Dear Label_Name,

Greetings! I hope you are well.

I am writing on behalf of an international publishing house, Science and Education Publishing, USA (http://www.sciepub.com).

Science and Education Publishing (SciEP) is a multidisciplinary open access publisher of Journals covering the fields of Science, Technology and Medicine. All SciEP publications are subject to high-quality peer review, editorial and production processes and are freely available online.

Welcome to the April, 2013 edition of SciEP newsletter, providing monthly summaries of articles on science & education related topics of interest to scientist and professionals. The mission of our journals is to provide an open access forum for publishing new findings on issues pertinent to scientific and academic field. We also invite you to submit original research papers, review articles, short reports, or case studies are considered for publication in our Multidisciplinary Journals.

American Journal of Public Health Research
DOI: 10.12691/ajphr-1-1-3

The Implementation of a Tele-Homecare System with Service Oriented Architecture and HL7 Message Transmission Standard
Ching-Sung Wang

American Journal of Medical and Biological Research
DOI: 10.12691/ajmbr-1-1-2

The Influence of Ethanol on Pyruvate Kinases Activity in Vivo, in Vitro, in Silico
Lelevich Sergey Vladimirovich, Khrustalev Vladislav Victorovich, Barkovsky Eugene Victorovich, Shedogubova Tatyana Aleksandrovna

American Journal of Medical Sciences and Medicine
DOI: 10.12691/ajmsm-1-1-1

Clinical and Histological Features in Wegener Granulomatosis
Li Cavoli Gioacchino, Passantino Rita, Bono Luisa, Tortorici Calogera, Ferrantelli Angelo, Giammarresi Carlo, Rotolo Ugo

American Journal of Infectious Diseases and Microbiology
DOI: 10.12691/ajidm-1-1-2

The Curse of Lymphatic Filariasis: Would the Continual Use of Diethylcarbamazine Eliminate this Scourge in Papua New Guinea?
Anne Lanham, Lillian Mwanri

We have released issues of some journals on February 2013.
American Journal of Public Health Research
American Journal of Medical Sciences and Medicine
American Journal of Medical and Biological Research
American Journal of Pharmacological Sciences
American Journal of Clinical Medicine Research
American Journal of Nursing Research
American Journal of Cancer Prevention
American Journal of Medicine Studies
American Journal of Infectious Diseases and Microbiology
American Journal of Cardiovascular Disease Research
American Journal of Biomedical Research
American Journal of Mechanical Engineering
American Journal of Microbiological Research
Journal of Preventive Medicine
American Journal of Food and Nutrition
American Journal of Hypertension Research
American Journal of Sports Science and Medicine
Journal of Cancer Research and Treatment
American Journal of Zoological Research
Journal of Biomedical Engineering and Technology
American Journal of Microbiological Research
Biomedical Science and Engineering

We are pleased to announce that submissions are now being accepted for peer review for all the journals across all our subject areas in SciEP.

Please submit your manuscript via our online submission system:
http://www.sciepub.com/author/signin

To unsubscribe from our mailing list, please click on the following link: unsubscribe

I am looking forward to hearing from you.

Kind regards,

David Rain
Email:join@sciepub.com
Science and Education Publishing (http://www.sciepub.com)

Laryngeal Leishmaniasis- A Rare Clinical Entity

Chettri ST, Karki Smriti, Paudel D*, Shah BP, Shah SP, Manandhar S, Jayaswal R

Department of Otorhinolaryngology, BPKIHS, Dharan, Nepal

Abstract: Isolated laryngeal leishmaniasis is a rare condition and we report a 46 years old patient who presented with progressive, non fluctuating hoarseness of voice for 8 months along with foreign body sensation of throat and difficulty in swallowing. Indirect laryngoscopy followed by flexible nasoendoscopy revealed grossly edematous epiglottis, right arytenoid, right aryepiglottic fold and medial wall of the right pyriform sinus. Direct laryngoscope was performed under general anesthesia and biopsy was taken. The histopathology report section revealed numerous extracellular L.D. bodies in an inflammatory milieu comprising of lymphocytes, neutrophils and macrophages set in an edematous subepithelial stroma. He has no other systemic manifestation. He had no HIV infection or immunocompromised condition nor took immunosuppressive drugs. He responded well with liposomal Amphotericin B.

