Mucosal Leishmaniasis: From Diagnosis to Treatment (2022 AMW)
2022 AAO-HNSF Annual Meeting & OTO Experience
The World Health Organization (WHO) considers leishmaniasis as one of the six most important infectious diseases, not only because of the high incidence and wide geographical distribution of the disease, but also because it can take forms that determine destructive, disfiguring and even incapacitating lesions. great impact on the individual's quality of life. Tegumentary leishmaniasis is a non-contagious infectious disease caused by different species of protozoa of the genus Leishmania, which affect the skin and mucosal. The disease has been described in almost all American countries, from the extreme south of the United States to northern Argentina. Approximately 3 to 5% of cutaneous leishmaniasis cases caused by L. braziliensis are estimated to develop mucosal lesions, either concomitantly or after resolution of the cutaneous disease. In almost 90% of the cases, ML affects the nasal mucosa. The second site of involvement is the pharynx mucosa, followed by the larynx and mouth mucosa. A proposal for clinical staging of mucosal leishmaniasis (ML) characterizing five stages of the disease according to the severity. It is known that antimony therapy is not the best drug for ATL, but due to the high cost of liposomal amphotericin B, antimony continues to be the first choice drug for treatment of ML in all counties of South and Central American. The standard treatment for the most cases of ML is pentavalent antimony. Of note, there has been greater use of newer and more efficacious therapies for cutaneous and ML over the past 20 years, including amphothericin B, pantamidine, miltefosine, combination of antimony and pentoxifylline and antimony with granulocyte/macrophage colony stimulating factor. The association of pentoxifylline, an inhibitor of TNF, plus antimony is more effective than antimony alone, and cure ML patients refractory to antimony. Antimony therapy associated with pentoxifylline, a TNF inhibitor, has been shown to decrease the healing time in CL and ML patients. The treatment of ML is still a challenge.
Credits
CME:1.0, MOC:1.0