MUCOSAL LEISHMANIASIS (ESPUNDIA ESCOMEL, 1911)
MUCOSAL LEISHMANIASIS (ESPUNDIA ESCOMEL, 1911)
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DOI：
10.1016/0035-9203(86)90243-9
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发表时间：
1986-01-01
影响因子：
2.2
通讯作者：
MARSDEN, PD
中科院分区：
文献类型：
--
作者：
MARSDEN, PD
当上呼吸道粘膜发炎时，利什曼病的一种更严重的临床形式发生在埃斯彭迪亚。这种并发症是巴西利什曼原虫（Lbb）引起的皮肤病变的转移，尽管已经描述了与其他利什曼原虫物种相关的病例。流行病学数据表明，在我们的研究领域，不到5%的Lbb感染患者发生可检测到的粘膜转移。这种并发症的决定因素在很大程度上仍不清楚。肉芽肿通常开始于鼻中隔。在大约三分之二的患者中，病变仍然局限于鼻子。其余的则依次累及咽、腭、喉和唇。通常很难分离寄生虫，常规诊断利什曼菌素皮肤反应和血清学试验是有帮助的。虽然病情严重，可能造成肢体残缺甚至死亡，但治疗仍然主要是40年前开始使用的五价锑剂。这些是最不令人满意的实地使用，胃肠外和相对有毒。在粘膜利什曼病，如果足够的锑可以定期每日剂量管理，复发率很小（3 42例患者平均随访5年）。此外，锑治疗的初始皮肤溃疡，由于Lbb随访了平均4年的83例患者导致随后的粘膜转移，只有2。由于埃斯彭迪亚是相对罕见的，针对这一具体问题的具体治疗是有效的短期解决方案。目前还没有令人满意的药物可替代目前使用的药物。
One of the more serious clinical forms of leishmaniasis occurs in espundia when the mucosae of the upper respiratory passages are inflamed. This complication is a metastasis from a skin lesion caused byLeishmania braziliensis braziliensis(Lbb) although cases have been described associated with other leishmanial species. Epidemiological data suggest that a detectable mucosal metastasis occurs in fewer than 5% of patients infected with Lbb in our study area. The determinants of this complication are still largely obscure. The granuloma usually commences on the nasal septum. In about two-thirds of our patients the lesion remained restricted to the nose. In the rest the pharynx, palate, larynx and lips were involved, in this order. It is often difficult to isolate the parasite and for routine diagnosis the leishmanin skin reaction and serological tests are helpful. Although a serious condition, with possible mutilation and even death as subsequent complications, treatment is still mainly with pentavalent antimonials, introduced 40 years ago. These are most unsatisfactory for field use, being given parenterally and relatively toxic. In mucosal leishmaniasis, if sufficient antimony can be administered in a regular daily dose, the relapse rate is small (3 of 42 patients followed for a mean of 5 years). Also, antimony treatment of the initial skin ulcer due to Lbb followed for a mean of 4 years of 83 patients resulted in subsequent mucosal metastasis in only 2. Since espundia is relatively rare, specific treatment targeted to this specific problem is the efficient short term solution. At present there is no satisfactory alternative drug to those in current use.