SUDANESE MUCOSAL LEISHMANIASIS - EPIDEMIOLOGY, CLINICAL-FEATURES, DIAGNOSIS, IMMUNE-RESPONSES AND TREATMENT

The epidemiology, clinical features, pathology, immune responses, diag nosis and treatment of 14 patients with mucosal leishmaniasis in the S udan are described. The condition occurred mainly in adult males, part icularly in certain closely related tribes from the western Sudan. It affected the mucosa of the upper respiratory tract and/or the oral muc osa and sometimes followed treated kala azar. The parasites were somet imes confined to the mucosa, sometimes spread to the lymph nodes, and rarely infected the bone marrow and spleen. One of the 2 patients with both visceral and mucosal leishmaniasis differed from classical kala azar cases; his infection was longer lasting, he was leishmanin positi ve, and his peripheral mononuclear cells proliferated in response to l eishmanial antigens. Mucosal leishmaniasis following treated kala azar is a similar phenomenon to post-kala azar dermal leishmaniasis and po st-kala azar uveitis. Post-kala azar mucosal leishmanisis can therefor e be added to the other post-kala azar leishmanial infections. Using t he polymerase chain reaction, Southern blot analysis with specific pro bes, and isoenzyme characterization, the causative parasite was identi fied as Leishmania donovani in 4 patients and as L. major in one. Unli ke American mucocutaneous leishmaniasis, mucosal leishmaniasis in the Sudan was not preceded or accompanied by cutaneous lesions and the res ponse to pentavalent antimony or ketoconazole was good.