Cutaneous leishmaniasis by Leishmania infantum: behind granulomatous lesions of unknown aetiology.

BACKGROUND: Cutaneous leishmaniasis (CL) is underestimated in Spain as in other European countries due to the polymorphism of its clinical manifestations and histopathological features discouraging doctors from suspecting leishmaniasis. Mucosal manifestations (ML) are misdiagnosed due to the fact that they often mimic cancer. OBJECTIVES: Given that leishmaniasis may be masked as different granulomatous diseases in Leishmania infantum endemic areas, the aim of this study was to verify this misdiagnosing and contributes to the improvement of CL/ML diagnosis. METHODS: A retrospective study involving formalin-fixed paraffin-embedded tissue biopsies with histopathological features of granulomatous lesions of unknown origin (GLUO) detected in 17 patients. This study included 13 patients with CL that was used as positive controls, nine patients with other confirmed diseases used as negative controls and seven patients with histological features suggestive of CL or ML without confirmation. Molecular analysis was blindly performed using two different PCR techniques. RESULTS: The PCR detected 15 CL cases in which the diagnosis was neither clinically nor histologically suspected. Leishmaniasis was confirmed in seven suspected patients in whom the classical techniques failed to detect the parasite. L. infantum was identified in all cases. A systematic review of CL cases in GLUO patients from European countries identified 45 reported cases. CONCLUSIONS: In L. infantum endemic areas, a high percentage of GLUO are due to Leishmania infection. The main consequences are delayed diagnosis and underestimation of the real incidence. PCR performed on paraffin-embedded tissue proved to be a reliable tool for diagnosis of CL/ML and must be performed routinely in any granulomatous dermatitis, even when the morphological features are no stereotypical of leishmaniasis.

Oral Cysticercosis: A Case Series and Review of Literature.

The cysticercus is the larval form of the pork tapeworm. Oral cavity involvement of cysticercosis is rare but frequently reported from developing countries. This report presents 3 cases of oral cysticercosis involving the tongue and buccal mucosa in isolation. All 3 patients were treated with surgical excision and had an uneventful postoperative course. A brief review of the PubMed English-language literature search is presented. Oral cavity involvement with cysticercosis presents a diagnostic dilemma. Management is primarily surgical and carries an excellent prognosis.

A Rare Case of Labial Myiasis caused by Dermatobia hominis.

INTRODUCTION: The aim of this article is to present a rare case of myiasis caused by Dermatobia hominis. Myiasis is a disease caused by invasion of tissues of animals and humans by larval stages of dipterous (2-winged) flies. There are few reports of oral myiasis in the literature, mostly related to Cochliomyia hominivorax larvae. We present a case of a 53-year-old man with painful swelling of the left lower lip that was confirmed to be myiasis caused by D. hominis. Though more common in tropical and subtropical regions of North and South America, myiasis should be considered in the differential diagnosis of subcutaneous masses among residents or travelers in endemic areas.

Mucosal leishmaniasis with primary oral involvement: a case series and a review of the literature.

OBJECTIVE: To analyze retrospectively a case series of primary oral leishmaniasis and to review the literature on head-neck primary mucosal leishmaniasis (ML) in immunocompetent patients. SUBJECTS AND METHODS: A PUBMED search was carried out from 1950 to 2013. Clinical records of patients with primary head-neck mucosal manifestations of leishmaniasis were analyzed. In addition, clinical records between 2001 and 2012 of patients with primary oral manifestations were collected in two independent hospitals. RESULTS: Our multicenter case series revealed seven patients with oral leishmaniasis. The most commonly affected site was the tongue (four patients, 57%), and the most common clinical presentation was an exophytic lesion (six patients, 85%). The literature review showed 11 reports published between 2005 and 2013, describing 13 patients (100% male) affected by head-neck primary ML (54% laryngeal, 31% oral, 23% pharyngeal, and 15% endonasal). The most common clinical presentation was an exophytic lesion (69%). CONCLUSIONS: The literature analysis revealed that in immunocompetent patients, the oral mucosa is the second most frequently affected site of the head and neck region. In the oral cavity, the tongue is the most affected site. Diagnosis of oral leishmaniasis represents a challenge but must be considered in any differential diagnosis of exophytic lesions of oral mucosa.

Diagnosis and management of oral leishmaniasis--case series and literature review.