Keywords: leishmania donovani, LD Bodies, larynx

Received August 26, 2014; Revised September 05, 2014; Accepted September 11, 2014

Citation: Chettri ST, Karki Smriti, Paudel D, Shah BP, Shah SP, Manandhar S, Jayaswal R, Laryngeal Leishmaniasis- A Rare Clinical Entity. American Journal of Medical Case Reports, 2 (9). 181-183. January 2014. doi:10.12691/ajmcr-2-9-5

1. Introduction

Leishmaniasis is a worldwide infection with a broad spectrum of clinic pathological features. [1] Leishmaniasis is caused by a protozoan parasite of the Genus Leishmania. The parasite is transmitted by the bites of sand fly infected with the parasite. [2] Clinical leishmaniasis presents in the three main clinical forms-coetaneous (C), Mucocutaneous (MC) and visceral (VL- KALA-AZAR) with a broad range of symptoms, signs and degree of the severity. Endemic foci of leishmaniasis are found in all continents except Australia and Antarctica. [3,4] There are more than 20 species that are divided into old and new world types. These include the L. donovani complex with 2 species (L. donovani,L. infantum [also known as L. chagasi in the New World]); the L. mexicana complex with 3 main species (L. mexicana, L. amazonensis, and L. venezuelensis); L. tropica, L. major, L. aethiopica and the subgenus Viannia with 4 main species (L. (V.) braziliensis, L. (V.) guyanensis, L. (V.) panamensis, and L. (V.) peruviana). [5] Based on geography leishmaniasis is divided in to old world type and new world type. New old type is found in some parts of Asia, the Middle East, Africa (particularly in the tropical region and North Africa, with some cases elsewhere), and southern Europe. [6] Old world type is found in some parts of Mexico, Central America, and South America [6].

We report a case of primary laryngeal leishmaniasis presented with hoarseness and confirmed with the histopathological examination of the tissue taken from direct laryngoscopic biopsy from right arytenoids and aryepigltotic fold.

2. Case

A 46 years old patient from endemic region of leishmaniasis presented with a hoarseness of voice for 8 months which was insidious onset, gradually progressive, non fluctuating and painless. It was associated with foreign body sensation in the throat and difficulty in swallowing.

There was no significant past medical and surgical history.

He consumes alcohol and was a smoker (15 pack years).

On general examination no abnormality was detected and on indirect laryngoscopy followed by flexible nasoendoscopy revealed grossly edematous epiglottis, right arytenoid, right aryepiglottic fold and medial wall of the right pyriform sinus.

Figure 1. Edematous Epiglottis on flexible naso-endoscopy

Figure 2. swollen right arytenoid and right aryepiglottic fold on flexible naso-endoscopy.

Figure 3. Histopathology showing LD bodies in 400 X

Figure 4. Histopathology showing LD bodies in oil immersion microscopy

Direct laryngoscopic biopsy was done under general anesthesia and the specimen sent for histopathology revealed numerous extracellular L.D. bodies in an inflammatory milieu comprising of lymphocytes, neutrophils and macrophages set in an edematous subepithelial stroma. Identification of species was not possible as culture of leishmania was not available in our set up. He had no other systemic manifestation, HIV infection or immune-compromised condition nor took immunosuppressive drugs. He was treated with liposomal AmphotericinB (3 mg/kg from day1 to 5, and further dose on day 14 and 21). [7] We used Evocin of Ranbaxy Laboratories Limited and it was available at hospital pharmacy. After treatment the patient was revaluated at 6 weeks and there was marked improvement in symptoms with no hoarseness and flexible nasoendoscopy showed minimal edema of right arytenoid.

