Assuntos
Ácido Aminolevulínico/análogos & derivados , Antirreumáticos/uso terapêutico , Artrite Reumatoide/tratamento farmacológico , Leishmaniose Mucocutânea/tratamento farmacológico , Fotoquimioterapia , Fármacos Fotossensibilizantes/administração & dosagem , Fator de Necrose Tumoral alfa/antagonistas & inibidores , Adalimumab/uso terapêutico , Ácido Aminolevulínico/administração & dosagem , Artrite Reumatoide/complicações , Artrite Reumatoide/imunologia , Feminino , Humanos , Hospedeiro Imunocomprometido , Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/patologia , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Creme para a Pele , Resultado do TratamentoRESUMO
Mucocutaneous leishmaniasis (MCL) is a chronic infection that can affect the skin and mucous membranes. We report a case of oral, nasopharyngeal, and penile lesions in a 35-year-old cocaine user. The patient presented with ulcerated lesions in 2014. Histopathologic analysis revealed amastigotes, and serological test results were positive for leishmaniasis. Systemic therapy with meglumine antimoniate was administered; however, the patient failed to present for follow-up. In 2018, he returned with nasal collapse, and another histopathologic test confirmed MCL. This case illustrates the importance of careful differential diagnosis of skin and mucous ulcers to identify the particular pathology.
Assuntos
Antiprotozoários/administração & dosagem , Transtornos Relacionados ao Uso de Cocaína/complicações , Leishmaniose Mucocutânea/diagnóstico , Antimoniato de Meglumina/administração & dosagem , Adulto , Humanos , Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/tratamento farmacológico , MasculinoRESUMO
Abstract Mucocutaneous leishmaniasis (MCL) is a chronic infection that can affect the skin and mucous membranes. We report a case of oral, nasopharyngeal, and penile lesions in a 35-year-old cocaine user. The patient presented with ulcerated lesions in 2014. Histopathologic analysis revealed amastigotes, and serological test results were positive for leishmaniasis. Systemic therapy with meglumine antimoniate was administered; however, the patient failed to present for follow-up. In 2018, he returned with nasal collapse, and another histopathologic test confirmed MCL. This case illustrates the importance of careful differential diagnosis of skin and mucous ulcers to identify the particular pathology.
Assuntos
Humanos , Masculino , Adulto , Leishmaniose Mucocutânea/diagnóstico , Transtornos Relacionados ao Uso de Cocaína/complicações , Antimoniato de Meglumina/administração & dosagem , Antiprotozoários/administração & dosagem , Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/tratamento farmacológicoRESUMO
The management of mucosal leishmaniasis in immunocompromised patients is not standardized and limited data are available on the use of miltefosine for treatment and secondary prophylaxis. We describe a case of mucosal leishmaniasis in an HIV-coinfected patient treated with miltefosine due to a severe allergic reaction to liposomal amphotericin B.
Assuntos
Leishmaniose Mucocutânea/tratamento farmacológico , Fosforilcolina/análogos & derivados , Coinfecção , Infecções por HIV/complicações , Humanos , Leishmaniose Mucocutânea/complicações , Masculino , Pessoa de Meia-Idade , Fosforilcolina/uso terapêutico , Fatores de TempoRESUMO
INTRODUCTION: Mucosal leishmaniasis has a progressive course and can cause deformity and even mutilation in the affected areas. It is endemic in the American continent and it is mainly caused by Leishmania (Viannia) braziliensis. OBJECTIVE: To describe a series of mucosal leishmaniasis cases and the infectious Leishmania species. MATERIALS AND METHODS: We included 50 patients with a clinical diagnosis of mucosal leishmaniasis and parasitological confirmation, and we described their clinical and laboratory results. We performed species typing by PCR-RFLP using the miniexon sequence and hsp70 genes; confirmation was done by sequencing. RESULTS: The median time of disease evolution was 2.9 years (range: 1 month to 16 years). The relevant clinical findings included mucosal infiltration (94%), cutaneous leishmaniasis scar (74%), total loss of the nasal septum (24%), nasal deformity (22%), and mucosal ulceration (38%). The symptoms reported included nasal obstruction (90%), epistaxis (72%), rhinorrhea (72%), dysphonia (28%), dysphagia (18%), and nasal pruritus (34%). The histopathological study revealed a pattern compatible with leishmaniasis in 86% of the biopsies, and amastigotes were identified in 14% of them. The Montenegro skin test was positive in 86% of patients, immunofluorescence in 84%, and culture in 8%. Leishmania (V.) braziliensis was identified in 88% of the samples, L. (V) panamensis in 8%, and L. (V.) guyanensis and L. (L.) amazonensis in 2% respectively. CONCLUSION: In this study, we found a severe nasal disease with destruction and deformity of the nasal septum in 25% of the cases, probably associated with late diagnosis. Leishmania (V.) braziliensis was the predominant species. We described a case of mucosal leishmaniasis in Colombia caused by L. (L.) amazonensis for the first time.
