Mucocutaneous leishmaniasis

Skin | Dermatology | Mucocutaneous leishmaniasis (Disease)


Description

Cutaneous leishmaniasis is the most common form of leishmaniasis. Visceral leishmaniasis is a severe form in which the parasites have migrated to the vital organs.

Leishmaniasis is a disease caused by protozoan parasites that belong to the genus Leishmania and is transmitted by the bite of certain species of sand fly (subfamily Phlebotominae). Although the majority of the literature mentions only one genus transmitting Leishmania to humans (Lutzomyia) in America, a 2003 study by Galati suggested a new classification for American sand flies, elevating several subgenera to the genus level. Elsewhere in the world, the genus Phlebotomus is considered the vector of leishmaniasis.

Causes and Risk factors

Most forms of the disease are transmissible only from animals (zoonosis), but some can be spread between humans. Human infection is caused by about 21 of 30 species that infect mammals. These include the L. donovani complex with three species (L. donovani, L. infantum, and L. chagasi); the L. mexicana complex with four main species (L. mexicana, L. amazonensis, and L. venezuelensis); L. tropica; L. major; L. aethiopica; and the subgenus Viannia with four main species (L. (V. ) braziliensis, L. (V. ) guyanensis, L. (V. ) panamensis, and L. (V. ) peruviana). The different species are morphologically indistinguishable, but they can be differentiated by isoenzyme analysis, DNA sequence analysis, or monoclonal antibodies.

Diagnosis and Treatment

Supportive measures (eg, adequate nutrition, transfusions, antibiotics for secondary bacterial infection) may be needed for patients with visceral leishmaniasis. Reconstructive surgery may be required if mucocutaneous leishmaniasis grossly distorts the nose or palate, but surgery should be delayed for 6 to 12 mo after therapy to avoid losing grafts because of relapses. This form frequently relapses, as does the visceral form in patients with AIDS. Treatment with highly active antiretroviral therapy (HAART) may reduce risk of relapse.

Drugs are given; selection depends on the form of disease, infecting species, resistance pattern, and geographic location. ...