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PURPOSE: This case report examines the clinical presentation, diagnosis, treatment, and outcomes of mucocutaneous leishmaniasis with primary oral involvement in HIV-positive and HIV-negative patients diagnosed in Brazil. METHODS: We discuss the clinical manifestations, diagnostic methods, and therapeutic strategies, highlighting the clinical and histopathologic diagnostic features and distinct progression patterns based on HIV status. Our findings are compared with patterns observed in other countries, emphasizing the differences between the Americas and Europe, Asia, and Africa. RESULTS: In the Americas, particularly in Brazil, mucocutaneous leishmaniasis often presents with localized oral lesions, even in the presence of systemic immunosuppression, whereas in the Europe, Asia, and Africa, oral involvement is typically associated with visceral leishmaniasis in immunocompromised patients. These differences were due to variations in the parasite species involved. CONCLUSION: This comparison underscores the importance of regional and immunological factors in diagnosing and managing this neglected infectious disease.

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Abstract: This study aimed to estimate the cost-effectiveness of four therapeutic approaches available for mucosal leishmaniasis in Brazil: miltefosine, meglumine antimoniate, combined with and without pentoxifylline, and liposomal amphotericin B. The perspective adopted was that of the Brazilian Unified National Health System (SUS). The outcome of interest was "cured patient", which was analyzed using a decision tree model. Estimates of direct costs and effectiveness were obtained from the scientific literature. Meglumine antimoniate alone was the base comparator strategy; liposomal amphotericin B showed an incremental cost-effectiveness ratio (ICER) of USD 7,409.13 per cured patient, and the combination of meglumine antimoniate with pentoxifylline presented an ICER of USD 85.13. Miltefosine was absolutely dominated, with higher cost and similar effectiveness when compared to meglumine antimoniate. Sensitivity analyses, varying the cost by ±25%, did not change the results. However, when the cost of miltefosine was estimated at less than USD 171.23, this strategy was dominant over meglumine antimoniate alone. The results confirm that treatment with liposomal amphotericin B remains the option with the highest ICER among the approaches analyzed. Miltefosine may be cost-effective based on the variation in the acquisition price, which deserves attention because it is the only available oral option. The non-accounting of other aspects prevent the use of these results immediately to support decision-making, but they point out the need to negotiate the prices of drugs available for mucosal leishmaniasis and indicates the need of encouraging technology transfer or other actions aimed at expanding the performance of the Brazilian national industrial complex.

Resumo: O objetivo deste estudo foi estimar o custo-efetividade de quatro abordagens terapêuticas disponíveis para leishmaniose mucosa no Brasil: miltefosina, antimoniato de meglumina, com e sem associação à pentoxifilina e anfotericina B lipossomal. A perspectiva adotada foi a do Sistema Único de Saúde (SUS). O desfecho de interesse foi "paciente curado", que foi analisado por meio de um modelo de árvore de decisão. Estimativas de custos diretos e efetividade foram obtidas da literatura científica. O antimoniato de meglumina isolado foi a estratégia de comparação de base; a anfotericina B lipossomal apresentou razão de custo-efetividade incremental (RCEI) de USD 7.409,13 por paciente curado, e a combinação de antimoniato de meglumina com pentoxifilina apresentou RCEI de USD 85,13. A miltefosina foi dominada, com maior custo e efetividade semelhante quando comparada àquelas do antimoniato de meglumina. As análises de sensibilidade, variando o custo em ±25%, não alteraram os resultados. No entanto, quando o custo da miltefosina foi estimado em menos de USD 171,23, essa estratégia foi dominante sobre o antimoniato de meglumina isolado. Os resultados confirmam que o tratamento com anfotericina B lipossomal continua sendo a opção com maior RCEI entre as abordagens analisadas. Por sua vez, a miltefosina pode ser custo-efetiva com base na variação do preço de aquisição, o que merece atenção por ser a única opção oral disponível. A não consideração de outros aspectos impede o uso imediato desses resultados para subsidiar a tomada de decisão, mas apontam a necessidade de negociação dos preços dos medicamentos disponíveis para a leishmaniose mucosa e indicam a necessidade de incentivar a transferência de tecnologia ou outras ações que visem ampliar a atuação do complexo industrial nacional.

