Mucocutaneous leishmaniasis: a clinicopathologic classification.
BACKGROUND
Leishmaniasis, a chronic parasitic disease transmitted by Phlebotomus sandflies, affects millions of patients. Mucocutaneous leishmaniasis caused by Leishmania brasiliensis is endemic in much of South America.


OBJECTIVE
Our purpose was to develop a system for staging mucocutaneous leishmaniasis on the basis of clinical, histopathologic, epidemiologic, and immunologic criteria.


METHODS
Seventy-five Bolivian patients with mucocutaneous leishmaniasis were evaluated by history and physical examination; cutaneous, mucosal, and bone marrow biopsy specimens; and immunologic assessment.


RESULTS
Mucocutaneous leishmaniasis may progress through three clinical stages: (1) the primary or cutaneous, (2) the cicatricial, and (3) the secondary or mucocutaneous stages. The primary stage can be further subdivided into three phases: lymphoplasmocytic, tuberculoid, and diffuse cutaneous phases. The secondary stage can also be subdivided into three phases: edematous, granulomatous proliferative, and granulomatous necrotizing stages.


CONCLUSIONS
A classification or staging system enhances the ability to evaluate patients with mucocutaneous leishmaniasis and determine more accurately their prognosis and treatment.
Sangueza
O P
OP
Ronald O. Perelman Department of Dermatology, New York University Medical School, New York.
Sangueza
J M
JM
Stiller
M J
MJ
Sangueza
P
P
D000328:Adult; D001706:Biopsy; D001838:Bolivia / Q000453:epidemiology; D005260:Female; D006801:Humans; D016773:Leishmaniasis, Cutaneous / Q000145:classification; D016774:Leishmaniasis, Diffuse Cutaneous / Q000145:classification; D007897:Leishmaniasis, Mucocutaneous / Q000145:classification* / Q000453:epidemiology / Q000473:pathology; D008297:Male; D012867:Skin / Q000473:pathology*