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Key Features

  • Destructive nasopharyngeal lesions

  • Amastigotes in macrophages in aspirates, touch preparations, or biopsies

  • Positive culture, serologic tests, PCR, or skin test

  • Occurs in lowland forest areas of the Americas

  • Caused by Leishmania braziliensis, Leishmania panamensis, and Leishmania peruviana

Clinical Findings

  • Mucosal lesions develop usually months to years after resolution of a cutaneous lesion

  • Nasal congestion is followed by ulceration of the nasal mucosa and septum

  • Mouth, lips, palate, pharynx, and larynx become involved as infection progresses

  • Extensive destruction can occur

  • Secondary bacterial infection is common

Diagnosis

  • Diagnosis is established by detecting amastigotes in scrapings, biopsy preparations, or aspirated tissue fluid, but organisms may be rare

  • Cultures from these samples may grow organisms

  • Serologic studies are often negative

  • Leishmanin skin test is usually positive

Treatment

  • Treat all cutaneous infections from regions where parasites include those that cause mucocutaneous disease to help prevent disease progression

  • Treatment with antimonials is disappointing, with responses in only about 60% in Brazil

  • See Leishmaniasis, Visceral (Kala Azar), but the drugs listed there have not been well studied for this indication

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