Case Report: Progressive Dysphonia and Dysphagia due to Laryngeal Leishmaniasis.

Laryngeal leishmaniasis is an unusual form of the disease. We report the case of a patient who consulted for dysphonia and dysphagia in a context of asthenia and weight loss. The patient had lesions that were suggestive of laryngeal cancer but were revealed to be leishmaniasis by histopathology examination and polymerase chain reaction. Treatment with amphotericin B and miltefosine permitted complete resolution of the lesions and no recurrence during the 18-month follow-up period.

Case Report: Atypical Presentation of Visceral Leishmaniasis: Two Cases from Northwest Ethiopia.

Human visceral leishmaniasis (VL) is a life-threatening disease caused by protozoan parasites belonging to the Leishmania donovani complex. Atypical cases of leishmaniasis and HIV coinfection have been documented in case reports, mostly associated with gastrointestinal tract, kidney, and skin involvement. We report two VL cases with atypical localizations not reported from east Africa before, both diagnosed and treated at the Leishmaniasis Research and Treatment Center, Gondar, Ethiopia. The first case was an HIV-infected patient with scrotal and penile involvement. Leishmania parasites were detected in the spleen and the scrotum. The second case was an immunocompetent individual with esophageal, laryngeal, and pharyngeal involvement and facial lesions. Leishmania parasites were detected in the spleen, skin, and esophageal biopsies. Current evidence suggests atypical presentation can occur in patients irrespective of their HIV status. Therefore, we suggest a high index of suspicion for VL among clinicians working in endemic areas of Ethiopia.

Additional characterization of the adult worm Mammomonogamus laryngeus (Railliet, 1899) and the tissue lesions caused by the infection in buffaloes.

Mammomonogamus spp. are parasites with curious characteristics, such as the "Y" shape that results from male and female maintaining the permanent copulation position and the controversial presence or absence of spicules. These nematodes are hematophagous and cause damage to the upper respiratory tracts of cattle, sheep, goats, deer, wild yaks, and orangutans. Human infection is rare and most cases until now have been in the Caribbean Islands or in Brazil, and mainly in farmworkers but recently there have been reports affecting tourists. In the present work, the parasites were recovered from the laryngopharynx and larynx region of Bubalus bubalis on the island of Marajó, Pará, Brazil. Different microscopy methodologies were applied (bright field, fluorescence, and scanning electron microscopy) to explore the ultrastructural details of the anterior end, genital structures and the host tissue damage caused by the nematodes. The well-developed mouth is an important structure in the identification of these nematodes and used by the parasite to adhere to the host's tissue. Different methodologies in microscopy and molecular biology contributed to a detailed morphological description and showed the phenotypic position of Mammomonogamus laryngeus. Light and scanning electron microscopy (SEM) showed details of the papillae, amphids, festoons, ribs, and teeth. Fluorescence microscopy enabled a detailed characterization of different structures, such as the bursal rays and SEM enabled the visualization of the specialized features of the cuticle surface in the male and female. Histopathological analyses, cryofracture and environmental SEM experiments of the infected tissues were carried out in order to investigate the lesions resultant from the parasitism. In addition, the parasite couples were submitted to cryofracture and these results revealed details of the reproductive structures of both sexes, including the male spicule.

Nondisseminated rhinosporidiosis with multisite involvement in the head and neck.

Rhinosporidiosis is a communicable disease prevalent in tropical countries that affects one or more mucocutaneous sites such as the nasal cavity, pharynx, skin, bronchus, genitals, and bone, in isolation or together. We report a case of multicentric rhinosporidiosis involving the nasal cavity, oropharynx, larynx, and cheek skin without disseminated disease outside the head and neck. Although the appearance of mucocutaneous lesions in our patient was similar to that of papilloma or neoplasm, the distinct clinicopathologic characteristics of the rhinosporidiosis guided us in managing the case successfully. In our own experience with 11 patients with rhinosporidiosis on whom we operated over the past 5 years, the nasal cavity and pharynx were the most commonly involved sites in the head and neck. Surgical excision of all lesions along with cauterization of the base and long-term dapsone therapy is the current standard of care for multicentric rhinosporidiosis.

[A rare case report of laryngeal leech infestation in a 70-year-old man]. / Cas rare de sangsue laryngée chez un homme de 70 ans.

Foreign bodies in the upper respiratory tract are one of the most difficult otolaryngological emergencies; leeches are a very rare foreign bodies in the world. We report the case of a 70-year-old man with no past medical history presenting with laryngeal dyspnea associated with low abundant paroxysmal hemoptysis. The patient underwent nasofibroscopy showing the presence of a living and mobile organism at the subglottic level evoking a leech. Extraction was carried out under local anesthesia using laryngoscope and Magill forceps. The presence of a leech as a foreign body in the upper respiratory tract should be suspected in patients with a recent history of consumption of non-potable water.