Introducción. La leishmaniasis mucosa tiene un curso progresivo y puede causar deformidad e incluso mutilación de las zonas afectadas. Es endémica en el continente americano y es causada principalmente por Leishmania (Viannia) brasiliensis. Objetivo. Describir una serie de casos de leishmaniasis mucosa y las especies de Leishmania infecciosas. Materiales y métodos. Se estudiaron 50 pacientes con diagnóstico clínico de leishmaniasis mucosa y confirmación parasitológica. Se describieron sus características clínicas y los resultados de laboratorio. La tipificación de especies se hizo mediante reacción en cadena de la polimerasa de los polimorfismos de la longitud de los fragmentos de restricción (Restriction Fragment Length Polymorphism Polymerase Chain Reaction, PCR-RFLP) en la secuencia del miniexon y el gen hsp70 y se confirmó por secuenciación. Resultados. La evolución de la enfermedad fue de un mes a dieciséis años (mediana de 2,8 años). Los hallazgos clínicos fueron los siguientes: infiltración mucosa (94 %), cicatriz de leishmaniasis cutánea (74 %), pérdida total del tabique nasal (24 %), deformidad nasal (22 %) y ulceración (38 %). Los síntomas reportados fueron: obstrucción nasal (90 %), epistaxis (72 %), rinorrea (72 %), disfonía (28 %), disfagia (18 %) y prurito nasal (34 %). La histopatología mostró un patrón compatible con leishmaniasis en 86 % de las biopsias y se identificaron amastigotes en 14 % de ellas. La prueba de Montenegro fue positiva en 86 % de los pacientes, la inmunofluorescencia en 84 %, y el cultivo en 8 %. Leishmania (V.) brasiliensis se identificó en 88 % de las muestras, L. (V) panamensis en 8 %, y L. (V.) guyanensis y L. (L.) amazonensis en 2 %, respectivamente. Conclusión. Se encontró enfermedad nasal grave con destrucción y deformidad del tabique nasal en una cuarta parte de los casos, probablemente debido a un diagnóstico tardío. Leishmania (V.) brasiliensis fue la especie predominante. Se describe por primera vez un caso de leishmaniasis mucosa causado por L. (L.) amazonensis en Colombia.
