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Mucosal leishmaniasis in Adult
See also in: Oral Mucosal Lesion
Other Resources UpToDate PubMed

Mucosal leishmaniasis in Adult

See also in: Oral Mucosal Lesion
Contributors: Nana Amma Sekyere BS, MS, Belinda Tan MD, PhD, Cristina Thomas MD, Susan Burgin MD
Other Resources UpToDate PubMed

Synopsis

Mucosal leishmaniasis (ML), a potential sequela of New World cutaneous leishmaniasis (NWCL), results from hematogenous or lymphatic dissemination of leishmanial parasites from the skin to the naso-oropharyngeal mucosa. The common etiologic agents are those in the Viannia subgenus, particularly Leishmania (Viannia) braziliensis, Leishmania (Viannia) panamensis, and Leishmania (Viannia) guyanensis, with L (V) braziliensis accounting for most ML cases. ML caused by L (V) braziliensis is endemic in Bolivia, Peru, and Brazil but can also be found throughout Mexico and other parts of South America. Leishmania amazonensis can also cause ML. Some Old World species have been identified as causal agents in immunocompromised hosts, specifically Leishmania infantum and Leishmania aethiopica. In Sudan, Leishmania major and Leishmania donovani have contributed to sporadic forms of primary ML.

The risk factors for ML are poorly understood but include both parasite and host immunity factors. Even what apparently is the same leishmanial species is not necessarily associated with the same risk for ML in different countries. For example, L (V) braziliensis infection in Brazil and Peru more commonly results in ML than does infection with this same species in Guatemala. Because ML is due to parasitic spread from the skin, most patients who develop ML did not receive optimal therapy for NWCL. In some settings, the risk for ML in patients not optimally treated for NWCL may be approximately 13%. Some patients do not recall a history of NWCL and do not have scars suggestive of prior cutaneous infection. Studies have also shown an increased risk of ML that correlates with male sex, age (specifically young adults), malnutrition, and duration of a primary NWCL ulcer of more than 4 months.

Usually, ML is first evident in the nasal mucosa (sometimes in the mouth) and appears years after the initial cutaneous lesions. It may present early on as nasal stuffiness, discharge, blockage, or epistaxis. If untreated, progressive, disfiguring, naso-oropharyngeal destruction may follow, and in some cases, the pharynx and other airway structures (eg, epiglottis, trachea, larynx) may be involved. Rarely, airway compromise or aspiration pneumonia may lead to death.

Patients with a history of NWCL, however remote, caused by relevant leishmanial species should be evaluated for ML with periodic naso-oropharyngeal examinations until 2 years following NWCL treatment.

Codes

ICD10CM:
B55.2 – Mucocutaneous leishmaniasis

SNOMEDCT:
403135004 – American mucocutaneous leishmaniasis

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Last Reviewed:05/05/2021
Last Updated:05/12/2021
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Mucosal leishmaniasis in Adult
See also in: Oral Mucosal Lesion
Mucosal leishmaniasis (Early Stage) : Erythema, Mexico and Central America, Nasal congestion, Nasal irritation, Smooth nodule, South America, Verrucous scaly papule, Epistaxis, Sandfly exposure
Clinical image of Mucosal leishmaniasis
A large exophytic plaque with a papillated surface on the hard and soft palate.
Copyright © 2021 VisualDx®. All rights reserved.