Resumen: El objetivo de este estudio fue estimar el coste-efectividad de cuatro terapéuticas disponibles para la leishmaniasis mucosa en Brasil: miltefosina, antimoniato de meglumina, asociado con y sin pentoxifilina, y anfotericina B liposomal. La perspectiva adoptada fue la del Sistema Único de Salud brasileño (SUS). El resultado de interés fue el "paciente curado", que se analizó mediante un modelo de árbol de decisión. Las estimaciones de costes directos y efectividad se obtuvieron de la literatura científica. El antimoniato de meglumina aislado fue la estrategia de comparación de referencia; el anfotericina B liposomal tuvo una razón coste-efectividad incremental (RCEI) de USD 7.409,13 por paciente curado, y la combinación de antimoniato de meglumina con pentoxifilina tuvo una RCEI de USD 85,13. Predominó la miltefosina, con un coste más elevado y una eficacia similar en comparación con la de antimoniato de meglumina. Los análisis de sensibilidad que variaron el coste en ±25% no alteraron los resultados. Sin embargo, cuando el coste de la miltefosina se estimó en menos de USD 171,23, esta estrategia resultó dominante sobre la antimoniato de meglumina aislada. Los resultados confirman que el tratamiento con anfotericina B liposomal sigue siendo la opción con el RCEI más elevado entre las terapéuticas evaluadas. A su vez, la miltefosina puede ser coste-efectiva en función de la variación del precio de compra, lo que merece atención al ser la única opción oral disponible. La falta de consideración de otros aspectos impide el uso inmediato de estos resultados para subvencionar la toma de decisiones, pero también apunta a la necesidad de negociar los precios de los fármacos disponibles para leishmaniasis mucosa y de fomentar la transferencia de tecnología u otras acciones dirigidas a ampliar el papel del sector industrial nacional.

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Leishmaniasis, caused by different Leishmania species, manifests as cutaneous or visceral forms. In the American continent, the cutaneous form is called American tegumentary leishmaniasis (ATL) and is primarily caused by Leishmania (Viannia) braziliensis. Mucosal leishmaniasis (ML), the most severe form of ATL, arises in approximately 20% of patients from a primary cutaneous lesion. Evidence indicates changes in overall expression patterns of mRNAs and lncRNAs of the host in response to Leishmania infection, with the parasite capable of modulating host immune response, which may contribute to disease progression. We evaluated whether the co-expression of lncRNAs and their putative target mRNAs in primary cutaneous lesions of patients with ATL could be associated with the development of ML. Previously available public RNA-Seq data from primary skin lesions of patients infected with L. braziliensis was employed. We identified 579 mRNAs and 46 lncRNAs differentially expressed in the primary lesion that subsequently progressed to mucosal disease. Co-expression analysis revealed 1324 significantly correlated lncRNA-mRNA pairs. Among these, we highlight the positive correlation and trans-action between lncRNA SNHG29 and mRNA S100A8, both upregulated in the ML group. S100A8 and its heterodimeric partner S100A9 form a pro-inflammatory complex expressed by immune cells and seems to participate in host innate immune response processes of infection. These findings expand the knowledge of the Leishmania-host interaction and indicate that the expression of lncRNAs in the primary cutaneous lesion could regulate mRNAs and play roles in disease progression.

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We detected Leishmania RNA virus 1 (LRV1) in 11 isolates of Leishmania (Viannia) panamensis collected during 2014-2019 from patients from different geographic areas in Panama. The distribution suggested a spread of LRV1 in L. (V.) panamensis parasites. We found no association between LRV1 and an increase in clinical pathology.

