Page 104 - Portuguese Journal - SPORL - Vol 61. Nº1

out phagocytosis and consequently favor the idI IV [intravenous] or IM [intramuscular] for
parasite’s growth. 1,6,8,10
The symptoms and signs include nasal
congestion, epistaxis, rhinorrhea, nasal
granuloma, ulcers, and scabs. As the disease
progresses, the skin of the nose thickens with
an increase in the volume of the nasal pyramid
(leishmaniasis facies) and may progress to
destruction of the septal cartilage. 1,6,8,11
The differential diagnoses of mucocutaneous
leishmaniasis include tumors, rhinophyma,
septal perforation from trauma or
substance abuse, vasculitis, syphilis, and
other granulomatous diseases such as
paracoccidioidomycosis, tuberculosis, and
leprosy. 3,6,8
Visceral leishmaniasis is the most severe
form of the disease and presents with
systemic manifestations such as fever,
hepatosplenomegaly, anorexia, weight loss,
and anemia. 1,8
A biopsy of the lesion should be performed
when there is a suspicion of this diagnosis.
Leishman-Donovan bodies can be visualized
in appropriate culture media and the
polymerase chain reaction technique allows
the molecular detection of the protozoan’s
DNA. Testing for anti-Leishmania spp.
antibodies is only recommended when
visceral leishmaniasis is suspected because
their specificity to distinguish between past
exposure and present infection is low. 10,12,13
The risk of morbidity (cosmetic disfigurement)
and mortality associated with mucocutaneous
leishmaniasis is higher than that with
cutaneous leishmaniasis; therefore, these
cases should be given systemic treatment.
The choice of anti-leishmaniasis medication,
dose, and treatment duration should be
individualized. Its administration can be oral
or parenteral. In the former case, the drugs
used are azoles (itraconazole 600 mg once/
day or ketoconazole 600 mg once/day for
four weeks or fluconazole 200 mg once/day
for six weeks) and miltefosine (2.5 mg/kg
maximum, 150 mg/day for four weeks); for
parenteral administration, the drugs used are
pentavalent antimony compounds (20 mg/kg
104 Portuguese Journal of Otorhinolaryngology - Head and Neck Surgery
four weeks) or liposomal amphotericin B (3-7
mg/kg with a total cumulative dose between
20 and 60 mg/kg). The aim of the treatment
is clinical cure and not parasitological
clearance. 12,13
The criteria for cure include the disappearance
of the lesions and symptoms in the three
months following treatment. Monthly follow-
up is recommended until the criteria for cure
are met, followed by annual follow-up because
there is a high probability of relapse. 8,9,10
The diagnosis and guidance of patients
with leishmaniasis should involve a
multidisciplinary team that includes the
specialties of dermatology, infectious diseases,
internal medicine, otorhinolaryngology, and
anatomical pathology.
Leishmaniasis is a disease with significant
morbidity. However, it has an excellent
prognosis when diagnosed at an early stage.
Although it rarely occurs in Portugal, it is
important that otorhinolaryngologists include
it as a differential diagnosis when presented
with similar cases.
Conflicts of Interest
The authors declare that there is no conflict
of interests regarding the publication of this
paper.
Data Confidentiality
The authors declare having followed the
protocols in use at their working center
regarding patients’ data publication.
Protection of humans and animals
The authors declare that the procedures
were followed according to the regulations
established by the Clinical Research and Ethics
Committee and to the 2013 Helsinki Declaration
of the World Medical Association.
Funding Sources
This work did not receive any contribution,
funding or scholarship.