Mucocutaneous Leishmaniasis

Incubation Period: 1 month- 24 years

Synonyms: Espundia, Uta, chiclero ulcer

Epidemiology:

Dark green: mucocutaneous leishmaniasis, Green: visceral leishmaniasis, Light green: cutaneous leishmaniasis

Source: http://travel.roughguides.com/health/

Mucotaneous leishmaniasis (MCL) cases are focused in South America, especially in Brazil, Paraguay, Ecaudor, Bolivia, Peru, Colombia, andVenezuela. Ninety percent of the cases occur in Brazil, Bolivia, and Peru. Twenty percent of leishmaniasis patients in Brazil develop MCL. In Ecuador, many of the cases seem to be focused in the Amazon region. During the 1990-2003 period, there were 21,805 reports of MCL mostly from the Amazonian lowlands, some inter-Andean valleys, and throughout the Pacific coastal region. Other infections caused by various Leishmania species have occurred in Ethiopia, Kenya, Namibia, Central America, Guyana, Surinam, Panam, and Sudan.

Pathogenesis:

Although the pathogenesis of visceral and cutaneous leishmaniasis are well understood, the pathogenesis of mucotaneous leishmaniasis (MCL) is still unclear. However, it is believed that host genetic factors are important in the advancement of the disease. MCL development is similar to that of cutaneous leishmaniasis, and the two infections can occur simultaneously. MCL occurs when cutaneous lesions expand to the mucosal region or through metastasis. Moreover, it is not uncommon for MCL to develop many years after the recovery of an initial lesion. The result is a gradual and progressive development of destructive lesions.

Clinical Manifestations:

Diagnosis:

Treatment:

Drug

mechanism of action

dosing

Therapy Duration

side effects

Results

Sodium

Stibogluconate (Pentostam)

*Not licensed for use in the US

Cause parasite

death by inhibiting glycolytic enzymes and fatty acid oxidation

Administered intravenously or intra-muscularly

20 mg/kg body weight daily for 28 days

Coughing, headache, vomiting

Cutaneous lesions may not usually require antimonials to heal. After several weeks, the lesions tend to heal on their own.

Amphotericin B (Fungizone)

 

Causes parasite death

intravenously

.5-1mg/kg lb per day for up to 8 weeks

Coughing, headache, vomiting, possible renal damage and bone marrow depression

Cutaneous lesions may not usually require antimonials to heal. After several weeks, the lesions tend to heal on their own.

Cycloguanil pamoate (Camolar)

*not available in the US

Folic acid

intramuscularly

Adults: 300 mg

Children: 280 mg

Infants: 140 mg

Photos: http://arachosia.univ-lille2.fr/labos/parasito/Internat/medicam/leish_me.html , http://www.drugs.com/pdr/AMPHOTERICIN_B_LIPID_COMPLEX.html , http://www.medicinescomplete.com/mc/clarke/current/CLK0444.htm

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Sources:

http://pathmicro.med.sc.edu/parasitology/blood-proto.htm

http://bioline.utsc.utoronto.ca/archive/00002713/

http://www.emedicine.com/med/topic1275.htm

http://bmj.bmjjournals.com/cgi/content/full/321/7264/801

http://www.emedicine.com/ped/topic1292.htm#target2

http://www.emedicine.com/EMERG/topic296.htm