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INTRODUCTION: The pathogenesis of cutaneous and mucosal leishmaniasis is associated with different immune responses. Vitamin D may modulate the immune system. Here we evaluate the association of vitamin D levels with the severity of the clinical forms of cutaneous and mucosal leishmaniasis. METHODS: We conducted an observational study evaluating the association between vitamin D levels, disease severity and therapeutic response in patients with cutaneous and mucosal leishmaniasis. Additionally, we conducted a cross-sectional study to compare vitamin D levels in patients with leishmaniasis and healthy subjects. Hypovitaminosis D was defined as a serum level of 25 (OH) D < 30 ng/mL. RESULTS: In patients with leishmaniasis, vitamin D serum levels were 38.5 ± 11.54 ng/mL, and 37.5 ± 10.43 ng/mL in healthy subjects The prevalence of hypovitaminosis D was 23.3% and 20.0%, respectively (p = 0.72). There was no correlation between vitamin D serum levels, disease severity, and healing time in the mucosal leishmaniasis group. CONCLUSION: Vitamin D levels are not associated with neither susceptibility nor severity of tegumentary leishmaniasis.

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Abstract Introduction The pathogenesis of cutaneous and mucosal leishmaniasis is associated with different immune responses. Vitamin D may modulate the immune system. Here we evaluate the association of vitamin D levels with the severity of the clinical forms of cutaneous and mucosal leishmaniasis. Methods We conducted an observational study evaluating the association between vitamin D levels, disease severity and therapeutic response in patients with cutaneous and mucosal leishmaniasis. Additionally, we conducted a cross-sectional study to compare vitamin D levels in patients with leishmaniasis and healthy subjects. Hypovitaminosis D was defined as a serum level of 25 (OH) D < 30 ng/mL. Results In patients with leishmaniasis, vitamin D serum levels were 38.5 ± 11.54 ng/mL, and 37.5 ± 10.43 ng/mL in healthy subjects The prevalence of hypovitaminosis D was 23.3% and 20.0%, respectively (p = 0.72). There was no correlation between vitamin D serum levels, disease severity, and healing time in the mucosal leishmaniasis group. Conclusion Vitamin D levels are not associated with neither susceptibility nor severity of tegumentary leishmaniasis.

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Objective: to analyze the notified and confirmed cases of ACL in a municipality in east Minas Gerais, from 2007 to 2020. Methods: a combined study was carried out as a cross-sectional and an ecological approach of time series type, using notified and confirmed ACL cases, from 2007 to 2020. Primary and secondary data were used. Data were analyzed using descriptive and inferential statistics (simple linear regression, T-test, Mann-Whitney, chi-square (χ2) at a 5% significance level). Results: a total of 219 cases were reported with a decreasing temporal trend, with a higher frequency observed for the cutaneous form (82.6%), age group 40 to 59 years (32.1%), black race (56.4%), and completed elementary school (47.7%). Individuals with the mucosal clinical form had lesions for a longer time, a greater chance of not progressing to cure, and used more vials of meglumine antimoniate when compared to patients with the cutaneous form. Conclusions: different correlations were observed between the variables studied and the profile of involvement described in the scientific literature, with the clinical form predominantly cutaneous and with a good prognosis.

Objetivo: analisar os casos notificados e confirmados de LTA em um município do leste de Minas Gerais, no período de 2007 a 2020. Métodos: foi realizado um estudo combinado com abordagem transversal e ecológica do tipo série temporal, utilizando casos notificados e confirmados de LTA, de 2007 a 2020. Foram utilizados dados primários e secundários. Os dados foram analisados por meio de estatística descritiva e inferencial (regressão linear simples, teste T, Mann-Whitney, qui-quadrado (χ2) com nível de significância de 5%). Resultados: foram notificados 219 casos com tendência temporal decrescente, com maior frequência observada para a forma cutânea (82,6%), faixa etária de 40 a 59 anos (32,1%), raça negra (56,4%) e ensino fundamental completo (47,7%). Indivíduos com a forma clínica mucosa apresentaram maior tempo de lesão, maior possibilidade de não evoluir para cura e utilizaram mais ampolas de antimoniato de meglumina quando comparados aos pacientes com a forma cutânea. Conclusões: foram observadas diferentes correlações entre as variáveis estudadas e o perfil de acometimento descrito na literatura científica, com a forma clínica predominantemente cutânea e com bom prognóstico.