Trichomonas gallinae: Prevalence and molecular characterization from pigeons in Minoufiya governorate, Egypt.

Trichomonas gallinae infects the upper digestive tract of pigeons. It is transmitted from mother to young squabs by feeding crop milk. Generally, infection resulted in severe mortalities in young birds. In this study, we examined 3315 pigeons of different ages from the Minoufiya governorate for the clinical infection by T. gallinae. The infection was confirmed in infected birds by microscopical examination of oral swabs, histopathological examination, and PCR of the ITS1/5.8S/ITS2 gene. The prevalence was 63 (1.9%). The parasite was found in 35 (2.04%) from Ashmoun, 15 (1.66%) from Minoof, 8 (1.6%) from Quesna, and 5 (2.5%) from El-Shohada birds. The infection was mainly detected in squabs 60 (1.8%). The sequence of T. gallinae ITS1/5.8S/ITS2 gene from Egypt has high nucleotide sequence identity (up to100%) to T. gallinae from pigeon of USA, Austria, Canada, and Spain. The sequence belongs to genotype B of T. gallinae. Histopathological examination presented the parasites in crop, liver, larynx, and trachea as poorly eosinophilic bodies with severe inflammatory cell infiltration. This is the first study to present the prevalence and genotype of T. gallinae from Minoufiya governorate, Egypt.

Localized mucosal leishmaniasis caused by Leishmania infantum mimicking cancer in the rhinolaryngeal region.

The clinical, microbiological, and histopathological findings of six patients with mucosal leishmaniasis are reported. Five of these patients were Spanish with no history of travel abroad, while the other was from Bolivia but had lived in Spain for more than 5 years. Two patients had no underlying disease, while the other four had several other medical conditions. Lesions were located in the nose in three patients and in the larynx in the other three. Symptoms included difficulty in swallowing, nasal obstruction, dysphonia, and polypoid lesions mimicking cancer. The diagnosis was based on the identification of parasites, or on PCR assay or culture. Five patients were treated with liposomal amphotericin B and the other with antimonial compounds.

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.

Oral manifestations in the American tegumentary leishmaniasis.

INTRODUCTION: American tegumentary leishmaniasis (ATL) can affect the skin or mucosa (mucocutaneous leishmaniasis - MCL) including the oral cavity. MCL oral lesions are often confused with other oral diseases, delaying diagnosis and specific treatment, and increasing the likelihood of sequelae. Thus, increasing the knowledge of the evolution of ATL oral lesions can facilitate its early diagnosis improving the prognosis of healing. OBJECTIVES: Evaluate the frequency of ATL oral lesion and describe its clinical, laboratory and therapeutic peculiarities. METHODS: A descriptive transversal study was carried out, using data from medical records of 206 patients with MCL examined at the outpatient clinics-IPEC-Fiocruz between 1989 and 2013. Proportions were calculated for the categorical variables and the association among them was assessed by the Pearson's chi-square test. Measures of central tendency and dispersion were used for the continuous variables and their differences were assessed by both parametric (t test) and non parametric (Mann-Whitney) tests. P-values <0.05 were considered as significant. RESULTS: The most affected site was the nose, followed by the mouth, pharynx and larynx. Seventy eight (37.9%) have oral lesions and the disease presented a lower median of the evolution time than in other mucous sites as well as an increased time to heal. The presence of oral lesion was associated with: the presence of lesions in the other three mucosal sites; a smaller median of the leishmanin skin test values; a longer healing time of the mucosal lesions; a higher recurrence frequency; and a smaller frequency of treatment finishing and healing. When the oral lesion was isolated, it was associated with an age 20 years lower than when the oral lesion was associated with other mucosal sites. CONCLUSION: Considering the worst therapy results associated with the presence of oral lesions, we suggest that lesions in this location represent a factor of worse prognosis for MCL.

Molecular, cytological, and immunocytochemical study and kDNA sequencing of laryngeal Leishmania infantum infection.

Mucosal leishmaniasis is a well-known clinical manifestation of infections mainly caused by New World Leishmania species, especially Leishmania braziliensis (Viannia) in Central and South America. It is extremely uncommon in the world, even in the endemic areas such as Fars Province, Southern Iran. Two male immunocompetent subjects who developed Leishmania mucosal lesion mimicking a laryngeal tumor presented with a several-months history of dysphonia, dyspnea, hoarseness, and odynophagia. Multiple smears from the lesions showed structures resembling the amastigote form of Leishmania. Nested PCR analysis to amplifying a fragment of Leishmania infantum kinetoplastid DNA from the Giemsa-stained smear resulted in a fragment of 680 bp. Sequence analysis of one of the strains showed 98% similarity to L. infantum strain IranJWinf (GenBank accession no. AB678348.1) and 96% similarity to L. infantum isolate MCAN/ES/98/10445 (GenBank accession no. EU437407.1), while another strain showed 97% similarity with two L. infantum strains from kala-azar patient (GenBank accession nos. AJ223725.1 and AF027577.1). Immunocytochemical staining with anti-L. infantum mAb (D2) was positive. Primary mucosal leishmaniasis (ML) may occur in the immunocompetent patients who reside in or travel to endemic areas of leishmaniasis. Mucosal leishmaniasis contracted in endemic areas, such as Iran, has to be considered in the differential diagnosis of lesions in the other mucosa and may occur in previously healthy persons. Therefore, cytology, PCR, and immunocytochemistry-based methods with anti-Leishmania mAb are helpful in the diagnosis of ML.

