Laryngeal Leishmaniasis in Malta

Leishmania donovani mucosal leishmaniasis in Malta

We report a case of a 76-year-old British man living in Malta who presented with a 7-month history of recurrent epistaxis and an enlarging right nasal vestibular lesion. Of note, his medical history included rheumatoid arthritis for which he was on long-term methotrexate. Blood results were unremarkable other than a mild lymphopaenia. Despite the use of various antibiotics and intranasal steroids, the lesion failed to resolve. This was eventually biopsied, and the histological picture was that of mucosal leishmaniasis. Leishmania donovani complex was detected by PCR. The patient was treated with liposomal amphotericin B on alternate days for a total of 20 doses. The lesion was found to have healed well at follow-up and the patient denied any further episodes of epistaxis.

Case Report: Old World Mucosal Leishmaniasis: Report of Five Imported Cases to the Hospital for Tropical Diseases, London, United Kingdom

Old World species of Leishmania typically cause visceral and cutaneous leishmaniasis. Mucosal involvement is typically seen with infection by Leishmania species found in South America, usually after the healing of cutaneous leishmaniasis. We present five imported cases of mucosal leishmaniasis caused by Old World Mediterranean Leishmania infantum exclusively affecting the nasal mucosa or vocal cord. In only one case was there a recollection of a preceding cutaneous lesion compatible with cutaneous Leishmaniasis. Of significance was that four out of five cases were receiving local corticosteroids for chronic lung disorders and four were systemically immunosuppressed. This report highlights the importance of considering mucosal leishmaniasis in the differential diagnosis in those presenting with upper respiratory tract mucosal lesions with a relevant travel history to the Mediterranean and in whom malignancy has been excluded.

Generalized Leishmanides in an Immunodeprived Man

Leishmanides have been rarely reported in the literature. In this study, the authors present a case of a 50-year-old HIV-positive man who developed a generalized cutaneous eruption of papules and plaques in which no microorganism was demonstrated by culture, microscopical examination, immunohistochemistry, or polymerase chain reaction. The patient was eventually diagnosed with laryngeal leishmaniasis, and when treated, the cutaneous lesions greatly improved.

Leishmaniasis

Leishmaniasis remains an important neglected tropical infection that affects children more than adults. Geographical variation exists in the distribution of the various Leishmania species. Although the majority of the disease burden is found in poor countries, leishmaniasis is also endemic in several countries within Southern Europe. Transmission is mediated by the sandfly and may follow an anthroponotic or zoonotic cycle that also varies by region. The expression of leishmaniasis depends on a complex interaction between the type of infecting species and the host immune response. Infection may be asymptomatic or may manifest as cutaneous disease that is pleiomorphic in presentation, muco-cutaneous disease or the visceral form that may be lethal if untreated. Molecular techniques aid diagnosis especially in cases where amastigotes are not visualised. The efficacy of treatment varies with the type of infecting species and resistance patterns. Preventive measures aimed at avoiding sandfly bites are effective in reducing acquisition of leishmaniasis and should be promoted for travellers visiting endemic regions. The persistent lack of a vaccine against human leishmaniasis is a result of the poor investment in this neglected parasitosis.

Leishmaniasis presenting to the otolaryngologist: a rare but important cause of persistent hoarseness

Objective:

We report a rare UK case of laryngeal leishmaniasis, mimicking laryngeal candidiasis, associated with long term steroid inhaler use.

Methods:

Case report and review of the world literature concerning leishmaniasis.

Results:

Laryngeal leishmaniasis is a protozoal infection which is rare in the Western world. It is becoming more common, however, with increased foreign travel. The disease can be difficult to diagnose histologically, and diagnosis is often delayed because of its rarity. It can mimic malignant laryngeal disease, and patients may therefore be subjected to significant and inappropriate treatment interventions.

Conclusions:

A diagnosis of leishmaniasis should be considered if initial treatment for persistent hoarseness is ineffective, particularly in a patient who is at low risk of malignancy.