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A Leishmaniose é um grupo de doenças causadas por protozoários do gênero Leishmania. Dentre as Leishmanioses do novo mundo está a Leishmaniose Tegumentar Americana (LTA), que podem se manifestar como lesões primárias na mucosa ou pele da região de cabeça e pescoço. Essas lesões podem afetar a cavidade oral e/ou o paciente apresentar sinais e sintomas detectáveis pelo cirurgião-dentista. O objetivo deste trabalho é realizar um levantamento bibliográfico sobre LTA nas principais bases de dados, buscando relacioná-lo a esta área de atuação. Para isso, foram realizadas buscas nas bases de dados SciELO, Pubmed/MEDLINE e LILACS com os descritores "Leishmaniose Mucocutânea", "Medicinal oral" e "Diagnóstico", nas línguas inglesa e portuguesa, no período entre 2011 a 2021. Como resultado foram encontrados 379 artigos e, após considerar os critérios de inclusão e exclusão, foram selecionados 20 artigos e 6 informes epidemiológicos. Logo, a LTA deve fazer parte do diagnóstico diferencial de lesões compreendidas nas áreas de atuação do cirurgião-dentista, possibilitando um diagnóstico precoce e encaminhamento para adequado tratamento médico. Além disso, esse conhecimento é necessário para que políticas públicas de prevenção e educação sejam mais eficazes, visando a diminuição da prevalência dessa patologia e aumento da qualidade de vida do paciente.

Leishmaniasis is a group of diseases caused by protozoa of the genus Leishmania. Among the Leishmaniasis of the new world is American Tegumentary Leishmaniasis (ATL), which can manifest as primary lesions in the mucosa or skin of the head and neck region. These lesions can affect the oral cavity and / or the patient has signs and symptoms detectable by the dentist. The objective of this work is to carry out a bibliographic survey on ATL in the main databases, seeking to relate it to this area of ​​activity. For this purpose, searches were carried out in the SciELO, Pubmed / MEDLINE and LILACS databases with the descriptors "Leishmaniasis Mucocutânea", "Oral Medicinal" and "Diagnostic", in the English and Portuguese languages, in the period between 2011 and 2021. As a result, 379 articles were found and, after considering the inclusion and exclusion criteria, 26 articles were selected. Therefore, ATL should be part of the differential diagnosis of lesions in the areas in which the dentist operates, enabling an early diagnosis and referral to appropriate medical treatment. In addition, this knowledge is necessary for public policies on prevention and education to be more effective, aiming at decreasing the prevalence of this pathology and increasing the patient's quality of life.

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ABSTRACT This cross-sectional population-based study compared clinical features of leprosy and American tegumentary leishmaniasis (ATL) in patients diagnosed with both diseases (n=414) and in those diagnosed with only leprosy (n=27,790) or only ATL (n=24,357) in Mato Grosso State, which is a hyperendemic area for both diseases in Midwest Brazil. All new cases of leprosy and ATL reported in the area from 2008 to 2017 were included. Patients diagnosed with both diseases were identified by a probabilistic linkage procedure applied to leprosy and ATL databases of the national reporting system. The distribution of the frequency of clinical features between groups was compared by the chi-square test, followed by a multivariate logistic regression. Patients diagnosed with both leprosy and ATL presented higher odds of having nerve damage (OR: 1.34; 95% CI: 1.09-1.66) and leprosy reactions (OR: 1.35; 95% CI: 1.04-1.76) compared to patients diagnosed only with leprosy. Mucocutaneous leishmaniasis (OR: 2.29; 95% CI: 1.74-3.00) was more frequent among patients with both diagnoses when compared to patients who only had ATL. In conclusion, patients diagnosed with both leprosy and ATL present more severe clinical features of such diseases. Our data can be useful for designing health policies aimed at timely and integrated management of leprosy and ATL in co-endemic areas.

