Cutaneous leishmaniasis (oriental sore) of the eyelid

Aspects of the association between leishmaniasis and malignant disorders

Given the prevalence of leishmaniasis and cancer, the co-existence of these two diseases may be merely coincidental. However, a number of epidemiological, experimental and laboratory studies suggest that an association between these two entities does exist. The aim of this review is to summarise the occurrence of leishmaniasis as an opportunistic infection associated with malignant disorders and to present the available literature potentially linking this infection with the development of cancerous lesions. We searched electronic databases and evaluated 37 studies involving 44 patients. Four different types of association between leishmaniasis and cancer were established: leishmaniasis mimicking a malignant disorder, such as lymphoma; leishmaniasis arising as a difficult to diagnose and treat infection among patients receiving chemotherapy for various malignant disorders; simultaneous diagnosis of leishmaniasis and a neoplastic disorder in the same tissue samples of immunocompromised patients; and direct involvement of Leishmania spp. in the pathogenesis/occurrence of malignant lesions, especially of the skin and mucous membranes. The main conclusion of this review is that leishmaniasis can directly or indirectly affect the presentation, diagnosis and course of various malignant disorders and it should be considered in the differential diagnosis of malignancies in geographic areas where it is endemic and/or in patients with travel history to these areas.

Ocular involvement in cutaneous leishmaniasis four cases with blepharoconjunctivitis

PURPOSE

To determine the rate of ocular involvement in cutaneous leishmaniasis (CL).

METHODS

Nine hundred and eighty seven cutaneous leishmaniasis patients diagnosed and identified by clinical examination and parasitological methods in Harrankapi Health Centre between January 1996 and November 1997 were examined at the Harran University School of Medicine Eye Clinic, Sanliurfa, Turkey.

RESULTS

One thousand seven hundred and three CL lesions were identified in 987 patients (484 women and 503 men) with ages ranging from 0 to 78 years (mean +/- SD 16.70 +/- 13.47 years). A total of 33 lesions were located on the eyelid and in the periorbital region, making up 1.93% of all cutaneous lesions and 3.57% of facial lesions. In three cases with ocular involvement, blepharoconjunctivitis was identified, and in one case with ocular involvement, mechanical ptosis, lagophthalmos and blepharoconjunctivitis were identified.

CONCLUSIONS

It was observed that the size of the lesions and their vicinity to the marginal free edge of the eyelid played an important role in the occurrence of ocular symptoms. It was concluded that many ocular findings could be missed because of the failure to conduct ophthalmological examination of CL cases with eyelid involvement, and hence, proper follow up and treatment may not be carried out.

Ocular alterations in patients with cutaneous and mucocutaneous leishmaniasis

Leishmaniasis is a parasitosis with high prevalence and increasing epidemiologic relevance. Ocular manifestations of visceral leishmaniasis (kala-azar) have been well studied, but less is known about ocular alterations in cutaneous and mucocutaneous leishmaniasis (CL/MCL). Fifty-five patients with CL/MCL and a seronegative control group of 39 were examined ophthalmologically in Paraguay. CL/MCL was diagnosed clinically by detection of the parasite, with serological methods and/or intradermal reaction.

Eyelid leishmaniasis in a patient with neurogenic ptosis

A patient with chronic progressive external ophthalmoplegia contracted cutaneous leishmaniasis of the upper eyelid. Infection of this site is rare because eyelid movements usually prevent the sandfly vector from biting the skin there. It is postulated that the relative immobility of the upper eyelid in this patient was a major predisposing factor for the infection.

Early surgical treatment of cutaneous leishmaniasis

Cutaneous leishmaniasis, treated or untreated, is known to leave disfiguring scars. These scars are usually on exposed parts, for which plastic surgery may be required. The present work deals with the treatment of cutaneous leishmaniasis using surgical techniques from the onset. In 20 patients, 35 lesions were excised down to the deep fascia. To cover the resulting defect, subcuticular sutures were used in 7 small lesions. Dufourmental (LLL flap) and Limberg flaps were used in 23 lesions of moderate size. Free grafting was resorted to in five large lesions. Using these techniques, morbidity was reduced and cosmetic results were satisfactory.

Cutaneous leishmaniasis in an infant

Cutaneous leishmaniasis (CL) in the United States is unusual. We report an infant who developed CL after returning from an endemic area. A skin biopsy yielded Leishmania organisms within 48 hours. The cutaneous lesions resolved with scarring after several months.

Leishmanial infections: a consideration in travellers returning from abroad

Seven cases of leishmaniasis, including a fatal case of visceral leishmaniasis and 6 cases of dermal leishmaniasis, were seen in Boston over a four-year period. Diagnosis was made by isolation of organisms in culture or by identification of organisms in stained preparations of tissue. Proper management of patients with leishmanial infections requires an appreciation of the geographical strain differences of each species.

Cryosurgery in cutaneous leishmaniasis

Thirty patients with cutaneous leishmaniasis were treated with cryotherapy using a CO2 cryomachine and all were cured without noticeable scarring within 4-5 weeks, with no relapse. Histopathological examination showed that cryotherapy eradicated all parasites in less than 1 hour. Leishmania tropica, L. ethiopica and L. brasiliensis are all markedly thermosensitive and thus cryotherapy seems parasiticidal to all types. Adequate cryotreatment of cutaneous leishmaniasis will preclude the development of mucocutaneous extension, and its use in mucocutaneous disease is also recommended.