Assuntos
Leishmania braziliensis/isolamento & purificação , Leishmania guyanensis/isolamento & purificação , Leishmaniose Mucocutânea/parasitologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Colômbia/epidemiologia , DNA de Protozoário/genética , Feminino , Genes de Protozoários , Proteínas de Choque Térmico HSP70/genética , Humanos , Leishmania braziliensis/classificação , Leishmania braziliensis/genética , Leishmania guyanensis/classificação , Leishmania guyanensis/genética , Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/epidemiologia , Leishmaniose Mucocutânea/patologia , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase , Polimorfismo de Fragmento de Restrição , Proteínas de Protozoários/genética , Análise de Sequência de DNA , Pele/parasitologia , Especificidade da Espécie , Adulto JovemRESUMO
Abstract Introduction: Mucosal leishmaniasis has a progressive course and can cause deformity and even mutilation in the affected areas. It is endemic in the American continent and it is mainly caused by Leishmania (Viannia) braziliensis. Objective: To describe a series of mucosal leishmaniasis cases and the infectious Leishmania species. Materials and methods: We included 50 patients with a clinical diagnosis of mucosal leishmaniasis and parasitological confirmation, and we described their clinical and laboratory results. We performed species typing by PCR-RFLP using the miniexon sequence and hsp70 genes; confirmation was done by sequencing. Results: The median time of disease evolution was 2.9 years (range: 1 month to 16 years). The relevant clinical findings included mucosal infiltration (94%), cutaneous leishmaniasis scar (74%), total loss of the nasal septum (24%), nasal deformity (22%), and mucosal ulceration (38%). The symptoms reported included nasal obstruction (90%), epistaxis (72%), rhinorrhea (72%), dysphonia (28%), dysphagia (18%), and nasal pruritus (34%). The histopathological study revealed a pattern compatible with leishmaniasis in 86% of the biopsies, and amastigotes were identified in 14% of them. The Montenegro skin test was positive in 86% of patients, immunofluorescence in 84%, and culture in 8%. Leishmania (V.) braziliensis was identified in 88% of the samples, L. (V) panamensis in 8%, and L. (V.) guyanensis and L. (L.) amazonensis in 2% respectively. Conclusion: In this study, we found a severe nasal disease with destruction and deformity of the nasal septum in 25% of the cases, probably associated with late diagnosis. Leishmania (V.) braziliensis was the predominant species. We described a case of mucosal leishmaniasis in Colombia caused by L. (L.) amazonensis for the first time.
Resumen Introducción. La leishmaniasis mucosa tiene un curso progresivo y puede causar deformidad e incluso mutilación de las zonas afectadas. Es endémica en el continente americano y es causada principalmente por Leishmania (Viannia) brasiliensis. Objetivo. Describir una serie de casos de leishmaniasis mucosa y las especies de Leishmania infecciosas. Materiales y métodos. Se estudiaron 50 pacientes con diagnóstico clínico de leishmaniasis mucosa y confirmación parasitológica. Se describieron sus características clínicas y los resultados de laboratorio. La tipificación de especies se hizo mediante reacción en cadena de la polimerasa de los polimorfismos de la longitud de los fragmentos de restricción (Restriction Fragment Length Polymorphism Polymerase Chain Reaction, PCR-RFLP) en la secuencia del miniexon y el gen hsp70 y se confirmó por secuenciación. Resultados. La evolución de la enfermedad fue de un mes a dieciséis años (mediana de 2,8 años). Los hallazgos clínicos fueron los siguientes: infiltración mucosa (94 %), cicatriz de leishmaniasis cutánea (74 %), pérdida total del tabique nasal (24 %), deformidad nasal (22 %) y ulceración (38 %). Los síntomas reportados fueron: obstrucción nasal (90 %), epistaxis (72 %), rinorrea (72 %), disfonía (28 %), disfagia (18 %) y prurito nasal (34 %). La histopatología mostró un patrón compatible con leishmaniasis en 86 % de las biopsias y se identificaron amastigotes en 14 % de ellas. La prueba de Montenegro fue positiva en 86 % de los pacientes, la inmunofluorescencia en 84 %, y el cultivo en 8 %. Leishmania (V.) brasiliensis se identificó en 88 % de las muestras, L. (V) panamensis en 8 %, y L. (V.) guyanensis y L. (L.) amazonensis en 2 %, respectivamente. Conclusión. Se encontró enfermedad nasal grave con destrucción y deformidad del tabique nasal en una cuarta parte de los casos, probablemente debido a un diagnóstico tardío. Leishmania (V.) brasiliensis fue la especie predominante. Se describe por primera vez un caso de leishmaniasis mucosa causado por L. (L.) amazonensis en Colombia.