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Leishmaniasis is a worldwide problem and has been neglected in a wide range of fields, from diagnosis to treatment. This report describes a case of mucosal leishmaniasis, which may developped after seven decades of an inadequately treated cutaneous lesion. A female patient, 79 years old, from the non-endemic area for leishmaniasis in northern Paraná, presenting mucosal lesion in the nose and throat, reported an "angry ulcer" treated inappropriately as a child when she lived in an endemic region of the state of São Paulo. Indirect immunofluorescence and direct parasite screening were positive. Polymerase chain reaction detected a parasite belonging to the subgenus Leishmania (Viannia) sp. Due to patients limitations, such as low weight and advanced age, the therapeutic model adopted was the combined small doses of Glucantime™ to pentoxifylline, which ensured treatment success.

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Abstract INTRODUCTION: The objective of this study was to estimate the direct medical costs of the treatment for mucosal leishmaniasis (ML) using three therapeutic approaches in the Brazilian context. METHODS: We performed this economic assessment from the perspective of the Brazilian public healthcare system. The following therapeutic approaches were evaluated: meglumine antimoniate, liposomal amphotericin B, and miltefosine. Direct medical costs were estimated considering four treatment components: a) drug, b) combined medical products, c) procedures, and d) complementary tests. RESULTS: Treatment with meglumine antimoniate had the lowest average cost per patient (US$ 167.66), followed by miltefosine (US$ 259.92) in the outpatient treatment regimen. The average cost of treatment with liposomal amphotericin B was US$ 715.35 both in inpatient regimen. In all estimates, the drugs accounted for more than 60% of the total cost for each treatment approach. CONCLUSIONS: These results demonstrate the marked differences in costs between the therapeutic alternatives for ML. In addition to efficacy rates and costs related to adverse events, our data have the potential to support a complete cost-effectiveness study in the future. Complete analyses comparing costs and benefits for interventions will assist health managers in choosing drugs for ML treatment in Brazil as well as in establishing effective public health policies.

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Resumen La leishmaniasis es una enfermedad desatendida, transmitida por dípteros de los géneros Phlebotomus y Lutzomyia. Existen tres formas clínicas principales de leishmaniasis: una visceral, y dos tegumentarias, las cuales se dividen en leishmaniasis cutánea (LC) y leishmaniasis mucocutánea (LM), todas presentes en Paraguay. El objetivo de este trabajo es describir las características epidemiológicas de la leishmaniasis tegumentaria en Paraguay. Aquí analizamos datos epidemiológicos de leishmaniasis tegumentaria (incluyendo LC y ML), tomados desde el 2006 hasta el 2017. La identidad de los pacientes se mantuvo confidencial. Un total de 2.918 casos positivos de leishmaniasis fueron estudiados. El pico de casos reportados se dio en el 2007. Una vista general muestra una disminución en la tendencia de leishmaniasis tegumentaria, donde los varones son más afectados que las mujeres, y el área endémica está localizada en las zonas este y noreste de Paraguay. Los casos en el Chaco (al oeste del Río Paraguay) están en aumento. La incidencia de leishmaniasis tegumentaria para el país es de 4 personas por 100.000 habitantes. Esta es considerada una enfermedad ocupacional ya que el 67% de los pacientes infectados fueron trabajadores rurales. Durante el periodo de estudio, la LC fue más común que la LM, excepto en los años 2010, 2014 y 2017. La mayoría de los pacientes afectados por LM son de avanzada edad. Conclusión. Remarcamos que la leishmaniasis no está restringida a las áreas húmedas del este de Paraguay, debido a que está también presente en zonas xerofíticas de Paraguay y Bolivia. Los trabajadores rurales de sexo masculino comprenden el grupo más susceptible. La alta frecuencia de LM en algunos años indica que es necesario que las agencias nacionales lleven a cabo más programas de educación en salud para prevenir o reducir la carga de LC (y por consiguiente también de LM) en el país.

