Oral manifestations in the American tegumentary leishmaniasis.
BACKGROUND
American tegumentary leishmaniasis (ATL) can affect the skin or mucosa (mucocutaneous leishmaniasis - MCL) including the oral cavity. MCL oral lesions are often confused with other oral diseases, delaying diagnosis and specific treatment, and increasing the likelihood of sequelae. Thus, increasing the knowledge of the evolution of ATL oral lesions can facilitate its early diagnosis improving the prognosis of healing.


OBJECTIVE
Evaluate the frequency of ATL oral lesion and describe its clinical, laboratory and therapeutic peculiarities.


METHODS
A descriptive transversal study was carried out, using data from medical records of 206 patients with MCL examined at the outpatient clinics-IPEC-Fiocruz between 1989 and 2013. Proportions were calculated for the categorical variables and the association among them was assessed by the Pearson's chi-square test. Measures of central tendency and dispersion were used for the continuous variables and their differences were assessed by both parametric (t test) and non parametric (Mann-Whitney) tests. P-values <0.05 were considered as significant.


RESULTS
The most affected site was the nose, followed by the mouth, pharynx and larynx. Seventy eight (37.9%) have oral lesions and the disease presented a lower median of the evolution time than in other mucous sites as well as an increased time to heal. The presence of oral lesion was associated with: the presence of lesions in the other three mucosal sites; a smaller median of the leishmanin skin test values; a longer healing time of the mucosal lesions; a higher recurrence frequency; and a smaller frequency of treatment finishing and healing. When the oral lesion was isolated, it was associated with an age 20 years lower than when the oral lesion was associated with other mucosal sites.


CONCLUSIONS
Considering the worst therapy results associated with the presence of oral lesions, we suggest that lesions in this location represent a factor of worse prognosis for MCL.
Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil.
Daniel Cesar Silva
DC
da Costa
Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil.
Mariana Reuter
MR
Palmeiro
Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil.
João Soares
JS
Moreira
Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil.
Ana Cristina da Costa
AC
Martins
Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil.
Aline Fagundes
AF
da Silva
Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil.
Maria de Fátima
Mde F
Madeira
Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil.
Leonardo Pereira
LP
Quintella
Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil.
Eliame Mouta
EM
Confort
Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil.
Armando de Oliveira
Ade O
Schubach
Laboratory of Immunoparasitology, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil.
Fátima da Conceição
Fda C
Silva
Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro-RJ, Brazil; Department of Otorhinolaryngology and Ophthalmology, Federal University of Rio de Janeiro, Rio de Janeiro-RJ, Brazil.
Cláudia Maria
CM
Valete-Rosalino
D000981:Antiprotozoal Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007830:Larynx / Q000469:parasitology / Q000473:pathology; D007892:Leishmania braziliensis / Q000472:pathogenicity; D007897:Leishmaniasis, Mucocutaneous / Q000188:drug therapy / Q000469:parasitology*; D008297:Male; D008536:Meglumine / Q000627:therapeutic use; D000077485:Meglumine Antimoniate; D008875:Middle Aged; D009059:Mouth Diseases / Q000469:parasitology / Q000473:pathology*; D009061:Mouth Mucosa / Q000469:parasitology / Q000473:pathology*; D009666:Nose / Q000469:parasitology / Q000473:pathology*; D009668:Nose Diseases / Q000469:parasitology / Q000473:pathology*; D009942:Organometallic Compounds / Q000627:therapeutic use; D010614:Pharynx / Q000469:parasitology / Q000473:pathology; D011379:Prognosis; D012189:Retrospective Studies
D000981:Antiprotozoal Agents; D009942:Organometallic Compounds; D008536:Meglumine; D000077485:Meglumine Antimoniate