The worldwide prevalence of leishmaniasis is increasing because of ecologic changes and increased medical profession awareness. Furthermore, solitary cases have been recently reported in Western countries. The authors describe the epidemiology, mode of transmission, and diagnosis of leishmaniasis and present 4 oral cases treated with systemic, localized, or combined therapy. The authors suggest that clinicians should maintain a high index of suspicion for atypical, resistant, oral and perioral lesions in individuals with a history of traveling in certain geographic regions. After diagnosis, treatment should be determined jointly by experts from the fields of oral and maxillofacial surgery, oral medicine, and dermatology based on leishmaniasis species and clinical presentation.

Oral cysticercosis.

Cysticercosis is a common disease in developing countries, but oral lesions caused by this parasitic infestation are rare. We report here a rare case of oral cysticercosis in a 17 year old male who sought treatment for an asymptomatic nodule of the lower lip that had previously been diagnosed as a mucocele.

[Buccal infection with Gongylonema pulchrum: an indigenous case in France]. / Infection buccale à Gongylonema pulchrum : un cas autochtone.

BACKGROUND: Although long known, infestations of the buccal mucosa by nematodes of the Gongylonema genus are rare, particularly in France. Herein we report a new case. PATIENTS AND METHODS: A 48-year old man consulted for itching in various parts of the buccal mucosa over the preceding weeks. The patient lived in a rural region in southern Alsace and had never visited Africa. His work comprised overseeing the unloading of flour at the port of Basel. The initial clinical examination was negative. However, the patient managed to photograph a filament previously present in his buccal mucosa, and to ultimately extract a worm. The latter was identified at the Strasbourg Institute of Parasitology by Pr Pesson as a nematode of the genus Gongylonema sp. pulchrum. No other treatment was considered necessary. DISCUSSION: It is important for dermatologists to be aware of this type of parasitosis. Its stereotyped clinical presentation allows ready diagnosis, but the possible absence of the parasite at the time of the visit may lead to a misdiagnosis of Ekbom syndrome (delusional parasitic infestation).

Record of oral myiasis by Cochliomyia hominivorax (Diptera: Calliphoridae): case evidencing negligence in the treatment of incapable.

Cases of myiasis in man associated with preexisting lesions are quite common. However, in the forensic field, certain behavioral habits related to insects may be useful to ratify mistreatment. This is a register of a case of oral myiasis by Cochliomyia hominivorax (Diptera: Calliphoridae), an obligate parasite of warm-blooded animals, in a 95-year-old man with Alzheimer's and Parkinson's disease. The identification of immatures removed (n = 87) was based on their morphological characteristics. Considering the developmental time and length of the maggots, it was possible to estimate an infestation of at least 143 h. Undoubtedly, the poor state of health was one of the cofactors for the infestation; however, the long time of infestation observed denotes negligence in the conduct of patient care. In terms of prophylaxis, it would be recommended that individuals who need special care must have access to more comprehensive physical examinations and periodicals, as well as hygienic conditions should be meticulously observed. Additionally, the immatures causing myiasis after being removed must be stored and forwarded for analysis, since their identification can be crucial to determine the exact time and circumstances of an infestation, and consequently its pathogenesis. If we consider the aggressiveness of C. hominivorax, a fast and reliable diagnosis becomes even more important for an adequate treatment. Finally, it is expected that this study encourages the health care professionals to improve the treatment of incapable patients.

Oral myiasis in an elderly patient.

BACKGROUND: Myiasis is the invasion of living tissue of humans and other mammals by eggs or maggots of flies of the order of Diptera. It occurs mainly in the Tropics and is associated with inadequate public and personal hygiene. Oral myiases in an older man appears to be rare. OBJECTIVE: To relate a case of oral myiases in a debilitated older man treated by mechanical removal of the maggots, identifying the adult insect that caused the infestation. METHODS: The diagnosis of oral myiasis was established by the clinical examination and it was detected that the infestation involved only soft tissue and the sinus cavity. The patient was submitted to two mechanical removal of the visible maggots. RESULTS: Total of 110 maggots was removed from the oral cavity of the patient and adult insects was identified as belonging to the Calliphoridae Family, Cochliomyia hominivorax species. The patient died two days after the second procedure by severe systemic complications. CONCLUSIONS: The mechanic removal and the identification of the maggots must be adopted as soon as possible to prevent further tissue damage and bacterial infection in cases of oral myiasis. Special attention should be given to the debilitated old patients that are particularly susceptible to oral myiasis infestation.

Leishmaniasis with oral mucosa involvement.