Abstract Leishmaniasis is a neglected disease transmitted by sandflies of the genera Phlebotomus and Lutzomyia. There are three main clinical forms of leishmaniasis: one visceral and two tegumentary, differentiated between cutaneous leishmaniasis (CL) and mucocutaneous leishmaniasis (ML), all present in Paraguay. The objective of this work is to describe the epidemiologic characteristics of tegumentary leishmaniasis in Paraguay. Here we analyzed epidemiological data of tegumentary leishmaniasis (including CL and ML), taken from 2006 to 2017. Patients' identities were kept confidential. A total of 2,918 cases of positive leishmaniasis infection were studied. The peak of reported cases was in 2007. An overview shows a decrease in the trend of tegumentary leishmaniasis, where males are more affected than females, and the endemic area located on the east and north-eastern parts of Paraguay. Cases in the Chaco (west of Paraguay river) are increasing. The incidence of tegumentary leishmaniasis for the country is 4 persons per 100,000 inhabitants. This is considered an occupational disease since 67% of the infected patients were rural workers. During the period of study CL was more common than ML, except for the years 2010, 2014, and 2017. Most of the patients affected by ML are elders. Conclusion. We remark that leishmaniasis is not only restricted to the humid area of eastern Paraguay, since it is also present in xerophytic areas of Paraguay and Bolivia. Male rural workers are the most susceptible group. The high frequency of ML in some years indicates that more educational programs have to be carried out by national agencies to prevent and reduce the burden of CL (and thus also ML) in the country.

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Abstract The first autochthonous cases of cutaneous and mucocutaneous leishmaniasis in the Americas were described in 1909, but visceral leishmaniasis only erupted as a public health problem in the region in 1934. Today Brazil is the country with the most cases of American tegumentary leishmaniasis, and alongside India has the highest incidence of visceral leishmaniasis. Knowledge production and efforts to control these diseases have mobilized health professionals, government agencies and institutions, international agencies, and rural and urban populations. My research addresses the exchange and cooperation networks they established, and uncertainties and controversial aspects when notable changes were made in the approach to the New World leishmaniases.

Resumo Os primeiros casos de leishmaniose cutânea e mucocutânea autóctones das Américas foram descritos em 1909, e em 1934 a leishmaniose visceral irrompeu como problema de saúde pública na região. O Brasil tem hoje o maior número de casos da leishmaniose tegumentar americana e, junto com a Índia, a mais elevada incidência de leishmaniose visceral. A produção de conhecimentos e os esforços para controlar essas doenças mobilizaram, em nível global, profissionais de saúde, populações urbanas e rurais, instituições governamentais e agências internacionais. Recuperam-se aqui alguns desses agrupamentos, redes de troca e cooperação, incertezas e polêmicas, identificando-se mudanças na abordagem das leishmanioses do Novo Mundo.

