MUCOCUTANEOUS LEISHMANIASIS - A CLINICOPATHOLOGICAL CLASSIFICATION

Background: Leishmaniasis, a chronic parasitic disease transmitted by Phlebotomus sandflies, affects millions of patients. Mucocutaneous lei shmaniasis caused by Leishmania brasiliensis is endemic in much of Sou th America. Objective. Our purpose was to develop a system for staging mucocutaneous leishmaniasis on the basis of clinical, histopathologic , epidemiologic, and immunologic criteria. Methods: Seventy-five Boliv ian patients with mucocutaneous leishmaniasis were evaluated by histor y and physical examination; cutaneous, mucosal, and bone marrow biopsy specimens; and immunologic assessment. Results: Mucocutaneous leishma niasis may progress through three clinical stages: (1) the primary or cutaneous, (2) the cicatricial, and (3) the secondary or mucocutaneous stages. The primary stage can be further subdivided into three phases : lymphoplasmocytic, tuberculoid, and diffuse cutaneous phases. The se condary stage can also be subdivided into three phases: edematous, gra nulomatous proliferative, and granulomatous necrotizing stages. Conclu sion: A classification or staging system enhances the ability to evalu ate patients with mucocutaneous leishmaniasis and determine more accur ately their prognosis and treatment.