Dear Editor,
Old world leishmaniasis is seen in a wide geographical area including Turkey, as well. The causative agent is generally Leishmaniasis tropica, and the agent is rarely identified to be leishmaniasis major in such patients.[1] Depending on the leishmaniasis type and the person's immune system, it may be in one of the cutaneous, mucocutaneous leishmaniasis (ML), or visceral leishmaniasis (VL) forms.[2] Mucosal involvement is rarely seen with old world leishmaniasis.[3] ML disease is an important endemic disease and public health problem in undeveloped countries, since it has a significant rate of morbidity and mortality.[4]
This study presents a retrospective assessment of 621 leishmaniasis patients with mucosal involvement.
14,400 leishmaniasis patients were retrospectively examined; after that 621 patients with lip mucosa involvement were assessed. One patient also had accompanying gingiva involvement. Only one of the patients with lip involvement had genital involvement, and this patient was excluded from the study. The patients are diagnosed using clinical and parasitological methods (direct examination by scraping or imprint, histopathology, and culture).
621 out of 14,400 leishmaniasis patients (4.3%) were identified to have mucosal involvement. 71.9% of patients with mucosal involvement (447 patients) also had accompanying cutaneous involvement. Female patients had the majority (F/M = 314/307), and their average age was 15.34 ± 15.26 years. The average lesion duration of the patients was identified as 14.36 ± 9 63 weeks. The lesion diameters and numbers were 14.37 ± 11.83 mm and 1.91 ± 1.45, respectively. As per the assessment made on the basis of lesion types, the ulcerated type lesions (68.44%) were the ones most frequently seen in leishmaniasis patients, followed by nodules (29.15%), papules (1.93%), and residence type 3 (0.48%) lesions, respectively. The ratio of patients receiving intramuscular injections of meglumine antimoniate was 10.7% (67 patients), and the treatment response rate was approximately 92%. As for the ratio of patients receiving intralesional injections of meglumine antimoniate, it was identified as 89.3% (554 patients) and the ratio of patients with treatment response was determined as 96% [Table 1].
Table 1.
Clinical characteristics of patients with lip leishmaniasis
While mucosal involvement is often seen with new world leishmaniasis, involvement is limited in the old world leishmaniasis.[5,6,7] An ML case without cutaneous lesions reported in Sudan by Ibrahim et al. also had visceral involvement.[5] In addition, another ML case reported in Sudan had involvement of the larynx, palate, and gingiva as well as mild generalized swelling in the upper lip. The patient who had no cutaneous findings has a history of VL from 10 years ago. This patient was successfully treated with intravenous sodium stibogluconate.[6] Kharfi et al. reported 5 ML patients with 4 being female and 1 being male. While only four of the patients had lip mucosa involvement, one patient also had accompanying endonasal mucosa involvement. All the patients responded to intramuscular meglumine antimoniate treatment.[7] The majority of our patients had cutaneous involvement and no visceral involvement. Only one of the patients had gingival involvement apart from the lip. The dominant type was the lesion type ulcer. The response rate of our patients to intramuscular meglumine antimoniate treatment was 92%.
We are of the opinion that our study will contribute to the literature since it is the largest case report with mucosal involvement in the old world leishmaniasis. When leishmaniasis disease develops especially in people living in endemic areas or travelling to those areas, we should definitely consider the ML disease in cases of treatment-resistant mucosal (especially lip involvement) lesions. Otherwise, the disease may result in significant morbidity and mortality due to delayed treatments.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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