Diagnosis Of Mucocutaneous Leishmaniasis Research Articles

MUCOSAL LEISHMANIASIS: A CASE REPORT OF AN EXTENSIVE AND MORIFORM LESION

Mucosal leishmaniasis is a chronic infection that affects the upper respiratory tract or oral mucosa caused by protozoan parasites of the genus Leishmania. A 70-year-old man presented with oral opening limitation and presence of a moriform lesion involving palate and oropharynx. The patient reported a history of pharyngeal cancer 3 years earlier. Incisional biopsy was performed, and the histologic analysis showed mononuclear inflammatory infiltrate with macrophage vacuoles containing scarce rounded microstructures suggestive of amastigotes. However, Giemsa staining and immunohistochemistry were negative. The patient returned and reported the death of his dogs recently. Dermatologic examination revealed ulcerated lesion under a beard in the region of the chin. The patient was referred to the infectious disease service, and the skin lesion biopsy showed aspects compatible with leishmaniasis. With the diagnosis of mucocutaneous leishmaniasis, the patient is still receiving treatment at the infectious disease service. Support: FAPEMIG (APQ01122/14)

Cutaneous and mucocutaneous leishmaniasis: experience of a Mediterranean hospital

BackgroundLeishmaniasis, considered by the World Health Organization as one of the most important tropical diseases, is endemic in the Mediterranean Basin. The aim of this study was to evaluate epidemiological and clinical characteristics of cutaneous (CL) and mucocutaneous leishmaniasis (MCL) in La Fe University Hospital, Valencia, Spain. The particular focus was on diagnosis techniques and clinical differences according to the immunological status of the patients.MethodsAn eleven-year retrospective observational study of CL and MCL episodes at the hospital was performed. Epidemiological, clinical and therapeutic variables of each case, together with the microbiological and anatomopathological diagnosis, were analyzed.ResultsA total of 42 patients were included, 30 of them were male and 28 were immunocompetent. Most of the cases (36/42) were diagnosed in the last 5 years (2013–2017). The incidence of CL and MCL increased from 3.6/100,000 (2006–2012) to 13.58/100,000 (2013–2017). The majority of the patients (37/42) exhibited CL, in 30 cases as single lesions (30/37). Ulcerative lesions were more common in immunosuppressed patients (13/14) than in immunocompetent patients (20/28), (P = 0.2302). The length of lesion presence before diagnosis was 7.36 ± 6.72 months in immunocompetent patients and 8.79 ± 6.9 months in immunosuppressed patients (P = 0.1863). Leishmania DNA detection (92.3%) was the most sensitive diagnostic technique followed by Giemsa stain (65%) and histopathological examination (53.8%). Twelve patients (12/42) had close contact with dogs or were living near to kennels, and 10 of them did not present underlying conditions. Intralesional glucantime (21/42) and liposomal amphotericin B (7/42) were the most common treatments administered in monotherapy. All patients evolved successfully and no relapse was reported.ConclusionsSome interesting clinical and epidemiological differences were found in our series between immunocompetent and immunosuppressed patients. Future studies can take these results further especially by studying patients with biological therapy. Skin biopsies combining NAAT with histological techniques are the most productive techniques for CL or MCL diagnosis.

Case report: Leishmaniasis in the tongue presenting as an SCC

AbstractA 72‐year‐old immunocompetent male with a frequent travel history to Spain presented with a 1 cm diameter ulcer with rolled edges on the left lateral border of the tongue. This was urgently biopsied as a squamous cell carcinoma (SCC) was suspected. Histopathology suggested a Leishmania infection which was confirmed by positive results for Leishmania DAT and K39 tests. This resulted in a diagnosis of mucocutaneous leishmaniasis. This was successfully treated by amphotericin B. Leishmaniasis solely affecting the oral mucosa is rare with few cases documented in literature.

Accuracy of mucocutaneous leishmaniasis diagnosis using polymerase chain reaction: systematic literature review and meta-analysis.

The diagnosis of mucocutaneous leishmaniasis (MCL) is hampered by the absence of a gold standard. An accurate diagnosis is essential because of the high toxicity of the medications for the disease. This study aimed to assess the ability of polymerase chain reaction (PCR) to identify MCL and to compare these results with clinical research recently published by the authors. A systematic literature review based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: the PRISMA Statement was performed using comprehensive search criteria and communication with the authors. A meta-analysis considering the estimates of the univariate and bivariate models was performed. Specificity near 100% was common among the papers. The primary reason for accuracy differences was sensitivity. The meta-analysis, which was only possible for PCR samples of lesion fragments, revealed a sensitivity of 71% [95% confidence interval (CI) = 0.59; 0.81] and a specificity of 93% (95% CI = 0.83; 0.98) in the bivariate model. The search for measures that could increase the sensitivity of PCR should be encouraged. The quality of the collected material and the optimisation of the amplification of genetic material should be prioritised.