Assuntos
Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Leishmania braziliensis/isolamento & purificação , Leishmaniose Mucocutânea/parasitologia , Leishmania guyanensis/isolamento & purificação , Pele/parasitologia , Especificidade da Espécie , Leishmania braziliensis/classificação , Leishmania braziliensis/genética , Polimorfismo de Fragmento de Restrição , Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/patologia , Leishmaniose Mucocutânea/epidemiologia , Proteínas de Protozoários/genética , Reação em Cadeia da Polimerase , DNA de Protozoário/genética , Análise de Sequência de DNA , Genes de Protozoários , Leishmania guyanensis/classificação , Leishmania guyanensis/genética , Colômbia/epidemiologia , Proteínas de Choque Térmico HSP70/genéticaRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Leishmaniose Mucocutânea/diagnóstico , Granuloma/cirurgia , Neoplasias da Língua/patologia , Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/patologia , Neoplasias da Língua/tratamento farmacológico , Espiramicina/administração & dosagem , Fluconazol/administração & dosagem , Anfotericina B/administração & dosagemRESUMO
Mucosal leishmaniasis (ML) is associated with progressive tissue destruction and granuloma formation, often after a considerable period of latency from an initial cutaneous infection. We report a case of recurrent epistaxis of 3 years duration and nasopharyngeal obstruction in a woman with treated cutaneous leishmaniasis nearly 30 years before and with no further exposure to Leishmania. Computed tomography revealed nasal septal perforation and histopathology demonstrated chronic inflammation. Microscopy was negative for amastigotes, but molecular testing of nasal mucosa biopsy detected Leishmania (Viannia) braziliensis. The patient underwent 28 days of treatment with IV sodium stibogluconate and her symptoms improved significantly. Sixteen months after treatment, she continues to have episodic epistaxis and detectable parasite load in her nasal lesion. Although ML is known to take years to decades to develop, there are few reported cases in the literature of such a long latency period. This report highlights the importance of considering ML in the differential diagnosis of chronic epistaxis in countries where leishmaniasis is endemic or in immigrants from these countries, even when presentation occurs decades after leaving an endemic region.
Assuntos
Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/diagnóstico , Mucosa Nasal/parasitologia , Perfuração do Septo Nasal/parasitologia , Adulto , Gluconato de Antimônio e Sódio/uso terapêutico , Antiprotozoários/uso terapêutico , Diagnóstico Diferencial , Epistaxe/parasitologia , Feminino , Humanos , Inflamação , Leishmania braziliensis/genética , Leishmania braziliensis/isolamento & purificação , Leishmaniose Mucocutânea/tratamento farmacológico , Perfuração do Septo Nasal/diagnóstico por imagem , Septo Nasal/diagnóstico por imagem , Septo Nasal/patologia , Carga Parasitária , Peru , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
Brazil is a country with a high prevalence of infectious diseases such as leprosy and leishmaniasis. However, coinfection of these diseases is still poorly understood. We report a case of a patient who presented with lepromatous leprosy and cutaneous-mucosal leishmaniasis at the same period. After clinical, laboratory, and histopathological diagnosis, the treatment was introduced and the patient showed important clinical improvement. He was followed in our outpatient clinic. Both pathologies play an important role in the immune system. Depending on the immune response profile of the host, diseases may present themselves in different ways. In this case, the patient showed a divergent immune response for each disease. We hypothesized that this response is specific for each pathogen.
Assuntos
Coinfecção/complicações , Leishmaniose Mucocutânea/complicações , Hanseníase Virchowiana/complicações , Coinfecção/imunologia , Coinfecção/patologia , Humanos , Imunidade Celular/imunologia , Leishmaniose Mucocutânea/imunologia , Leishmaniose Mucocutânea/patologia , Hanseníase Virchowiana/imunologia , Hanseníase Virchowiana/patologia , Masculino , Pessoa de Meia-IdadeRESUMO
Abstract: Brazil is a country with a high prevalence of infectious diseases such as leprosy and leishmaniasis. However, coinfection of these diseases is still poorly understood. We report a case of a patient who presented with lepromatous leprosy and cutaneous-mucosal leishmaniasis at the same period. After clinical, laboratory, and histopathological diagnosis, the treatment was introduced and the patient showed important clinical improvement. He was followed in our outpatient clinic. Both pathologies play an important role in the immune system. Depending on the immune response profile of the host, diseases may present themselves in different ways. In this case, the patient showed a divergent immune response for each disease. We hypothesized that this response is specific for each pathogen.