INTRODUCTION: The term leishmaniasis comprises a group of diseases caused by different protozoan species of the genus Leishmania. There are three main clinical forms of leishmaniasis: visceral, cutaneous and mucocutaneous. Exclusive involvement of the mucosa is very rare. OBJECTIVES: To present a case of mucocutaneous leishmaniasis in an elderly patient, discuss the clinical presentation, diagnostic process and treatment emphasizing the distinctions from other granulomatous lesions. CASE REPORT: A 71-year-old male presenting with a symptomatic lesion on the hard and soft palate, which had developed over a period of 6 months was evaluated. The oral exam revealed a lesion with multiple ulcerated nodules on the hard and soft palate extending to the oropharynx. The diagnostic hypothesis was chronic infectious disease (paracoccidioidomycose, tuberculosis and leishmaniasis) or squamous cell carcinoma. Histopathological, histochemical and immunohistochemical analysis were performed. A chest x-ray revealed a normal pulmonary pattern. The Montenegro skin test was positive. The definitive diagnosis was leishmaniasis with exclusive oral manifestation and the patient was treated with liposomal amphotericin. CONCLUSIONS: Localized oral mucosa leishmaniasis is an uncommon event in an immunocompetent patient. Dentists play an important role in the diagnosis of oral leishmaniasis, which has systemic repercussions.

Myiasis in palate by Cochliomyia hominivorax.

Myiasis is the infestation of tissues and organs of animals and humans caused by the larvae of certain dipteran flies. It is more common in undeveloped and tropical countries and usually affects elderly patients, persons who are sick, and patients with mental illness. Oral myiasis is a rare pathologic condition and a risk to the patient's life because of its great destructive potential. Therefore, appropriate treatment is necessary. This article aimed to report a case of myiasis caused by Cochliomyia hominivorax in the palate of a patient with primary progressive aphasia, which was successfully treated through mechanical removal of larvae plus administration of ivermectin.

Oral myiasis caused by the screwworm Cochliomyia hominivorax treated with subcutaneous ivermectin and creolin: report of six cases after trauma.

Human myiasis is a rare condition that is more common in regions with a warm and humid climate. The larvae involved in myiasis are voracious; they destroy healthy tissues and may cause serious haemorrhage. The condition can be life threatening. Six patients with craniofacial trauma and oral myiasis are reported. The diagnoses were made after larvae had been extracted. Treatment consisted of subcutaneous ivermectin therapy and the application of a phenol preparation (10% creolin) as a local measure for the control of larvae. After 12 (±1) days of hospitalization, no larvae remained in the patients' mouths and the patients were discharged. The laboratory identified the larvae as those of the fly Cochliomyia hominivorax. Healing was uneventful in the six cases presented, and no undesirable reactions were observed throughout the period of treatment. Although the usual treatment for myiasis involves surgical removal of the maggots, pharmacological therapies are emerging as effective alternatives.

High prevalence of buccal ulcerations in largemouth bass, Micropterus salmoides (Centrarchidae) from Michigan inland lakes associated with Myzobdella lugubris Leidy 1851 (Annelida: Hirudinea).

Widespread mouth ulcerations were observed in largemouth bass collected from eight inland lakes in the Lower Peninsula of Michigan during the summer months of 2002 and 2003. These ulcerations were associated with, and most likely caused by, leech parasitism. Through the use of morphological dichotomous keys, it was determined that all leeches collected are of one species: Myzobdella lugubris. Among the eight lakes examined, Lake Orion and Devils Lake had the highest prevalence of leech parasitism (34% and 29%, respectively) and mouth ulcerations (53% and 68%, respectively). Statistical analyses demonstrated that leech and ulcer prevalence varied significantly from one lake to the other. Additionally, it was determined that the relationship between the prevalence of ulcers and the prevalence of leech attachment is significant, indicating that leech parasitism is most likely the cause of ulceration. The ulcers exhibited deep hemorrhagic centers and raised irregular edges. Affected areas lost their epithelial lining and submucosa, with masses of bacteria colonizing the damaged tissues. Since largemouth bass is a popular global sportfish and critical to the food web of inland lakes, there are concerns that the presence of leeches, damaged buccal mucosa, and general unsightliness may negatively affect this important sportfishery.

Experimental oral and ocular Encephalitozoon cuniculi infection in rabbits.

