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11/42. Localized mucosal leishmaniasis due to Leishmania (Leishmania) infantum: clinical and microbiologic findings in 31 patients.

    The clinical and microbiologic characteristics of 31 patients with mucosal leishmaniasis due to Leishmania (Leishmania) infantum are described. Twenty-eight (90%) patients were male. Mean age at presentation was 48 /- 14 years. Thirteen (42%) patients had no underlying disease, while 18 (58%) patients had several other medical conditions. Fifteen (48%) patients were immunocompromised, 7 patients were infected with human immunodeficiency virus (hiv), and 3 were graft recipients. The primary location of lesions was the larynx in 11 (35%) patients, oral mucosa in 10 (32%) patients, and the nose in 5 (16%) patients. Mucosal lesions were painless in all patients but 2 and consisted of whitish, red, or violaceous nodular swelling or tumorlike masses. Ulceration was reported in 6 patients. Pathologically, the lesions showed a chronic inflammatory infiltrate. granuloma may be seen.The localization of the lesions determined the symptomatology of the disease. Symptoms included hoarseness, difficulty swallowing, and nasal obstruction. The disease presentation was usually protracted, with a mean time from the onset of symptoms to diagnosis of 13 months (range, 3 wk-4.5 yr), and the clinical diagnosis was usually mistaken for neoplasia of the upper aerodigestive tract. No laboratory abnormalities were found in these patients due to the localized disease, apart from those attributed to underlying diseases.parasites were easily identified in smears or sections by Giemsa stain or hematoxylin-eosin stain. Leishmania was grown in culture in 12 (60%) patients; culture was negative in 8 (40%) patients. Leishmania (Leishmania) infantum was identified in only 9 instances. The following zymodemes were reported: MON-1 (2 patients), MON-24 (2 patients), MON-27 (1 patient), and MON-34 (1 patient). Serologic test results were known in 25 patients. serology was usually positive at low titer; 6 (24%) patients had negative serologic test results.Twenty patients were treated with antimonial compounds for between 3 and 36 days. Three patients were given drugs other than antimonial drugs. Five patients were treated only locally, by surgery (3 patients) or topical medical therapy. One patient received no therapy, and treatment was not reported in 2 cases. patients were cured in 25 (89%) cases, and sequelae were uncommon (14%). Relapse was detected in 2 individuals and 1 patient developed visceral leishmaniasis after treatment. Two hiv-coinfected patients died of causes unrelated to leishmaniasis.The results of the present report stress the clinical importance of searching for the presence of Leishmania in patients with suspected neoplasia of the upper respiratory tract if they have visited or resided in zones endemic for Leishmania (Leishmania) infantum. The treatment of choice for these patients is not established yet, but most patients respond to antimonial compounds given for 28 days or less.
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12/42. Imported mucosal leishmaniasis in a traveler.

    We report a case of mucosal leishmaniasis in a traveler returning from south america. The traveler developed nasal symptoms 2 months after the appearance of cutaneous ulcers. diagnosis of mucosal Leishmania viannia braziliensis infection was made 5 years later. The clinical presentation and diagnosis for the patient are reported, and previous cases in travelers are reviewed. We recommend that mucosal examination should be part of follow-up for L. viannia braziliensis infection in travelers. Mucosal leishmaniasis should be part of the differential diagnosis of mucosal lesions in patients with a history of travel to south america, however remote the likelihood of infection.
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keywords = leishmaniasis
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13/42. Disseminated mucocutaneous leishmaniasis resulting from chronic use of corticosteroid.

    Mucocutaneous leishmaniasis is a granulomatous disease clinically characterized by ulcerated skin and mucosal lesions whose clinical manifestations can regress spontaneously, but with possible long subclinical evolution. The course of the disease is often related to the host immune response. The purpose of this article is to describe the clinical and microscopic findings of cutaneous and mucosal lesions of mucocutaneous leishmaniasis in a patient who presented an unusual form of the disease associated with an immunosuppressive state.
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14/42. Oral leishmaniasis associated with kala-azar. A case report.

    Mucosal leishmaniasis as an oral disease in the form of chronic periodontitis with involvement of the oral mucosa is described. Leishmania parasites were isolated from the oral lesions, lymph nodes, and bone marrow. The patient had a low-grade fever and hepatosplenomegaly that regressed along with the oral lesions after treatment with stibogluconate sodium.
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keywords = leishmaniasis
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15/42. Disseminated American muco-cutaneous leishmaniasis caused by leishmania braziliensis braziliensis in a patient with AIDS: a case report.