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Hanseníase Virchowiana/complicações , Leishmaniose Mucocutânea/complicações , Coinfecção/complicações , Hanseníase Virchowiana/imunologia , Hanseníase Virchowiana/patologia , Leishmaniose Mucocutânea/imunologia , Leishmaniose Mucocutânea/patologia , Coinfecção/imunologia , Coinfecção/patologia , Imunidade Celular/imunologiaAssuntos
Antiprotozoários/administração & dosagem , Leishmaniose Mucocutânea/tratamento farmacológico , Doenças da Boca/tratamento farmacológico , Paromomicina/administração & dosagem , Administração Tópica , Humanos , Leishmania tropica , Leishmaniose Mucocutânea/complicações , Masculino , Pessoa de Meia-Idade , Doenças da Boca/parasitologia , Mucosa BucalRESUMO
The authors present a clinical report of deforming mucocutaneous leishmaniasis of the nose in a native American woman, left untreated for 25 years. The nose was reconstructed using the local tissue displaced as flaps, and using cartilage grafts taken from the nasal septum and the ear shell. To the best of the authors' knowledge, the literature offers just 1 report on a similar patient.
Assuntos
Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/patologia , Deformidades Adquiridas Nasais/parasitologia , Deformidades Adquiridas Nasais/cirurgia , Rinoplastia/métodos , Idoso de 80 Anos ou mais , Feminino , Humanos , Deformidades Adquiridas Nasais/patologiaAssuntos
Neoplasias Faciais/complicações , Neoplasias Faciais/diagnóstico , Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/diagnóstico , Face/patologia , Neoplasias Faciais/tratamento farmacológico , Humanos , Injeções Intramusculares , Leishmaniose Mucocutânea/tratamento farmacológico , Masculino , Meglumina/administração & dosagem , Antimoniato de Meglumina , Pessoa de Meia-Idade , Compostos Organometálicos/administração & dosagemRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto , Leishmaniose Mucocutânea/patologia , Pavilhão Auricular/patologia , Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/diagnóstico , HIV , Biópsia/métodosAssuntos
Granulomatose Orofacial/parasitologia , Leishmaniose Mucocutânea/diagnóstico , Antiprotozoários/uso terapêutico , Diagnóstico Diferencial , Humanos , Leishmaniose Mucocutânea/complicações , Masculino , Meglumina/uso terapêutico , Antimoniato de Meglumina , Compostos Organometálicos/uso terapêutico , Adulto JovemRESUMO
No disponible
Assuntos
Adulto , Humanos , Masculino , Leishmaniose Mucocutânea/complicações , Leishmaniose Mucocutânea/diagnóstico , Leishmania infantum/isolamento & purificação , Leishmania infantum/patogenicidade , Leishmania braziliensis/isolamento & purificação , Leishmaniose Mucocutânea/fisiopatologia , Leishmaniose Mucocutânea , Doenças Vestibulares/patologia , Mucosa Nasal/patologia , FotomicrografiaRESUMO
BACKGROUND: After the onset of HAART, some HIV-infected individuals under treatment present a exacerbated inflammation in response to a latent or a previously treated opportunistic pathogen termed immune reconstitution inflammatory syndrome (IRIS). Few reports of tegumentary leishmaniasis have been described in association with IRIS. Moreover, the immunopathogenesis of IRIS in association with Leishmania is unclear. CASE PRESENTATION: The present study reports on a 29-year-old HIV-infected individual who developed mucocutaneous leishmaniasis associated with immune reconstitution inflammatory syndrome (IRIS) five months following highly active antiretroviral therapy (HAART). Severe lesions resulted in the partial destruction of the nasal septum, with improvement observed 15 days after treatment with Amphotericin B and corticosteroids. The immune response of this patient was evaluated before and after the lesions healed. IRIS was diagnosed in association with high levels of TNF-α and IL-6. Decreased production of IFN-γ and a low IFN-γ/IL-10 ratio were also observed in response to Leishmania antigens. After receiving anti-leishmanial treatment, the individual's specific Th1 immune response was restored. CONCLUSION: The results suggest that the production of inflammatory cytokines by unstimulated T-lymphocytes could contribute to occurrence of leishmaniasis associated with IRIS.