New World Leishmaniasis: The Role of Confocal Microscopy in Diagnosis and Follow-up - Tropical Dermatology

Ana Ortins-Pina, Luís Soares-de-Almeida, Paulo Filipe, André Laureano Oliveira

Resumo


Cutaneous leishmaniasis may mimic other infections in overlapping endemic areas and timely treatment prevents dissemination of the parasite. The required histopathological and microbiological examinations are not always available, and can only give a deferred confirmation of the diagnosis. In contrast, reflectance confocal microscopy (RCM) allows real-time visualization till the level of papillary dermis. A 59-year-old Brazilian male presented with ulcerated plaques and tumors on the extremities. The clinical differential diagnosis included leishmaniasis and other infections with lymphocutaneous pattern of dissemination. RCM showed the characteristic picture of «eggs in a bird’s nest» which has been described in cutaneous leishmaniasis. The diagnosis of leishmaniasis was later confirmed by skin biopsy, in which Leishmania guyanensis was identified by parasitological examination. After treatment with liposomal amphotericin B, reassessment with RCM corroborated the clinical cure, showing an «empty nest» picture. In conclusion, RCM noninvasively provides useful information for diagnosis and follow-up of cutaneous leishmaniasis.


Palavras-chave


Dermoscopy; Leishmania; Leishmaniasis, Cutaneous/diagnosis; Microscopy, Confocal

Texto Completo:

PDF (English)

Referências


Handler MZ, Patel PA, Kapila R, Al-Qubati Y, Schwartz

RA. Cutaneous and mucocutaneous leishmaniasis: Differential

diagnosis, diagnosis, histopathology, and

management. J Am Acad Dermatol. 2015;73:911-26.

doi: 10.1016/j.jaad.2014.09.014

Alvar J, Vélez I, Bern C, Herrero M, Desjeux P, Cano

J, et al. WHO Leishmaniasis Control Team: Leishmaniasis

worldwide and global estimates of its incidence.

PLoS One. 2012;7:e35671. doi: 10.1371/journal.

pone.0035671.

World Health Organization. Control of the leishmaniases.

World Heal Organ Tech Rep Ser. 2010;949:1-

Buljan M, Zalaudek I, Massone C, Hofmann-Wellenhof

R, Fink-Puches R, Arzberger E. Dermoscopy and reflectance

confocal microscopy in cutaneous leishmaniasis

on the face. Australas J Dermatol. 2016;57:316-8.

doi: 10.1111/ajd.12404.

Alarcon I, Carrera C, Puig S, Malvehy J. In vivo

confocal microscopy features of cutaneous leishmaniasis.

Dermatology. 2014;228:121-4. doi:

1159/000357525.

Goihman-Yahr M. American mucocutaneous leishmaniasis.

Dermatol Clin. 1994;12:703-12.

Vega-Lopez F. Diagnosis of cutaneous leishmaniasis.

Curr Opin Infect Dis. 2003;16:97-101.

Al-Hucheimi S, Sultan B, Al-Dhalimi M. A comparative

study of the diagnosis of Old World cutaneous leishmaniasis

in Iraq by polymerase chain reaction and

microbiologic and histopathologic methods. Int J Dermatol.

;48:404-8. doi: 10.1159/000357525.

Skoryna-Karcz B, Chojecka-Adamska A, Adamski Z.

The case of cutaneous leishmaniasis - diagnostic difficulties.

Przegl Dermatol. 1994;81:544-7.

Kalter D. Laboratory tests for the diagnosis and evaluation

of leishmaniasis. Dermatol Clin. 1994;12:37-

Practical guide for specimen collection and reference

diagnosis of leishmaniasis [Internet]. US Centers for

Disease Control and Prevention Website. 2014 [cited

Aug 20]. Available from: https://www.cdc.gov/

parasites/leishmaniasis/resources/pdf/cdc_diagnosis_

guide_leishmaniasis.pdf

Llambrich A, Zaballos P, Terrasa F, Torne I, Puig S, Malvehy

J. Dermoscopy of cutaneous leishmaniasis. Br J

Dermatol. 2009;160:756-61. doi: 10.1111/j.1365-

-2133.2008.08986.x.

Yucel A, Gunasti S, Denli Y, Uzun S. Cutaneous

leishmaniasis: new dermoscopic findings. Int J Dermatol.

;52:831-7. doi: 10.1111/j.1365-

-4632.2012.05815.x.

Rajadhyaksha M, Gonza S, Zavislan JM, Anderson RR,

Webb RH. In Vivo Confocal Scanning Laser Microscopy

of Human Skin II : Advances in Instrumentation and

Comparison With. J Invest Dermatol. 1999;113:293-

Cinotti E, Perrot JL, Labeille B, Cambazard F. Reflectance

confocal microscopy for cutaneous infections

and infestations. J Eur Acad Dermatol Venereol. 2016;30:754-63. doi: 10.1111/jdv.13254.

Cinotti E, Perrot JL, Labeille B, Vercherin P, Chol C,

Besson E, et al. Reflectance confocal microscopy for

quantification of Sarcoptes scabiei in Norwegian scabies.

J Eur Acad Dermatol Venereol. 2013;27:e176-8.

doi: 10.1111/j.1468-3083.2012.04555.x.

Slutsky JB, Rabinovitz H, Grichnik JM, Marghoob

AA. Reflectance confocal microscopic features of

dermatophytes, scabies, and Demodex. Arch Dermatol.

;147:1008. doi: 10.1001/archdermatol.

193.

Goldgeier M, Alessi C, Muhlbauer J. Immediate noninvasive

diagnosis of herpesvirus by confocal scanning

laser microscopy. J Am Acad Dermatol. 2002;46:783-5.




DOI: http://dx.doi.org/10.29021/spdv.76.4.972

Apontadores

  • Não há apontadores.




Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.