Mucocutaneous Leishmaniasis/HIV Coinfection Presented as a Diffuse Desquamative Rash

Case Reports in Infectious Diseases, Dec 2014

Leishmaniasis is an infectious disease that is endemic in tropical areas and in the Mediterranean. This condition spreads to 98 countries in four continents, surpassing 12 million infected individuals, with 350 million people at risk of infection. This disease is characterized by a wide spectrum of clinical syndromes, caused by protozoa of the genus Leishmania, with various animal reservoirs, such as rodents, dogs, wolves, foxes, and even humans. Transmission occurs through a vector, a sandfly of the genus Lutzomyia. There are three main clinical forms of leishmaniasis: visceral leishmaniasis, cutaneous leishmaniasis, and mucocutaneous leishmaniasis. The wide spectrum of nonvisceral forms includes: localized cutaneous leishmaniasis, a papular lesion that progresses to ulceration with granular base and a large framed board; diffuse cutaneous leishmaniasis; mucocutaneous leishmaniasis, which can cause disfiguring and mutilating injuries of the nasal cavity, pharynx, and larynx. Leishmaniasis/HIV coinfection is considered an emerging problem in several countries, including Brazil, where, despite the growing number of cases, a problem of late diagnosis occurs. Clinically, the cases of leishmaniasis associated with HIV infection may demonstrate unusual aspects, such as extensive and destructive lesions. This study aims to report a case of mucocutaneous leishmaniasis/HIV coinfection with atypical presentation of diffuse desquamative eruption and nasopharyngeal involvement.

A PDF file should load here. If you do not see its contents the file may be temporarily unavailable at the journal website or you do not have a PDF plug-in installed and enabled in your browser.

Alternatively, you can download the file locally and open with any standalone PDF reader:

http://downloads.hindawi.com/journals/criid/2014/293761.pdf

Mucocutaneous Leishmaniasis/HIV Coinfection Presented as a Diffuse Desquamative Rash

Mucocutaneous Leishmaniasis/HIV Coinfection Presented as a Diffuse Desquamative Rash Guilherme Almeida Rosa da Silva,1 Daniel Sugui,1 Rafael Fernandes Nunes,1 Karime de Azevedo,2 Marcelo de Azevedo,2 Alexandre Marques,3 Carlos Martins,1 and Fernando Raphael de Almeida Ferry1 1Federal University of the State of Rio de Janeiro (UNIRIO), 20550-110 Urca, RJ, Brazil 2Federal University of Rio de Janeiro (UFRJ), 20550-110 Urca, RJ, Brazil 3Porto University, 4099-002 Porto, Portugal Received 27 June 2014; Accepted 20 November 2014; Published 8 December 2014 Academic Editor: Pere Domingo Copyright © 2014 Guilherme Almeida Rosa da Silva et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Leishmaniasis is an infectious disease that is endemic in tropical areas and in the Mediterranean. This condition spreads to 98 countries in four continents, surpassing 12 million infected individuals, with 350 million people at risk of infection. This disease is characterized by a wide spectrum of clinical syndromes, caused by protozoa of the genus Leishmania, with various animal reservoirs, such as rodents, dogs, wolves, foxes, and even humans. Transmission occurs through a vector, a sandfly of the genus Lutzomyia. There are three main clinical forms of leishmaniasis: visceral leishmaniasis, cutaneous leishmaniasis, and mucocutaneous leishmaniasis. The wide spectrum of nonvisceral forms includes: localized cutaneous leishmaniasis, a papular lesion that progresses to ulceration with granular base and a large framed board; diffuse cutaneous leishmaniasis; mucocutaneous leishmaniasis, which can cause disfiguring and mutilating injuries of the nasal cavity, pharynx, and larynx. Leishmaniasis/HIV coinfection is considered an emerging problem in several countries, including Brazil, where, despite the growing number of cases, a problem of late diagnosis occurs. Clinically, the cases of leishmaniasis associated with HIV infection may demonstrate unusual aspects, such as extensive and destructive lesions. This study aims to report a case of mucocutaneous leishmaniasis/HIV coinfection with atypical presentation of diffuse desquamative eruption and nasopharyngeal involvement. 1. Introduction Iconographic records of nonvisceral leishmaniasis (NVL) are primarily known to belong in the ceramics of pre-Inca Peru and Ecuador (400–900 AD). In these objects, we can observe the mutilated facies with characteristic mucocutaneous leishmaniasis (MCL) noses. In the Old World (Asia, Africa, and Europe) the written reports of the disease are dated from the first century AD [1]. Only a thousand years later, in 1903, the agent of the disease was first described, separately by Leishman and Donovan. A protozoan was identified in spleen tissue of two patients residing in India affected by a fatal disease. The disease in question was visceral leishmaniasis (VL) and the agent identified was Leishmania donovani [2]. Leishmaniasis is included in the group of neglected tropical diseases and, according to the World Health Organization (WHO) and the Laboratory of Tropical Diseases (LTD), considered one of the six most important diseases in the world [2, 3]. It is endemic in the tropics and in the Mediterranean, being spread by 98 countries in four continents with a total of 12 million infected people and 350 million at risk of infection. It is estimated that approximately 0.2 to 0.4 million of new VL cases and 0.7 to 1.2 million of new NVL cases occur each year worldwide [1, 4, 5]. From 2005 to 2009, a total of 96,351 cases of NVL and 13,563 cases of VL were registered in Brazil [6]. Between 2001 and 2011, 38,808 VL cases were recorded in the Americas. Although these cases are distributed in 12 countries, including recent reports from Paraguay and Argentina, 96% of American VL cases occur in Brazil (37,503 cases). In 2001, approximately 0.7% of all VL cases were reported in HIV-infected patients, while in 2012 this percentage increased to 8.5%. Epidemiological studies on NVL/HIV coinfection in Latin America are needed [7]. This disease is characterized by a wide spectrum of clinical syndromes caused by obligate intracellular protozoa of the genus Leishmania, from Trypanosomatidae family. Leishmania has mammal reservoirs extending to rodents, dogs, wolves, foxes, and even humans [2, 4]. Transmission occurs through a vector, a sandfly of the genus Lutzomyia, with Lutzomyia longipalpis and Lutzomyia intermedia currently known. Leishmaniasis is endemic where the vector, the animals that act as hosts, and reservoirs of the disease are found [8]. There are three main clinical forms of leishmaniasis: cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL), capable of producing disfiguring injuries and severe scarring, and visceral leishmaniasis (VL) or “kala-azar” that is fatal (...truncated)


This is a preview of a remote PDF: http://downloads.hindawi.com/journals/criid/2014/293761.pdf

Guilherme Almeida Rosa da Silva, Daniel Sugui, Rafael Fernandes Nunes, Karime de Azevedo, Marcelo de Azevedo, Alexandre Marques, Carlos Martins, Fernando Raphael de Almeida Ferry. Mucocutaneous Leishmaniasis/HIV Coinfection Presented as a Diffuse Desquamative Rash, Case Reports in Infectious Diseases, 2014, 2014, DOI: 10.1155/2014/293761