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.

Case Report: Scabies Invading Gingival Tissue.

Non-plaque-induced lesions may occur on the gingiva as medical disorders or manifestations of systemic conditions. Scabies is a parasitic infection caused by Sarcoptes scabiei. Here, we present the first case of oral scabies reported in the literature located on the gingiva in a 43-year-old woman. She was admitted to the hospital complaining of an ulcerative lesion on the gingiva with unknown duration, with a suggestive diagnosis of pemphigoid. A diagnosis of scabies infestation was made based on the visualization of eggs and larvae/nymph forms. The treatment consisted of 100 mg of ivermectin (three times per day for 15 days), supplemental oral hygiene with chlorhexidine, and extensive cleaning. The follow-up was made 30 days after treatment with ivermectin. The patient did not report side effects, with skin and oral lesions completely healed. Based on this, we need to perform a thoughtful ectoscopy examination and be alert to signs that indicate unusual causes to diagnose correctly and choose the appropriate treatment.

Mucocutaneous leishmaniasis in a US citizen.

Mucocutaneous leishmaniasis (MCL) is endemic to many areas of Central and South America. A case of MCL in a US citizen is reported here. An ulcer appeared on the patient's left hard palate, years after a working trip to Peru. Punch biopsies of the lesion were obtained, Leishmania promastigotes were isolated by culture and animal inoculation, and the patient was appropriately treated. As this case demonstrates, a patient's travel history is a key element in making a differential diagnosis of oral lesions.

Visceral leishmaniasis and HIV co-infection: a rare case of pulmonary and oral localization.

Visceral leishmaniasis (VL) has increased as a complicating infection in subjects with human immunodeficiency virus (HIV) in countries bordering the Mediterranean sea. The clinical course as well as organ involvement of VL are often atypical in HIV positive subjects. In this study a case of VL with pulmonary and oral mucose localisation in a patient with acquired immune deficiency syndrome (AIDS), is reported. These findings, together with the presence of the parasite in the peripheral blood smear, confirm that in HIV positive patients the impaired immune system allows the spreading and the atypical localisation of the Leishmania amastigotes more easily than in immuno-competent individuals. In endemic areas and in HIV positive subjects a systemic and careful parasitological follow-up is necessary to ensure that any clinical form of leishmaniasis is not overlooked.

Oral mucosal involvement in visceral leishmaniasis.

Leishmaniasis affects both the visceral and cutaneous tissues in body. Oral Mucosal involvement in leishmaniasis is rare and is often overlooked. We present a case 17 year old boy from the north east region of Bihar who has a history of visceral leishmaniasis one year back, came to the department of oral surgery for treatment of persistent oral ulcers. Oral examination did not give any diagnostic information while systemic examination revealed enlarged spleen and low grade fever. Patient was screened for leishmaniasis by rK39 based immunochromatographic strip test which came to be positive. Biopsy of the ulcer as well as splenic and bone marrow aspirate confirmed the presence of leishmaniasis. Patient was administered Amphotericin B for 20 days following which significant clinical and haematological improvement followed.

Zoonotic anatrichosomiasis in an Illinois resident.

We describe a case of zoonotic anatrichosomiasis in a patient from Illinois. A 44-year-old immigrant from Mexico originally presented with a history of multiple oral ulcers and two submucosal nodules on the dorsal surface of the tongue. An incisional biopsy was taken to assist with diagnosis. Examination of stained sections revealed the presence of a coiled nematode. The histologic examination displayed trichuroid features. Anatomic structures that aided in the identification included esophagus embedded in a prominent stichosome in the anterior end, paired bacillary bands, and small size. The location of the worm within the oral mucosal epithelium also facilitated the diagnosis.

Advanced stage of oral myiasis in children: a clinical case report.

Human myiasis is characterized by larval infestation of body tissues or cavities of live individuals. Although most frequently observed in underdeveloped and tropical countries, reports of human myiasis have been encountered throughout the world. Conventional treatment is the mechanical removal of the larvae, one by one, which is painful and embarrassing and repugnant to both health professional and patient. Even though human myiasis is not considered rare, most dental professionals have very little knowledge of the diagnosis and treatment of this pathology. The purpose of this article, therefore, is to report a case of advanced-stage oral myiasis in a 9-year-old patient treated at a health and dentistry clinic. Diagnosis was based on visual observation of Cochliomyia hominivorax larvae, a dipterous fly of the Calliphoridae family, which were between the second and third stages of development. Predisposition factors include lack of information, malnutrition, poor oral hygiene, preexistence of oral lesions, and severe halitosis, which decisively influence the appearance and development of oral myiasis. A brief review of the literature is also included, in which the importance of early clinical diagnosis, myiasis etiology, and possible associations with other pathologies and different types of treatment are discussed.

Oral leishmaniasis: a clinicopathological study of 11 cases.

Leishmaniasis is a parasitic disease with diverse clinical manifestations, and considered a public health problem in endemic countries such as Brazil. Mucosal lesions usually involve the upper respiratory tract, with a predilection for nose and larynx. Oral involvement is unusual and in most cases it becomes evident after several years of resolution of the original cutaneous lesions. Oral lesions classically appear as mucosal ulcerations, mainly in the hard or soft palate. This report describes the clinicopathological data of 11 cases of mucocutaneous leishmaniasis with oral manifestations. Two cases of Leishmania (Viannia) braziliensis and one case of Leishmania (Leishmania) amazonensis were confirmed by polymerase chain reaction-restriction fragment length polymorphism or DNA sequencing in mucosal samples.

Noma (cancrum oris) associated with oral myiasis in an adult.

Noma is a devastating oro-facial necrotic condition affecting debilitated subjects. Oral myiasis is an infectious disease caused by deposition of larval flies in oral wounds and lesions. Oro-facial noma-myiasis association has not been previously reported in the literature. The aim of this paper is to report a case of noma associated with myiasis in a 65-year-old Brazilian male.

Imported mucocutaneous leishmaniasis.

We report a case of mucocutaneous leishmaniasis in a otherwise fit Caucasian man who had traveled in an endemic area. Initial tissue microscopy failed to identify the causative organism, which was only determined by subsequent culture as Leishmania braziliensis. This case illustrates the variability in the presence of Leishman-Donovan (LD) bodies in histopathological studies and emphasizes the need for culture in suspected cases of leishmaniasis, particularly given the ability of certain Leishmania species such as L. braziliensis to cause recalcitrant and destructive infections of the nose and mouth.