Encephalitozoon cuniculi is an obligate intracellular pathogen that has a wide host distribution, but primarily affects rabbits. The aim of this study was to characterize both the cell-mediated and the antibody response in rabbits after experimental infection using 2 different infection routes: oral and ocular. SPF rabbits were infected with low (10³ spores) and high (107 spores) infection doses. Monitored parameters included clinical signs, detection of spores in urine, antibody response detected with ELISA, and cell-mediated immunity detected by antigen-driven lymphocyte proliferation. At week 13 post-infection, half of the rabbits in each group were suppressed by intramuscular administration of dexamethasone. At week 18 post-infection, animals were euthanized. Clinical signs were mild with exacerbation after immunosuppression. Spores in urine and antigen-specific cell-mediated immunity were detected from weeks 5 and 4 post-infection, respectively. Specific IgM was detected 1 week after infection, and IgG antibodies followed 1 week later in rabbits infected with the high dose. Immunological responses were dose dependent. The authors can conclude that both oral and ocular experimental infection with E. cuniculi resulted in an immune response of the infected animals. Rabbits could be used as an experimental model for the study of ocular microsporidiosis.

Aberrant infestation of goat mandibles with Oestrus ovis larvae.

Nasal oestrosis is primarily an infestation of sheep. However, a non descript goat, aged three years was presented in lateral recumbency with clinical history of sneezing fits, laboured breathing, eroded mandibular lesions and bilaterally housing nasal bots therein. The first ever occurrence of nasal bots in an aberrant location (mandibles) in a goat, its therapeutic management and public health significance have been documented and discussed.

Primary oral myiasis due to Chrysomya bezziana treated with Ivermectin. A case report.

Primary oral myiasis due to Chrysomya bezziana is a rare condition caused by invasion of tissues by larvae of the flies. A case of Oral myiasis is presented in a 12 year old boy with neuro-degenerative disease with seizures. Intra orally, a soft tissue pocket in the left buccal mucosa and a pocket under the palatal mucosa was seen containing maggots. Extra orally indurated erythematous swelling was present near the commissure of the mouth. Predisposing factors identified in the present case were mouth breathing, incompetent lips, low socioeconomic condition, malnutrition, and inability of the child to perform daily activities due to his neurodegenerative disease. Treatment consisted of manual removal of maggots following irrigation and application of turpentine oil along with a single dose Ivermectin 3 mg that was given systemically. Complete healing of the lesion was observed within 10 days without any recurrence for a follow up period of 1 year Medical personnel taking care of old / debilitated / unconscious patients need to bear in mind the possibility of Chrysomya bezziana infestation in them.

Massive airway myiasis: an extreme rarity.

Intubations are important live saving skills to maintain adequate ventilation and oxygenation. Common indications include impending upper airway obstruction, respiratory failure and impaired conscious level. Oral myiasis is an infrequently found disease which is characterised by ectoparasitic infestation of body tissues by fly maggots.We present a case report and share valuable experiences on a patient with massive airway myiasis causing upper airway obstruction which require emergency intubation.

Oral myiasis caused by Cochliomyia hominivorax treated with ivermectin and nitrofurazone: case report.

Myiasis is the infestation of tissues and organs of animals and humans by certain dipteran fly larvae. This phenomenon is well-documented, especially among animals and people in tropical and subtropical areas. Oral myiasis is a rare condition that can be caused by several species of dipteran fly larvae. When the larvae are removed from the mouth, the tissues seem to recover with no subsequent complications and no need for further treatment. This article presents a case involving a patient with oral myiasis caused by Cochliomyia hominivorax and treated with ivermectin and nitrofurazone.

Oral myiasis in a captive hippopotamus.

Causes of dental infections can be related to failed dental eruption, malocclusion, abrasion, fractures with or without exposure of the dental pulp, and periodontal disease. Reports of oral myiasis in megavertebrates in captivity are infrequent, perhaps due to the difficulty in observing the oral cavity in such species. This report describes a case of oral myiasis in an adult male hippopotamus in the gingival area and alveolar mucosa of the left mandibular canine tooth.

Orofacial manifestations of mucocutaneous leishmaniasis: a case series from Brazil.

The dental surgeon plays a fundamental role in the early diagnosis of oral leishmaniasis, since oral mucosa may be the primary site of the disease manifestation. This study reports seven clinical cases of orofacial mucocutaneous leishmaniasis. All had mucocutaneous leishmaniasis with oropharyngeal involvement confirmed by laboratory tests. Five out of the seven cases were males, and in four cases, patients had associated comorbidities. Late diagnosis was observed, resulting in treatment delay and increased hospitalization stay. One patient had severe psychological consequences due to facial deformity. The lack of differential diagnosis due the great variability of clinical presentation of the lesions and frequent unspecific histopathology represent a challenge for the dental surgeon. In two reported cases, there were unspecific biopsy results. The multidisciplinary approach plays an important role in orofacial leishmaniasis diagnosis and treatment. Leishmaniasis should be investigated in case of atypical and persistent lesions in patients from endemic regions. This recommendation may avoid diagnosis delays and decrease dissemination of the disease.