Laryngeal leishmaniasis in a patient taking inhaled corticosteroids.

We present a case of a man in his late 60s, who had spent 3-4 months of the year in rural Spain, presenting with intermittent hoarseness of voice. He had a background of asthma and bronchiectasis, and was taking inhaled corticosteroids. His dysphonia was initially managed as bronchiectasis with little improvement. Bronchoscopy revealed a cystic lesion on his left vocal fold, and tissue biopsy revealed Leishmania amastigotes. This confirmed a diagnosis of laryngeal leishmaniasis. We propose that this is likely secondary to his inhaled corticosteroid therapy. The infection was treated with a 30-day course of miltefosine, and at most recent follow-up the patient was deemed free from leishmanial infection.

Aberrant laryngeal location of Onchocerca lupi in a dog.

Onchocerca lupi (Spirurida, Onchocercidae) is an emerging vector-borne helminth that causes nodular lesions associated with acute or chronic ocular disease in dogs and cats. Since its first description in dogs in 1991, this zoonotic filarioid has been increasingly reported in Europe and the United States. An 8-year-old outdoor mixed-breed female dog from the Algarve (southern Portugal) was presented with a history of severe dyspnoea. Cervical and thoracic radiographs revealed a slight reduction in the diameter of the cervical trachea and a moderate increase in radiopacity of the laryngeal soft tissue. An exploratory laryngoscopy was performed, revealing filiform worms associated with stenosis of the thyroid cartilage and a purulent necrotic tissue in the larynx lumen. A single sessile nodule, protruding from the dorsal wall of the laryngeal lumen caused a severe reduction of the glottis and tracheal diameter. Fragments of the worms were morphologically and molecularly identified as O. lupi. Histological examination of the nodule showed a granulomatous reaction with sections of coiled gravid female nematodes. Following laryngoscopy, a tracheostomy tube was inserted to relieve dyspnoea and ivermectin (300 µg/kg, once a week, for 8 weeks) combined with prednisolone was prescribed. The dog showed a complete recovery. Although O. lupi has been isolated in human patients from the spinal cord, this is the first report of an aberrant migration of O. lupi in a dog. The veterinary medical community should pay attention to aberrant location of O. lupi and consider onchocercosis as a differential diagnosis for airway obstruction in dogs.

Isolated laryngeal leishmaniasis in an immunocompetent patient: a case report.

Isolated laryngeal leishmaniasis in an immunocompetent patient: a case report. OBJECTIVE: Isolated laryngeal Leishmaniasis presents neither explicit laryngeal lesions nor specific symptoms. In fact, it may mimic many inflammatory and neoplastic diseases. Considering the low incidence of this atypical localization, laryngeal Leishmaniasis, is rarely contemplated by physicians in differential diagnoses of laryngeal tumour lesions. We present the case of a 62-year-old immunocompetent subject who developed a single Leishmania mucosal lesion on the left vocal cord, simulating a laryngeal cancer. METHODS: A case report and discussion of the clinical case by referring to the literature. RESULTS: Specific therapy with miltefosine led to clinical and endoscopic improvement. We had no relapse after three years of follow-up. CONCLUSIONS: This clinical case highlights the need to consider isolated laryngeal Leishmaniasis in the differential diagnoses of laryngeal tumour lesions, even in immunocompetent subjects who live in endemic zones, in order to ensure an early and correct therapeutic approach.

Leishmaniasis mucosa nasolaringotraqueal en un adolescente / Nasolaryngotracheal mucosal leishmaniasis in an adolescent

La leishmaniasis es un problema creciente de salud pública, que produce un gran impacto social. La leishmaniasis laríngea y sin puerta de entrada evidente es rara, en especial en pacientes inmunocompetentes. Describimos un caso de leishmaniasis laríngea con extensión traqueal y estenosis secundaria en un adolescente previamente sano y sin factores de riesgo ambiental o personal.

Leishmaniasis is a growing public health problem and it produces a great social impact. Laryngeal leishmaniasis without obvious gateway is rare; especially in immunocompetent patients. We report a case of laryngeal leishmaniasis with tracheal involvement and stenosis on a previously healthy teenager without environmental or personal risk factors.

[Nasolaryngotracheal mucosal leishmaniasis in an adolescent]. / Leishmaniasis mucosa nasolaringotraqueal en un adolescente.

Leishmaniasis is a growing public health problem and it produces a great social impact. Laryngeal leishmaniasis without obvious gateway is rare; especially in immunocompetent patients. We report a case of laryngeal leishmaniasis with tracheal involvement and stenosis on a previously healthy teenager without environmental or personal risk factors.

