Page 103 - Portuguese Journal - SPORL - Vol 61. Nº1

clinical improvement and the patient the infection among dogs (the main reservoir
developed nephrotoxicity and muscle pain;
therefore, amphotericin B was replaced by
itraconazole (600 mg once/day), which was
given for three months. Subsequently, clinical
resolution was achieved with improvement
in the erythema, nasal congestion, epistaxis,
and nasal discomfort; in addition, the post-
treatment biopsies showed no Leishman-
Donovan bodies.
The patient is being followed up in the
dermatology and ORL clinics and, so far, has
exhibited no further manifestations of the
disease.
Figure 3
After treatment
Discussion
Leishmaniasis is a primarily zoonotic
infection, caused by protozoan parasites of
the genus Leishmania spp. All species of
Leishmania are transmitted through the bite
of female sand flies of the genera Lutzomyia
and Phlebotomus. Transmission occurs by
inoculation of the promastigote forms into the
skin of the vertebrate host. 1,3,8
This disease is mostly endemic to the tropical
rural areas of Central and South America (New
World), Africa, India, and the Middle East
(Old World), as well as Mediterranean regions
of Europe. In Portugal, the most recently
collected data show that the prevalence of
of human leishmaniasis) and cats is a cause
for concern regarding the risk of increased
number of cases and dissemination of this
parasitosis. 5,6
The severity of the clinical manifestations of
leishmaniasis depends on factors such as the
parasite, the natural host’s resistance, and the
magnitude of the immune response. Visceral
leishmaniasis is usually more severe and is
often fatal if not treated. HIV increases the
host’s susceptibility to active disease, which
usually manifests as a more aggressive and
atypical form. In Portugal, there has been an
increase in the number of cases of visceral
leishmaniasis in adults with HIV co-infection,
a trend that has been decreasing since the
introduction of anti-retroviral therapy. 2,9
Leishmaniasis may be cutaneous,
mucocutaneous, or visceral. Cutaneous
and mucocutaneous leishmaniasis is not a
notifiable disease; therefore, it is believed to
be underdiagnosed given the usually benign
course of the lesions. Visceral leishmaniasis
has been a notifiable disease since the 1950s.
2
Cutaneous leishmaniasis is the most
common presentation of the disease and is
characterized by single or multiple pinkish
macular lesions that progress to nodules and
subsequently to painless well-defined ulcers
with raised borders that can affect any area of
the body. It is usually accompanied by painless
enlarged lymph nodes located near the site of
parasite inoculation. 1,3,8
Mucocutaneous leishmaniasis is the rarest
manifestation of the disease and is mainly
caused by L. Braziliensis. It is almost always
secondary to the cutaneous presentation.
It may appear when the cutaneous lesion is
still active, but it usually appears months or
years after its resolution. It primarily affects
the nasal mucosa; however, as the disease
becomes more aggressive, it can affect the
mucosa of the oral cavity, pharynx, and larynx.
The anterior region of the nasal septum is a
favorable environment for the development
of amastigotes. Low temperatures in this part
decrease the ability of macrophages to carry
Volume 61 . Nº1 . March 2023 103