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.
Ronald O. Perelman Department of Dermatology, New York University Medical School, New York.
O P
OP
Sangueza
J M
JM
Sangueza
M J
MJ
Stiller
P
P
Sangueza
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*