Mucocutaneous Leishmaniasis
Incubation Period: 1 month- 24 years
Synonyms: Espundia, Uta, chiclero ulcer
Epidemiology:
Dark green: mucocutaneous leishmaniasis, Green: visceral leishmaniasis, Light green: cutaneous leishmaniasis
Source: http://travel.roughguides.com/health/
Mucotaneous leishmaniasis (MCL) cases are focused in South America, especially in Brazil, Paraguay, Ecaudor, Bolivia, Peru, Colombia, andVenezuela. Ninety percent of the cases occur in Brazil, Bolivia, and Peru. Twenty percent of leishmaniasis patients in Brazil develop MCL. In Ecuador, many of the cases seem to be focused in the Amazon region. During the 1990-2003 period, there were 21,805 reports of MCL mostly from the Amazonian lowlands, some inter-Andean valleys, and throughout the Pacific coastal region. Other infections caused by various Leishmania species have occurred in Ethiopia, Kenya, Namibia, Central America, Guyana, Surinam, Panam, and Sudan.
Pathogenesis:
Although the pathogenesis of visceral and cutaneous leishmaniasis are well understood, the pathogenesis of mucotaneous leishmaniasis (MCL) is still unclear. However, it is believed that host genetic factors are important in the advancement of the disease. MCL development is similar to that of cutaneous leishmaniasis, and the two infections can occur simultaneously. MCL occurs when cutaneous lesions expand to the mucosal region or through metastasis. Moreover, it is not uncommon for MCL to develop many years after the recovery of an initial lesion. The result is a gradual and progressive development of destructive lesions.
Clinical Manifestations:
-
inital symptoms are similar to that of cutanous leishmaniasis
-
single or multpile lesions and ulcers develop at the mucosal regions (nose, mouth, throat cavities) and in the adjacent tissue
-
extensive disfiguring of the nasal septum, lips, and palate (does not include the bones)
Sources (L-R): http://pathmicro.med.sc.edu/parasitology/blood-proto.htm, http://www.sgul.ac.uk/depts/id/espundia.jpg, http://www.mpibpc.gwdg.de/abteilungen/145/pressrelease/abb05_s.jpg,Lesions may multiply and increase in size, which can contribute to severe deformity. Because it causes major disability, those infected may be humiliated and suffer from being ostracized by their society. Respiratory tract mucosal invasion may also occur, causing numerous respiratory problems, and can result in malnutrition and pneumonia. Secondary infection is responsible for most deaths.
Diagnosis:
-
Travel history, in combination with clinical presentation, may be helpful
-
Xenodiagnostic with a hamster using biopsy specimen of ulcer
-
Aspiration of ulcer edge (Click for a video, courtesy of http://www.pdhealth.mil/leish.asp)
-
DNA hybridization and PCR techniques
-
Skin test (postive only after 2-3 months of infections)
-
Parasite detection with Geimsa-stain or culturing the organsim (not approved in the US)
Treatment:
Drug |
mechanism of action |
dosing |
Therapy Duration |
side effects |
Results |
Sodium Stibogluconate (Pentostam)
*Not licensed for use in the US |
Cause parasite death by inhibiting glycolytic enzymes and fatty acid oxidation |
Administered intravenously or intra-muscularly |
20 mg/kg body weight daily for 28 days |
Coughing, headache, vomiting |
Cutaneous lesions may not usually require antimonials to heal. After several weeks, the lesions tend to heal on their own. |
Amphotericin B (Fungizone)
|
Causes parasite death |
intravenously |
.5-1mg/kg lb per day for up to 8 weeks |
Coughing, headache, vomiting, possible renal damage and bone marrow depression |
Cutaneous lesions may not usually require antimonials to heal. After several weeks, the lesions tend to heal on their own. |
Cycloguanil pamoate (Camolar)
*not available in the US |
Folic acid |
intramuscularly |
Adults: 300 mg Children: 280 mg Infants: 140 mg |
|
|
Photos: http://arachosia.univ-lille2.fr/labos/parasito/Internat/medicam/leish_me.html , http://www.drugs.com/pdr/AMPHOTERICIN_B_LIPID_COMPLEX.html , http://www.medicinescomplete.com/mc/clarke/current/CLK0444.htm
Sources: