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Mucosal leishmaniasis of the lip: an emerging clinical form in Tunisia.
J Eur Acad Dermatol Venereol. 2015 Jun; 29(6):1212-5.JE

Abstract

BACKGROUND

Mucosal leishmaniasis (ML), which mostly occurs in the New World, is mainly associated with Leishmania braziliensis. Primary lip ML is very rare in the Mediterranean basin and particulary in Tunisia despite the endemicity of both cutaneous and visceral leishmaniasis in this area.

OBJECTIVES

To highlight a recent emergence of primary lip ML in Tunisia, to describe its epidemiological and clinical features and to identify the causative Leishmania species.

METHODS

Epidemiological, clinical and therapeutic data of 10 cases presenting a ML of the lip were collected. Diagnosis confirmation of leishmaniasis was obtained by microscopic examination of Leishmania parasites in Giemsa stained smears of the lesion sampling and in cutaneous biopsies. Polymerase chain reaction (PCR) detecting Leishmania DNA directly from dermal scraping was also performed for diagnosis and species identification.

RESULTS

Seven men and three women with lip ML were diagnosed during the last 6 years (2008-2013). The mean age was 29.7 years. Clinical presentation was characterized by an infiltrated and ulcerated plaque leading to macrocheilitis involving the upper lip in eight cases and the lower lip in two cases. Mean diagnosis delay was 6.9 months. PCR identified L. infantum in seven cases and L. major in two cases. Seven patients received intramuscular injections of meglumine antimoniate (MA) and three patients received both MA intralesional injections of MA and cryotherapy. A clinical remission was rapidly observed in all cases (on average in 2.2 months).

CONCLUSIONS

Primary lip ML is emerging in Tunisia. Macrocheilitis of the upper lip is the main clinical presentation. PCR revealed more sensitive than direct examination in the diagnosis of such form (P < 0.01). Leishmania infantum was the most identified species (7 cases) while L major was involved in only two lesions. A benign local evolution and a rapid recovery were observed in all cases after MA treatment.

Authors+Show Affiliations

Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia.Research Lab "Parasitoses médicales, Biotechnologie & Biomolécules" LR 11 IPT 06, Pasteur Institute of Tunis, Tunis, Tunisia.Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia.Research Lab "Parasitoses médicales, Biotechnologie & Biomolécules" LR 11 IPT 06, Pasteur Institute of Tunis, Tunis, Tunisia.Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia.Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia.Research Lab "Parasitoses médicales, Biotechnologie & Biomolécules" LR 11 IPT 06, Pasteur Institute of Tunis, Tunis, Tunisia.Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia.Research Lab "Parasitoses médicales, Biotechnologie & Biomolécules" LR 11 IPT 06, Pasteur Institute of Tunis, Tunis, Tunisia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24910266

Citation

Hammami-Ghorbel, H, et al. "Mucosal Leishmaniasis of the Lip: an Emerging Clinical Form in Tunisia." Journal of the European Academy of Dermatology and Venereology : JEADV, vol. 29, no. 6, 2015, pp. 1212-5.
Hammami-Ghorbel H, Ben Abda I, Badri T, et al. Mucosal leishmaniasis of the lip: an emerging clinical form in Tunisia. J Eur Acad Dermatol Venereol. 2015;29(6):1212-5.
Hammami-Ghorbel, H., Ben Abda, I., Badri, T., Chelbi, H., Fenniche, S., Mokhtar, I., Bouratbine, A., Benmously-Mlika, R., & Aoun, K. (2015). Mucosal leishmaniasis of the lip: an emerging clinical form in Tunisia. Journal of the European Academy of Dermatology and Venereology : JEADV, 29(6), 1212-5. https://doi.org/10.1111/jdv.12580
Hammami-Ghorbel H, et al. Mucosal Leishmaniasis of the Lip: an Emerging Clinical Form in Tunisia. J Eur Acad Dermatol Venereol. 2015;29(6):1212-5. PubMed PMID: 24910266.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Mucosal leishmaniasis of the lip: an emerging clinical form in Tunisia. AU - Hammami-Ghorbel,H, AU - Ben Abda,I, AU - Badri,T, AU - Chelbi,H, AU - Fenniche,S, AU - Mokhtar,I, AU - Bouratbine,A, AU - Benmously-Mlika,R, AU - Aoun,K, Y1 - 2014/06/09/ PY - 2014/01/31/received PY - 2014/03/25/revised PY - 2014/05/05/accepted PY - 2014/6/10/entrez PY - 2014/6/10/pubmed PY - 2016/3/24/medline SP - 1212 EP - 5 JF - Journal of the European Academy of Dermatology and Venereology : JEADV JO - J Eur Acad Dermatol Venereol VL - 29 IS - 6 N2 - BACKGROUND: Mucosal leishmaniasis (ML), which mostly occurs in the New World, is mainly associated with Leishmania braziliensis. Primary lip ML is very rare in the Mediterranean basin and particulary in Tunisia despite the endemicity of both cutaneous and visceral leishmaniasis in this area. OBJECTIVES: To highlight a recent emergence of primary lip ML in Tunisia, to describe its epidemiological and clinical features and to identify the causative Leishmania species. METHODS: Epidemiological, clinical and therapeutic data of 10 cases presenting a ML of the lip were collected. Diagnosis confirmation of leishmaniasis was obtained by microscopic examination of Leishmania parasites in Giemsa stained smears of the lesion sampling and in cutaneous biopsies. Polymerase chain reaction (PCR) detecting Leishmania DNA directly from dermal scraping was also performed for diagnosis and species identification. RESULTS: Seven men and three women with lip ML were diagnosed during the last 6 years (2008-2013). The mean age was 29.7 years. Clinical presentation was characterized by an infiltrated and ulcerated plaque leading to macrocheilitis involving the upper lip in eight cases and the lower lip in two cases. Mean diagnosis delay was 6.9 months. PCR identified L. infantum in seven cases and L. major in two cases. Seven patients received intramuscular injections of meglumine antimoniate (MA) and three patients received both MA intralesional injections of MA and cryotherapy. A clinical remission was rapidly observed in all cases (on average in 2.2 months). CONCLUSIONS: Primary lip ML is emerging in Tunisia. Macrocheilitis of the upper lip is the main clinical presentation. PCR revealed more sensitive than direct examination in the diagnosis of such form (P < 0.01). Leishmania infantum was the most identified species (7 cases) while L major was involved in only two lesions. A benign local evolution and a rapid recovery were observed in all cases after MA treatment. SN - 1468-3083 UR - https://www.unboundmedicine.com/medline/citation/24910266/Mucosal_leishmaniasis_of_the_lip:_an_emerging_clinical_form_in_Tunisia_ L2 - https://doi.org/10.1111/jdv.12580 DB - PRIME DP - Unbound Medicine ER -