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INTRODUCTION: Mucocutaneous leishmaniasis (MCL) is a complication of tegumentary leishmaniasis, causing potentially life-threatening lesions in the ear, nose, and throat (ENT) region, and most commonly due to Leishmania (Viannia) braziliensis. We report a case of relapsing MCL in an Italian traveler returning from Argentina. CASE DESCRIPTION: A 65-year-old Italian male patient with chronic kidney disease, arterial hypertension, prostatic hypertrophy, and type-2 diabetes mellitus was referred for severe relapsing MCL acquired in Argentina. ENT examination showed severe diffuse pharyngolaryngeal edema and erythema, partially obstructing the airways. A nasopharyngeal biopsy revealed a lymphoplasmacytic inflammation and presence of Leishmania amastigotes, subsequently identified as L. (V.) braziliensis by hsp70 PCR-RFLP analysis and sequencing. Despite receiving four courses of liposomal amphotericine B (L-AmB) and two courses of miltefosine over a 2-year period, the patient presented recurrence of symptoms a few months after the end of each course. After the patient was referred to us, a combined treatment was started with intravenous pentamidine 4 mg/kg on alternate days for 10 doses, followed by one dose per week for an additional seven doses, intralesional meglumine antimoniate on the nasal lesion once per week for six doses, oral azoles for three months, and aerosolized L-AmB on alternate days for three months. The treatment led to regression of mucosal lesions and respiratory symptoms. Renal function temporarily worsened, and the addition of insulin was required to maintain glycemic compensation after pentamidine discontinuation. CONCLUSIONS: This case highlights the difficulties in managing a life-threatening refractory case of MCL in an Italian traveler with multiple comorbidities. Even though parenteral antimonial derivatives are traditionally considered the treatment of choice for MCL, they are relatively contraindicated in cases of chronic kidney disease.The required dose adjustment in cases of impaired renal function is unknown, therefore the use of alternative drugs is recommended. This case was resolved with combination treatment, including aerosolized L-AmB, which had never been used before for MCL.

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AIMS: The aim of this study was to evaluate characteristics of B cells in human tegumentary leismaniasis (TL) analysing cutaneous leishmaniasis (CL), most prevalent form and mucosal leishmaniasis (ML), aggressive form characterized by the destruction of the oral-nasal-pharyngeal cavities. METHODS AND RESULTS: By flow cytometry analysis, we found decreased percentages of non-class-switched memory B cells in TL with the degree of the loss related to clinical severity. Using commercial ELISA, we reported high levels of B-cell activating factor (BAFF) and IgG preferentially in aggressive CL and markedly in ML together with decreased BAFF receptors in the latter. We also found lower levels of BAFF after clinical recovery suggesting a relation between BAFF and disease activity. Mucosal leishmaniasis history of therapeutic failure presented high levels of BAFF accompanied by detectable concentrations of IFN-γ and IL-6 (assayed by commercial ELISA and cytometric bead arrays respectively), cytokines involved in exaggerated inflammatory responses and tissue damage in TL. CONCLUSION: We demonstrate B-cell disturbances in TL with the degree of the alterations related to clinical severity. We suggest a relation between excess of BAFF and disease activity and point towards a possible implication of BAFF in the inflammatory phenomenon of ML.

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Leishmaniasis is a parasitic infection transmitted by the bite of infected female sandflies. It principally affects the skin, and the frequency of mucosal involvement is about 5% to 20%. Considering the rarity of leishmaniasis affecting the upper aerodigestive tract mucosa, we evaluated the characteristics of mucocutaneous leishmaniasis and mucosal leishmaniasis and the diagnostic difficulty when the parasites are scarce in tissue samples. The clinical, histopathological, histochemical, immunohistochemical, and molecular features of 17 cases of mucocutaneous leishmaniasis and mucosal leishmaniasis were assessed. Mucosal disease was principally found in the soft palate, oropharynx, and nose, manifesting mainly as a solitary ulcer. In hematoxylin and eosin-stained sections, 10 cases revealed abundant amastigotes within the macrophages. Giemsa staining was not shown to be helpful to confirm the diagnosis in 6 cases with scarce or nondetectable amastigotes. Immunohistochemistry (IHC) showed high sensitivity by positive staining in 14 out of 17 cases (82.3%). Polymerase chain reaction was shown to be more sensitive than IHC with 13 out of 14 (92.8%) positive cases, including the 3 IHC negative cases; however, this technique is not available in many endemic regions. In summary, we suggest that the IHC is a simple technique with rapid results and relatively low cost, when compared with other laboratorial procedures; thus, IHC is a helpful tool that should be implemented in the routine diagnosis of leishmania.

