic analysis. The variables of interest were epidemiologic (sex and age) and clinic (lesion location, associated symptoms and voice quality.Results26 patients under ML treatment and monitored by speech therapists were studied. 21 (81%) were male and five (19%) female, with ages ranging from 15 to 78 years (54.5+15.0 years). The lesions were distributed in the following structures 88.5% nasal, 38.5% oral, 34.6% pharyngeal and 19.2% laryngeal, with some patients presenting lesions in more than one anatomic site. The main complaint was nasal obstruction (73.1%), followed by dysphonia (38.5%), odynophagia (30.8%) and dysphagia (26.9%). 23 patients (84.6%) presented voice quality perturbations. Dysphonia was significantly associated to lesions in the larynx, pharynx and oral cavity.ConclusionWe observed that vocal quality perturbations are frequent in patients with mucosal leishmaniasis, even without laryngeal lesions; they are probably associated to disorders of some resonance structures (larynx, pharynx and nasal and oral cavities) or even to compensation mechanisms caused by the presence of lesions in the upper airways and digestive tract.

Highlights

Leishmaniasis is considered as one of the six most important infectious diseases because of its high detection coefficient and ability to produce deformities
Materials and Methods: A descriptive transversal study was conducted in a cohort of mucosal leishmaniasis (ML) patients treated at the Laboratory for Leishmaniasis Surveillance of the Evandro Chagas National Institute of Infectious Diseases - Fiocruz, between 2010 and 2013
Dysphonia was significantly associated to lesions in the larynx, pharynx and oral cavity

Summary

Introduction

Leishmaniasis is considered as one of the six most important infectious diseases because of its high detection coefficient and ability to produce deformities. Mucosal leishmaniasis (ML) occurs as a consequence of cutaneous leishmaniasis. Mucosal lesions can leave sequelae, interfering in the swallowing, breathing, voice and speech processes and requiring rehabilitation. Tegumentary leishmaniasis (TL) is found in several countries with annual registration of 1 to 1.5 million cases [1]. Mucosal leishmaniasis (ML) occurs from blood or lymph spread of a cutaneous lesion, even after several years from the primary skin lesion has healed [3,4,5]. The lesions can leave sequelae such as retraction of the nasal pyramid, perforation of the nasal septum or palate and destruction of the uvula [10], these can interfere with the process of swallowing, breathing, voice and speech, requiring rehabilitation [11]

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Conclusion