An unusual cause of hemoptysis: leech in the supraglottic region of the larynx.

Leeches live in fresh water and moist terrestrial environments. Most infestations are cutaneous. However, internal infestation occurs principally in the rural parts of the Mediterranean countries as well as in Africa and Asia. Thus,the possibility of leech endoparasitism should be kept in mind for a patient presenting with hemoptysis and with a history of close contact with fresh water in tropical countries.Human infestation is rare and usually occurs after consumption of contaminated water or swimming in leech-infested still waters such as lakes and dams.Herein, we report 2 live leech cases with hemoptysis in the supraglottic region of the larynx.

Laryngeal leishmaniasis: case report of a rare infection.

BACKGROUND: We report a case of laryngeal leishmaniasis in a United Kingdom (UK) resident who lived in Spain for 5 years. METHODS AND RESULTS: The patient presented with a history of hoarseness. He had returned to the UK after spending 5 years in Spain as a retiree. His past medical history includes chronic obstructive pulmonary disease (COPD). Histology of a vocal cord biopsy was suggestive of leishmaniasis and polymerase chain reaction (PCR) test was positive for Leishmania donovani. His use of steroid inhaler probably contributed to his acquiring this extremely unusual infection. He was successfully treated with intravenous amphotericin. CONCLUSIONS: Laryngeal leishmaniasis is an extremely rare infection and is rarely reported in the UK. The ease of travel ensures that many tropical infections may present to UK clinicians.

Surprising cause of respiratory distress in child: laryngeal leech.

Foreign body aspiration is a major problem that can cause respiratory distress and oral bleeding in a child. Leeches are rarely seen foreign bodies in the larynx. Generally, they live in springwater and can be aspirated by drinking. They can cause respiratory distress, oral bleeding, and anemia, if diagnostic process is delayed. When leeches are detected, urgent diagnosis and treatment are necessary. In this case, we present a 7-year-old child examined in the emergency service with these symptoms. A dark green living body in the larynx was detected and removed urgently under sedo-analgesia. The living body was seen as a leech that is 5 cm in length.

Equine laryngeal rhinosporidiosis in western Canada.

A 12-year-old female Argentinean Warmblood mare was evaluated because of respiratory noise. The horse resided in Calgary, Alberta, Canada, but had been imported from Argentina 28 months prior to presentation. Endoscopy of the upper respiratory tract revealed a single polypoid mass on the left arytenoid. The mass was surgically excised and was diagnosed histologically as rhinosporidiosis. Polymerase chain reaction and DNA sequencing were used to confirm the etiological agent. Four weeks postoperatively, endoscopy was repeated, revealing recurrence of the original lesion with multiple additional polypoid masses on the larynx and in the oropharynx. Resolution of the disease had not been attained at the time of publication. The current report outlines a case of rhinosporidiosis in an unusual anatomical and geographic location. The infection most likely originated in Argentina, with a prolonged subclinical phase. Due to increased travel of human beings and animals, there is potential for the introduction of exotic diseases into nonendemic areas.

[Prevalence of Mammomonogamus laryngeus(Strongylida:Syngamidae) nematodes in a bovine slaughterhouse]. / Prevalencia de Mammomonogamus laryngeus (Strongylida: Syngamidae) en ganado bovino de la central de beneficio del municipio de La Tebaida, Quindío, Colombia.

INTRODUCTION: Mammomonogamus laryngeus is a nematode parasite that is usually found in the larynx of mammals in the tropics, especially in cattle, sheep and cats. OBJECTIVE: The prevalence of M. laryngeus was determined in cattle brought to an abattoir as an indicator of its prevalence in the general population. Materials and methods. The present study was undertaken in the municipality of La Tebaida, Quindio, Colombia, to determine the presence of M. laryngeus infection in cattle brought to a local abattoir between December and February 2009. The tracheae and lungs of 500 slaughtered cattle were examined. RESULTS: Parasite prevalence was 14.8% (n=74). The majority of worms were located on aryteno-epiglottic folds, but never in the tracheae or bronchi. The infection rate was highest (47%) in 2 to 2.5 year old animals. In infected animals, an average of 6.4 parasite pairs was found, with higher numbers in older animals. The prevalence of infection in cattle was greater than seen in the provinces of Valle del Cauca (10.0%), Quindío(3,0%) pr Caquetá (1.2%). CONCLUSIONS: Reports of this parasite in cattle indicate its circulation throughout Colombia and recommend surveillance studies where cattle are raised and prepared for human consumption.

