title: Clinical complexity of Leishmania (Viannia) braziliensis infections amongst travelers.
abstract: The protozoan parasite Leishmania (Viannia) braziliensis is one of the main causes of cutaneous and mucocutaneous leishmaniasis in South America. Here, we describe three cases of L. (V.) braziliensis infection which were acquired during travelling in Bolivia, Peru or Paraguay and illustrate the phenotypic heterogeneity and therapeutic complexity of the disease. Two patients presented with unusual clinical manifestations, i.e. with prominent regional lymphadenopathy ("bubonic leishmaniasis") and with simultaneously emerged skin and mucosal lesions, respectively. Both patients insufficiently responded to oral treatment with miltefosine; resolution of the lesions was only achieved after a course of intravenous liposomal amphotericin B.
authors.affiliation: Hautklinik Mikrobiologisches Institut-Universitätsklinikum Erlangen Wasserturmstraße 3/5, 91054 Erlangen Germany.
authors.forename: Saskia
authors.initials: S
authors.lastname: Eichner
authors.forename: Sybille
authors.initials: S
authors.lastname: Thoma-Uszynski
authors.forename: Ilka
authors.initials: I
authors.lastname: Herrgott
authors.forename: Heidi
authors.initials: H
authors.lastname: Sebald
authors.forename: Andrea
authors.initials: A
authors.lastname: Debus
authors.forename: Athanasios
authors.initials: A
authors.lastname: Tsianakas
authors.forename: Jan
authors.initials: J
authors.lastname: Ehrchen
authors.forename: Gundel
authors.initials: G
authors.lastname: Harms
authors.forename: Miklos
authors.initials: M
authors.lastname: Simon
authors.forename: Cord
authors.initials: C
authors.lastname: Sunderkötter
authors.forename: Christian
authors.initials: C
authors.lastname: Bogdan
mesh_terms: D000328:Adult; D000368:Aged; D000666:Amphotericin B / Q000627:therapeutic use*; D000981:Antiprotozoal Agents / Q000627:therapeutic use*; D006801:Humans; D007892:Leishmania braziliensis; D016773:Leishmaniasis, Cutaneous / Q000188:drug therapy* / Q000469:parasitology; D008297:Male; D010767:Phosphorylcholine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D013020:South America; D014195:Travel; D055815:Young Adult
chemical_list: D000981:Antiprotozoal Agents; C068538:liposomal amphotericin B; D010767:Phosphorylcholine; C039128:miltefosine; D000666:Amphotericin B
keywords: Leishmania (V.) braziliensis; cutaneous leishmaniasis; mucosal leishmaniasis