Mucosal leishmaniasis: urgent need for more research

Abstract

Leishmaniasis is one of the most neglected tropical diseases and is strongly associated with poverty. Mucocutaneous or mucosal leishmaniasis (ML) is an important and devastating form of the disease that usually develops after the primary cutaneous lesion or as a primary manifestation. ML pathogenesis is related to parasite and host factors, in particular, the host’s immunological response. ML may present many distinct manifestations, from lesions limited to the nasal and oral cavity (mild stage), involvement of the epiglottis (moderate stage), to the involvement of the vocal cords, subglottic region, trachea, and even bronchi (severe stage). In some cases, mucosal involvement may lead to the destruction of the face structure, and respiratory failure associated with death. The disfigurement related to ML often leads to economic losses, severe stigmatization, and may cause psychological disorders as well as restrict social participation of the individual. Over 90% of ML cases occur in Bolivia, Brazil, Ethiopia, and Peru. In the American region, ML represents around 4% of tegumentary leishmaniasis cases; however, in some countries this proportion can be even higher. In 2013, Paraguay and Argentina reported 37% and 14.4% of ML cases, respectively. In 2014, 1,953 ML cases were reported in the American region, with 1,016 in Brazil alone...