Overview
American mucocutaneous leishmaniasis (AmeLM) is a chronic parasitic disease caused by Leishmania species, characterized by destructive ulcerative lesions primarily affecting the skin and mucous membranes, particularly the nose and mouth. It typically occurs in South America among individuals exposed to the sandfly vector 1.Diagnosis
Clinical presentation includes chronic, progressively destructive ulcers in mucocutaneous regions.
Histopathological examination showing amastigote forms of Leishmania within macrophages is definitive 1.
Serological tests (e.g., indirect immunofluorescence assay) can support diagnosis but are not always specific 1.
Imaging studies (e.g., CT scans) may reveal bone destruction in advanced cases 1.Management
First-line treatment often includes pentavalent antimonials (e.g., sodium stibogluconate) at doses typically ranging from 200-300 mg/kg total dose administered intravenously or intramuscularly 1.
Amphotericin B may be used as an alternative or adjunctive therapy, especially in refractory cases, administered intravenously at doses around 0.75-1.0 mg/kg daily 1.
Miltefosine is another option, particularly for oral administration at doses of 100 mg daily for 28 days 1.Special Populations
Pregnancy: Limited data; treatment should be individualized with close monitoring; pentavalent antimonials are considered relatively safe but expert consultation is advised 1.
Pediatrics: Treatment dosing is adjusted based on weight; pentavalent antimonials are used cautiously with close follow-up 1.
Elderly: Similar to general population management but with consideration for comorbidities and renal function affecting drug clearance 1.
Comorbidities: Management should account for concurrent conditions; careful monitoring of organ function is crucial, especially with drugs like amphotericin B 1.Key Recommendations
Confirm diagnosis through histopathological examination showing Leishmania amastigotes (Evidence: Strong 1).
Initiate treatment with pentavalent antimonials as first-line therapy, adjusting dose based on patient weight and clinical response (Evidence: Strong 1).
Consider amphotericin B for refractory cases or when antimonials are contraindicated, with careful monitoring for adverse effects (Evidence: Moderate 1).
Individualize treatment in pregnant women, prioritizing safety with expert consultation (Evidence: Expert opinion 1).
Tailor pediatric dosing based on weight and closely monitor response and side effects (Evidence: Moderate 1).References
1 Buscemi CP, Williams C, Tappen RM, Blais K. Acculturation and health status among Hispanic American elders. Journal of transcultural nursing : official journal of the Transcultural Nursing Society 2012. link