Mucocutaneous Leishmaniasis: clinical markers in presumptive diagnosis

Abstract

Mucocutaneous Leishmaniasis (ML) can lead to serious sequela; however, early diagnosis can prevent complications.

Aim: To evaluate clinical markers for the early diagnosis of ML.

Materials and methods: A series study of 21 cases of ML, which were evaluated through clinical interview, nasal endoscopy, biopsy and the Montenegro test.

Results: A skin scar and previous diagnosis of cutaneous leishmaniasis (CL) were reported in 8(38%) patients, and 13(62%) of them denied having had previous CL and had no scar. Nasal/oral symptom onset until the ML diagnosis varied from 5 months to 20 years, mean value of 6 years. In the Montenegro test, the average size of the papule was 14.5 mm, which did not correlate with disease duration (p=0.87). The nose was the most often involved site and the extension of the injured mucosa did not correlate with disease duration. The parasite was found in 2 (9.52%) biopsy specimens.

Conclusions: ML diagnosis was late. Finding the parasite in the mucosa, cutaneous scar and/or previous diagnosis of CL were not clinical markers for ML. ML diagnosis must be based on the Montenegro test, chronic nasal and/or oral discharge and histological findings ruling out other granulomatous diseases.

Graph 1

Correlation between the Montenegro test and symptom onset - Papule diameter in the Montenegro skin test and clinical symptom evolution time of the mucosal leishmaniasis of patients seen in the Otorhinolaryngology Clinic of the University Hospital between April 2008 and April of 2009.