Mucosal leishmaniasis: A forgotten disease. Description and identification of species in 50 Colombian cases

Abstract

Introduction: Mucosal leishmaniasis has a progressive course and can cause deformity and even mutilation in the affected areas. It is endemic in the American continent and is mainly caused by Leishmania (Viannia) braziliensis. Objective: To describe a series of mucosal leishmaniasis cases and the infectious Leishmania species. Materials and methods: Fifty patients with a clinical diagnosis of mucosal leishmaniasis and parasitological confirmation were included. We describe the clinical and laboratory results. Species typing was performed by PCR-RFLP using miniexon and hsp70 genes and confirmed by sequencing. Results: The median time of disease evolution was 2.9 years (1 month to 16 years). The relevant clinical findings included mucosal infiltration (94%), cutaneous leishmaniasis scar (74%), total loss of the nasal septum (24%), nasal deformity (22%) and mucosal ulceration (38%). The symptoms reported included nasal obstruction (90%), epistaxis (72%), rhinorrhea (72%), dysphonia (28%), dysphagia (18%) and nasal pruritus (34%). Histopathology revealed a pattern compatible with leishmaniasis in 86% of the biopsies, and amastigotes were identified in 14%. The Montenegro skin test was positive in 86% of patients, immunofluorescence in 84%, and culture in 8%. L. (V.) braziliensis was identified in 88% of the samples, L. (V) panamensis in 8%, L. (V.) guyanensis and L. (L.) amazonensis in 2%. Conclusion: In this study, we found a severe nasal disease with destruction and deformity of the nasal septum, in a quarter of the cases that was probably related to late diagnosis. L. (V.) braziliensis was the predominant species. A case of mucosal leishmaniasis in Colombia caused by L. (L.) amazonensis is described for the first time.