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Leishmaniasis is a chronic inflammatory disease caused by several species of the parasite Leishmania that is transmitted by insects of the genus Phlebotomus spp. or Lutzomyia spp. This disease can affect skin, mucous membranes and viscera being classified as cutaneous, mucocutaneous and visceral leishmaniasis, depending on the spectrum of clinical manifestations. Diagnosis can be achieved through biopsy, microscopical analysis, Montenegro intradermoreaction and/or ELISA. The dentist plays an important role in the diagnosis of this disease due to frequent involvement of oral mucosa. This article reports two clinical cases of leishmaniasis with oral mucosa involvement, their diagnosis workup and treatment.

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Abstract Mucocutaneous leishmaniasis (MCL) is a chronic infection that can affect the skin and mucous membranes. We report a case of oral, nasopharyngeal, and penile lesions in a 35-year-old cocaine user. The patient presented with ulcerated lesions in 2014. Histopathologic analysis revealed amastigotes, and serological test results were positive for leishmaniasis. Systemic therapy with meglumine antimoniate was administered; however, the patient failed to present for follow-up. In 2018, he returned with nasal collapse, and another histopathologic test confirmed MCL. This case illustrates the importance of careful differential diagnosis of skin and mucous ulcers to identify the particular pathology.

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RESUMO

La Leishmaniasis es un grupo de enfermedades transmitidas por vectores y causada por la Leishmania, un parásito intracelular, que se presenta de preferencia en regiones tropicales y subtropicales. Se manifiesta mediante un amplio rango de formas clínicas como la cutánea, mucocutánea, y visceral, dependiendo de la especie y respuesta inmunológica del paciente. Se presenta el caso de un hombre de 35 años que acudió derivado a Unidad de Estomatología del Hospital Señor del Milagro, Salta, Argentina, presentando en la cavidad oral lesión, granulomatosa, ulcerada, dolorosa a la palpación, única, en paladar blando, de tres meses de evolución. Se realizaron estudios serológicos, parasitológicos y PCR. Los ELISAs lisados, PCRs y cultivos de materiales de lesiones fueron positivos, confirmando diagnóstico de leishmaniasis mucocutánea. El paciente fue derivado al Servicio de Dermatología donde recibió tratamiento con Antimoniato de Meglumina, con repuesta clínica favorable. El conocimiento de las manifestaciones orales puede llevar al diagnóstico clínico de leishmaniasis mucocutánea por parte del odontólogo, pudiendo entregar un tratamiento oportuno y a la vez ayudar al paciente, evitando complicaciones de esta enfermedad.

Leishmaniasis is a group of vector-borne diseases caused by Leishmania, an intracellular parasite, which occurs preferentially in tropical and subtropical regions. It manifests itself through a wide range of clinical forms such as cutaneous, mucocutaneous, and visceral, depending on the species and the patient's immune response. We present a case of a 35-year-old man who was referred to the Stomatology Unit of the Señor del Milagro Hospital, Salta, Argentina, presenting in the oral cavity lesion, granulomatous, ulcerated, painful on palpation, unique, soft palate with three months of evolution. Serological, parasitological and PCR studies were performed. Lysed ELISAs, PCRs and cultures of lesion materials were positive, confirming diagnosis of mucocutaneous leishmaniasis. The patient was referred to the Dermatology Service where he received treatment with Meglumine Antimony, with favorable clinical response. The knowledge of the oral manifestations can lead to the clinical diagnosis of mucocutaneous leishmaniasis by the dentist, being able to provide timely treatment and at the same time help the patient, avoiding complications of this disease.

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