Mucocutaneous Leishmaniasis Overview

Mucocutaneous Leishmaniasis

• Characterized by partial or complete destruction of nasal, oral, and throat mucous membranes.
• Predominantly found in Bolivia, Brazil, Ethiopia, and Peru (over 90% of cases).
• Classic lesion (Leishmania major) in Iraq shows a volcanic appearance with raised edges.
• Diagnosis methods:
  • Microscopic identification of amastigotes (non-motile, intracellular forms) in stained lesion samples.
  • Intradermal Montenego test (leishmanin antigen) is often positive in established disease, less useful in early or immunocompromised cases.
  • Serological tests (IFA or ELISA).
• Infectious agents:
  • Eastern hemisphere: Leishmania tropica, Leishmania major, Leishmania aethiopica.
  • Western hemisphere: Leishmania braziliensis, Leishmania mexicana.
• Reservoir hosts: Diverse, including humans, wild rodents, and domestic dogs.
• Incubation period: At least one week, up to several months.
• Transmission:
  • Bite of infected female phlebotomine sandflies (e.g., P. papatasi, P. sergenti).
  • Rarely, through blood transfusion.
• Communicability: Not directly person-to-person. Infectious to sandflies while parasites are in lesions (untreated cases can last a few months to 2 years).
• Susceptibility: General. Possible life-long immunity after healing from L. tropica and L. major, but not against other Leishmania species.
• Control methods:
  • Preventive: Similar to visceral leishmaniasis prevention.
  • Patient, contact, and environmental control:
    • Reporting to health authorities.
    • Isolation, disinfection, and contact investigation/quarantine (not applicable): Interrupt transmission cycle practically.
    • Investigate contacts and infection source.
  • Specific treatment:
    • Antimony-containing compounds:
      • Meglumine antimoniate
      • Sodium stibogluconate
    • Other drugs:
      • Amphotericin B
      • Ketoconazole
      • Miltefosine
      • Paromomycin
      • Pentamidine
• Epidemic measures:
  • Provide diagnostic/treatment facilities.
  • Control sandflies and mammalian reservoirs.
• Leishmania-HIV coinfection:
  • High risk of full-blown disease, relapse, and mortality in coinfected patients.
  • Antiretroviral treatment reduces disease development, delays relapse, and improves survival.
  • High coinfection rates reported in Brazil, Ethiopia, and Bihar, India.

Leishmaniasis Overview

• Three main forms: Visceral (most serious), cutaneous, mucocutaneous.
• Caused by Leishmania parasites transmitted by sandfly bites.
• Impacts vulnerable populations due to malnutrition, displacement, poor housing, and weak immune systems.
• Linked to environmental changes like deforestation, dam construction, irrigation, and urbanization.
• Estimated 700,000-1,000,000 new cases annually.
• Only a fraction of infected individuals develop the disease.