Leishmaniasis, Mucocutaneous

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