Disseminated leishmaniasis: clinical, pathogenic, and therapeutic aspects

Abstract

Disseminated leishmaniasis is a severe and emerging form of American tegumentary leishmaniasis. Disseminated leishmaniasis is defined by the presence of more than 10 polymorphic cutaneous lesions, distributed over more than two noncontiguous parts of the body. Nasal mucosal involvement is observed in almost half of cases. Disseminated leishmaniasis patients present with a decreased production of Th1 cytokines in the peripheral blood due to the attraction of leishmania- activated T cells to the multiple cutaneous lesions. Disseminated leishmaniasis development is poorly understood and is related to a complex network involving environmental, host immune response, and parasite factors, in which L. braziliensis polymorphism plays an important role. Disseminated leishmaniasis is a challenging disease to cure, presenting a high failure rate of 75% to pentavalent antimony therapy. Despite its importance and severity, this form of American tegumentary leishmaniasis has been poorly studied and documented, deserving greater attention from professionals working in endemic areas.

Generation and Characterization of a Dual-Reporter Transgenic Leishmania braziliensis Line Expressing eGFP and Luciferase

“…As a next step, one can envisage in vivo imaging coupled to tissue localization as a read-out for parasite presence, for example. This would be particularly interesting for L. braziliensis which causes mucosal (Bacellar et al, 2002) and disseminated disease (Machado et al, 2019). To this date, it remains unknown how parasite disseminate from the primary lesion to secondary sites.…”

Clinical and epidemiological aspects of American cutaneous leishmaniasis with genital involvement

“…1 , 2 Clinically, ACL is divided into localized cutaneous leishmaniasis, disseminated cutaneous leishmaniasis (DL), diffuse cutaneous leishmaniasis, and mucosal leishmaniasis. 1 , 2 , 3 …”

“…1 This clinical form is characterized by the presence of numerous skin lesions, ten or more, distributed in two or more non-contiguous body segments. 3 Skin lesions are polymorphic and typically consist of acneiform papules, infiltrated or ulcerated plaques, warty lesions and ulcers with a granular bottom and raised edges. 1 , 3 Verrucous and vegetating lesions are rare.…”

“… 3 Skin lesions are polymorphic and typically consist of acneiform papules, infiltrated or ulcerated plaques, warty lesions and ulcers with a granular bottom and raised edges. 1 , 3 Verrucous and vegetating lesions are rare. 3 Systemic symptoms such as fever, myalgia, asthenia, and weight loss occur in 50% to 75% of cases; mucosal involvement, predominantly in the nasal mucosa, is observed in up to 53% of DL cases.…”

“…1 , 3 Verrucous and vegetating lesions are rare. 3 Systemic symptoms such as fever, myalgia, asthenia, and weight loss occur in 50% to 75% of cases; mucosal involvement, predominantly in the nasal mucosa, is observed in up to 53% of DL cases. 3 , 4 …”