Mucocutaneous leishmaniasis: an imported infection among travellers to central and South America

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Abstract
Introduction Leishmaniasis is caused by protozoan parasites belonging to the genus Leishmania.1 2 The infection is transmitted by phlebotomine sandflies, and a wide range of domestic and wild vertebrates and humans serve as reservoirs of infection. Leishmaniasis is endemic throughout the Middle East, north Africa, parts of Europe, and central and South America.1 2 The worldwide prevalence is 12 million, with a tenth of the world's population at risk. The infecting Leishmania species determines the clinical presentation of disease, of which there are three dominant clinical forms: cutaneous leishmaniasis, mucocutaneous leishmaniasis (MCL), and visceral leishmaniasis.1 2 Mucocutaneous disease is a chronic inflammatory process involving the nasal, pharyngeal, and laryngeal mucosa, which can lead to extensive tissue destruction. MCL develops as a complication of cutaneous leishmaniasis, parasites disseminating from the primary cutaneous lesion via lymphatic vessels and blood to reach the upper respiratory tract mucosa. Such metastatic spread more commonly occurs with species belonging to the L viannia subgenus (formerly known as the L braziliensis complex), which are present in tropical forested areas of central and South America.1 2 MCL is estimated to develop as a complication of L viannia cutaneous leishmaniasis in 5-20% of untreated patients living in areas where leishmaniasis is endemic.3 Over the past 20 years, “exotic” foreign travel from the United Kingdom has increased, resulting in more cases of imported tropical infections. Increased awareness of such diseases is important as early recognition and treatment may improve outcome. Here we describe three healthy British travellers who developed MCL after travelling to Latin America. Each was managed jointly at the Hospital for Tropical Diseases in London by tropical medicine physicians and otorhinolaryngologists. We emphasise the importance of a history of travel to Latin America in patients presenting with unusual skin lesions or chronic nasopharyngeal symptoms and describe the diagnostic process. Footnotes Mucocutaneous leishmaniasis may be acquired by travellers to central and South America Contributors SA helped to collect patients' data and to write the manuscript. SDL provided medical care for the patients, collected patients' data, and wrote the manuscript. JK and HG provided otorhinolaryngology assessments and contributed to the manuscript. DNJL was responsible for the care of the patients and contributed to the manuscript. DNJL is the guarantor. Funding None. Competing interests None declared.

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