Mucosal Leishmaniasis: From Diagnosis to New Treatment Perspectives

PROGRAM DESCRIPTION: Leishmaniasis is one of the six most significant infectious diseases due to its high incidence, wide geographical distribution, and its potential to cause destructive, disfiguring, and even disabling lesions, profoundly impacting an individual’s quality of life.
American Cutaneous Leishmaniasis (ACL) is a non-contagious infectious disease caused by different species of protozoa from the genus Leishmania, which affect the skin (cutaneous leishmaniasis) and mucosa (mucosal or mucocutaneous leishmaniasis).
It is estimated that 3–5% of cutaneous leishmaniasis (CL) cases caused by Leishmania Viannia braziliensis progress to mucosal lesions, either concurrently with or following the resolution of the cutaneous disease. The classic form of mucosal leishmaniasis (ML) develops secondary to a skin lesion. However, in rare cases, ML can be primary, occurring without a prior or concurrent history of cutaneous lesions.
In nearly 90% of cases, ML primarily affects the nasal mucosa. A clinical staging system for mucosal leishmaniasis was recently proposed, categorizing the disease into five stages. Stage I: Nodulation in the nasal septum mucosa; Stage II: Fine-grained superficial ulceration; Stage III: Deep-grained ulceration; Stage IV: Nasal septum perforation and Stage V: Destruction of the nasal pyramid
Antimonial therapy remains the first-line therapy for ML across South and Central American countries due to the high cost of liposomal amphotericin B. However, this drug is associated with numerous adverse effects and contraindications.
In the last two decades, newer and more effective therapies have been increasingly utilized for CL and ML, including amphotericin B, pentamidine, miltefosine, and combinations of antimony with other agents such as pentoxifylline or granulocyte/macrophage colony-stimulating factor. The combination of pentoxifylline, a tumor necrosis factor (TNF) inhibitor, with antimony has been shown to be more effective than antimony alone, even curing ML cases resistant to antimony treatment.