    The authors report a case of culture-proven disseminated American muco-cutaneous leishmaniasis caused by leishmania braziliensis braziliensis in an hiv positive patient. Lesions began in the oropharynx and nasal mucosa eventually spreading to much of the skin surface. The response to a short course of glucantime therapy was good.
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keywords = leishmaniasis
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16/42. Haemoculture of Leishmania (Viannia) braziliensis from two cases of mucosal leishmaniasis: re-examination of haematogenous dissemination.

    Leishmania parasites were isolated from peripheral blood leucocytes of 2 patients with mucosal disease among a total of 23 parasitologically confirmed cases of leishmaniasis. One had had mucosal leishmaniasis for 4 years and active pulmonary tuberculosis was also diagnosed. The other patient presented a cutaneous lesion on his right leg of 3 months duration and asymptomatic mucosal involvement. He had received intravenous antimonials before isolation of parasites. Both patients had positive indirect fluorescent antibody and montenegro skin tests. L. (Viannia) braziliensis was isolated from both patients. This culture of parasites from leucocytes provided direct evidence for metastatic spread of Leishmania via the blood.
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keywords = leishmaniasis
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17/42. Mucocutaneous leishmaniasis in a US citizen.

    Mucocutaneous leishmaniasis (MCL) is endemic to many areas of Central and south america. A case of MCL in a US citizen is reported here. An ulcer appeared on the patient's left hard palate, years after a working trip to peru. Punch biopsies of the lesion were obtained, Leishmania promastigotes were isolated by culture and animal inoculation, and the patient was appropriately treated. As this case demonstrates, a patient's travel history is a key element in making a differential diagnosis of oral lesions.
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keywords = leishmaniasis
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18/42. Ulcerative post-kala azar mucosal leishmaniasis masquerading as a carcinoma--a case report.

    Post kala-azar mucosal leishmaniasis (PKML) is relatively rare in the Indian subcontinent. We describe an ulcerative variant of PKML with nasal involvement in a Nepalese adult male. He had ulcerated plaque over the upper lip with extensive involvement of nasal columella and septum. He came from endemic area for kala-azar and had a previous history of kala-azar. There were plenty of LD bodies in microsections and FNA of submandibular lymph node.
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keywords = leishmaniasis
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19/42. Therapy of Venezuelan patients with severe mucocutaneous or early lesions of diffuse cutaneous leishmaniasis with a vaccine containing pasteurized Leishmania promastigotes and bacillus Calmette-Guerin: preliminary report.

    Severe mucocutaneous (MCL) and diffuse (DCL) forms of American cutaneous leishmaniasis (ACL) are infrequent in venezuela. Chemotherapy produces only transitory remission in DCL, and occasional treatment failures are observed in MCL. We have evaluated therapy with an experimental vaccine in patients with severe leishmaniasis. Four patients with MCL and 3 with early DCL were treated with monthly intradermal injections of a vaccine containing promastigotes of Leishmania (Viannia) braziliensis killed by pasteurization and viable bacillus Calmette- Guerin. Clinical and immunological responses were evaluated. Integrity of protein constituents in extracts of pasteurized promastigotes was evaluated by gel electrophoresis. Complete remission of lesions occurred after 5-9 injections in patients with MCL or 7-10 injections in patients with early DCL. DCL patients developed positive skin reactions, average size 18.7 mm. All have been free of active lesions for at least 10 months. Adverse effects of the vaccine were limited to local reactivity to BCG at the injection sites and fever in 2 patients. Extracts of pasteurized and fresh promastigotes did not reveal differences in the integrity of protein components detectable by gel electrophoresis. immunotherapy with this modified vaccine offers an effective, safe option for the treatment of patients who do not respond to immunotherapy with vaccine containing autoclaved parasites or to chemotherapy.
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keywords = leishmaniasis
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20/42. azithromycin in the treatment of mucosal leishmaniasis.

    This report describes three elderly patients with mucosal form of American tegumentary leishmaniasis associated with chronic cardiopathy. Due to the known toxicity of classical drugs with activity against Leishmania sp., the patients received three oral courses of azithromycin therapy in single 500 mg daily dose during ten days, every other month. All lesions healed after the third series. One of the patients relapsed and a new series of azithromycin was prescribed. azithromycin may be an alternative drug for the treatment of leishmaniasis in special situations due to its optimal mucosal and intraphagocyte concentration, single daily posology, high tolerance and oral administration. The mechanism of this drug on Leishmania sp. is unknown at present.
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keywords = leishmaniasis
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