[A case of leech infestation mimicking upper respiratory tract infection]. / Üst Solunum Yolu Enfeksiyonunu Taklit Eden Bir Sülük Enfestasyonu Olgusu.

Urban life and industrialization leads to a decrease in the incidence of many parasitic diseases. Especially, using the supervised water supplies in urban areas decreases the chance of such infestations and limits it in rural areas. However, the people who live in urban areas and have diseases such as kidney stones think that mountain waters may be beneficial for their illness. These types of water supplies are generally unsafe, uncontrolled and septic. That is why usage of them can cause some elusive parasitic infestations in people who live in urban areas. It is meaningful to submit the case described below to illustrate the possibility of parasitic infestations in patients who have upper respiratory tract infection symptoms who are admitted to the physician.

[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.

A human case of Clinostomum complanatum infection in Korea.

A 33-year-old Korean man visited a medical clinic with complaints of throat discomfort and pain for one week. The symptoms occurred one day after eating raw brackish water fish, perch. Endoscopy revealed a fluke, about 5 mm in length, attaching to and peristaltically moving on the surface of the mucosa at the arytenoid region of the larynx. Microscopically, the testes were triangular, tandem, and separated by the uterus. The ovary and cirrus pouch were placed apart from median line between testes. Numerous blood cells were observed in the ceca. The worm was identified to be Clinostomum complanatum. This is the second human case of clinostomiasis in Korea.

Death due to an unrecognized ascariasis infestation: two medicolegal autopsy cases.

Two unusual autopsy cases of fatal Ascaris infection have been presented. The first case presents lethal diffuse peritonitis due to duodenal rupture caused by the presence of parasitic Ascaris worm in gastrointestinal tract of 2.5-year-old child. The second one is a case of subacute asphyxia caused by obturation of upper respiratory tract by a large number of adult Ascaris roundworms. General economic crisis and inefficient medical service make possible spreading of almost eradicated disease, thus the possibility of the most serious complications of this helminthiasis must not be forgotten.

A Human Case of Clinostomum complanatum Infection in Korea

A 33-year-old Korean man visited a medical clinic with complaints of throat discomfort and pain for one week. The symptoms occurred one day after eating raw brackish water fish, perch. Endoscopy revealed a fluke, about 5 mm in length, attaching to and peristaltically moving on the surface of the mucosa at the arytenoid region of the larynx. Microscopically, the testes were triangular, tandem, and separated by the uterus. The ovary and cirrus pouch were placed apart from median line between testes. Numerous blood cells were observed in the ceca. The worm was identified to be Clinostomum complanatum. This is the second human case of clinostomiasis in Korea.

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

Visceral leishmaniasis, a protozoan disease caused by Leishmania infantum, is endemic in the Mediterranean basin, especially southern and Tyrrhenian Italy. Its aetiological agent can also sporadically cause isolated laryngeal localization in at-risk patients (i.e., heavy smokers, immunocompromised patients). This rare localization is often pauci-symptomatic and thus can easily escape diagnosis. A case of isolated leishmaniasis limited to the left vocal cord in an immunocompetent Italian male without significant risk factors, randomly discovered upon histological examination, is described herein. We inquire how many patients affected by non-specific symptoms such as dysphonia and live in countries where Leishmania infantum infection is reported, could be truly affected by Leishmania spp infection.

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.

Detection of Leishmania infantum kinetoplast DNA in laryngeal tissue from an immunocompetent patient.

Mucosal leishmaniasis of the upper respiratory tract is usually associated with the visceral form or is found in immunosuppressed individuals. This report presents a case of isolated mucosal leishmaniasis in an immunocompetent patient, whose diagnosis mainly rested on histology and positive polymerase chain reaction result for Leishmania donovani in the laryngeal tissue. A 59-year-old man, who never lived outside Italy, showed a subglottic mucosal polypoid-like lesion. The typical morphological picture and positive polymerase chain reaction result for L donovani by DNA extracted from laryngeal biopsy specimens allowed the diagnosis of mucosal leishmaniasis. Specific amphotericin B therapy was started, resulting in clinical and endoscopic improvement. Increased knowledge about the histological and molecular tissue analysis of Leishmania enhances the diagnostic testing for mucosal leishmaniasis, as primary mucosal leishmaniasis may occur in both immunosuppresed and immunocompetent patients who travel to or reside in areas endemic for Leishmania.