Leishmaniasis, Mucocutaneous

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

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 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

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