[Leeches of the upper aerodigestive tract]. / Sangsues des voies aérodigestives supérieures.

INTRODUCTION: The leech is an aquatic worm living in fresh water, especially in tropical areas. It may be found exceptionally in the upper aerodigestive tract (UADT) after consumption of spring water or water from natural wells, after swimming in still waters (lakes and dams). The author's objective was to study epidemiological, clinical, therapeutic, and evolutive aspects of this infestation. PATIENT AND METHODS: This prospective 2-year study was carried out from January 1, 2007 to December 31, 2008. We included all patients consulting at the emergency unit presenting with leeches in the UADT. RESULTS: Twenty patients living in rural settings were included: 16 children, mostly boys (sex ratio 3:1). All cases were recorded during the summer season, with 14 cases due to consumption of fresh water and six due to swimming in still waters. The delay between infestation and onset of symptoms ranged from 2 to 15 days. Leeches were found in the oropharynx (six cases), the nasopharynx (five cases), the hypopharynx (six cases), and the glottis (three cases). An anemia syndrome was noted in four patients. All parasites were removed. All patients were given local antiseptics and analgesics. Patients with anemia were given iron supplementation. The outcome was favorable for all patients. DISCUSSION: UADT leeches are not uncommon in Morocco. The infestation is usually observed in the summer. Symptoms vary according to UADT localization. The diagnosis should be made rapidly to prevent complications. Whatever the localization, removing the parasite is difficult. In laryngeal localizations induction general anesthesia is recommended, without intubation. Evolution after treatment is rapidly favorable, with complete disappearance of symptoms.

Primary laryngeal leishmaniasis: a rare case report.

Laryngeal leishmaniasis is extremely rare. We report a case of primary laryngeal leishmaniasis in a 70-year-old male who was admitted with complaints of gradual progressive hoarseness of the voice, dyspnea, cough for the past 3 months and noisy breathing for the past 5 days. An X-ray of the soft tissue of the neck showed a prevertebral soft tissue mass causing narrowing of the airway at the C6-C7 vertebral level. A computerized tomography (CT) scan showed a soft tissue mass in the subglottic region causing significant narrowing of the airway. A direct laryngoscopy showed a pinkish-white, friable mass involving the subglottic region and the anterior half of the vocal cords. With the clinical suspicion of malignancy, an endoscopic biopsy was done. A histopathological examination showed diffuse mixed inflammatory cell infiltrate in subepithelium with numerous Leishmania donovani bodies in the cytoplasm of histiocytes.

A case of laryngeal paracoccidioidomycosis masquerading as chronic obstructive lung disease.

Paracoccidioidomycosis (South American blastomycosis) is a systemic infection caused by a dimorphic fungus (Paracoccidioides brasiliensis). It is common in the rural areas of Latin America. The majority of the reported cases come from Brazil, Colombia and Venezuela. Paracoccidioidomycosis is the most important systemic mycosis of the tropical Americas and can affect any organ, causing symptomatic or asymptomatic lesions. Paracoccidioidomycosis can mimic other diseases, which must be considered in making the differential diagnosis. Patients get infected by inhaling mycelia found in the natural environment or rarely from traumatic inoculation via mucous membranes. The most common lesions frequently occur in the buccal pharynx mucosa. Others lesions occur in the larynx, adrenal glands, liver, bones, gastrointestinal tract, lungs and nervous system.

Laryngeal leishmaniasis in Malta.

The localization of Leishmania spp. in the larynx is rare especially when not associated with immunosuppression or with visceral or cutaneous leishmaniasis. We present a case of isolated laryngeal leishmaniasis, the first of its kind documented in Malta and infrequently reported from the Mediterranean basin.

[First case report of Mammomonogamus (Syngamus) laryngeus human infection in Colombia]. / Reporte del primer caso humano de infección parasitaria por Mammomonogamus laryngeus en Colombia.

First case report of Mammomonogamus (Syngamus) laryngeus human infection in Colombia Parasitic nematodes of the genus Mammomonogamus affect the respiratory tract of domestic mammals. The male and female of M. laryngeus remain in permanent copula so that the pair appears as a "Y'. To date, a few more than 100 cases of human infections by this parasite have been reported in the biomedical literature. This report describes the first infected patient in Colombia. He had a persistent and productive cough and after an episode of coughing a pair of worms were expelled in sputum with total clinical recovery. Since there is scant clinical information about this parasite, this report includes a description of the adult worms, a summary of the epidemiology and the clinical manifestations in humans. Photographs are presented to facilitate future identification by morphological characteristics.