Figure 5. Post treatment picture of flexible endoscopy showing normal larynx

3. Discussion

Leishmania donovaniwas discovered in 1900 by William Fleishman (Scottish army doctor) and Charles Donovan (professor of physiology at Madras University, India) separately in the spleen of the patient with kala-azar. [8] The vector was indentified after long journey in 1921 with a experimental proof of transmission to human by the bite of the sandfly of genus Phlebotomas by Edouard and Etienne [9,10].

Leishmania is an obligate intracellular parasite infecting the macrophages of the host with a variety of clinical manifestation of CL, MC and VL. In vertebrate they are found in the amastigote form Leishmania Donovani (LD) bodies. They replicate into the cells of the reticulo-endothelial system. The parasite enters into the gut of the sandfly and develops into promastigote and migrates to salivary glands and is inoculated to the innocent new host. [11] The mucosal disease is usually associated with the coetaneous and visceral disease. However HIV and other immunosuppressive condition like malnutrition, steroid therapy, chemotherapy, chronic alcohol and smoking are the risk factors for the disease [4,8,11].

Mucosal leishmaniasis is a rare disease and few cases reported involving oral mucosa and mucosa of the upper respiratory tract. [13] Nasal septum was found to be the most common site and present with epistaxis, with destruction of the pharynx and larynx. [14] Clinically evident leishmanial infection of the naso-oropharyngeal mucosa is the potentially disfiguring metastatic complication the coetaneous leishmaniasis [15].

Treatment with pentavalent antimonial compound is moderately effective for the mucosal disease and Amphotericin B can be considered the first line treatment in mucosal disease. Patient with the respiratory compromise can be co-administered with the glucocoticosteriods. [15]

Very few cases have been reported in laryngeal leishmaniasis. Trevor et al., 2012 reported the vocal cord leishmaniasis in 84 years old man with hoarseness of voice. [3] Kamran et al., 2005 reported the mucosal leishmaniasis on a vocal cord without systemic involvement in patient with hoarseness and difficulty in breathing. [10] Kumar et al., 2009 reported a 70 years old male with suspicious of the subglottic mass with a final diagnosis of subglottic leishmaniasis in patient with hoarseness of the voice, dyspnoea and cough for 3 months duration. [8] Our patient also presented with similar complain of hoarseness with discomfort of throat and difficulty in swallowing.

4. Conclusion

Laryngeal leishmaniasis should be considered one of the differential diagnoses of laryngeal mass besides carcinoma and tuberculosis in endemic zone of leishmaniasis.

References

[1]   | González U, Pinart M, Rengifo-Pardo M, Macaya A, Alvar J, Tweed JA: Interventions for American cutaneous and mucocutaneous leishmaniasis (Review): The Cochrane Library. 2012, Issue 6: 3.
[2]   | Santangeli L, McCluney NA, Hathorn I, Shakeel M, Anderson C. Leishmaniasis presenting to the otolaryngologist: a rare but important cause of persistent hoarseness. Laryngol Otol. 2009; 123: 1181-1183.
[3]   | Trevor A. Teemul, Montserrat Giles-Lima, John Williams, Shane E. Lester: Laryngeal leishmaniasis: Case report of a rare infection: HEAD & NECK DOI 10.1002/HED. 2013 sept; 35 (9): E277-9.
[4]   | Fsadni C, Fsadni P, Piscopo T, Mallia Azzopardi C: Laryngeal Leishmaniasis in Malta. J Infection. 2007; 54:61-63.
[5]   | Centers for Disease Control and Prevention. Parasite home: leishmaniasis. Biology. Available at http://www.cdc.gov/parasites/leishmaniasis/epi.html. Accessed September 8, 2014.
[6]   | Centers for Disease Control and Prevention. Parasite home: leishmaniasis. Epidemiology & risk factors. Available at http://www.cdc.gov/parasites/leishmaniasis/epi.html. Accessed September 8, 2014
[7]   | Rosenthal PJ. Antiprotozoal drugs. In: Katzung BG, Masters SB, Trevor AJ, editors. Basics and Clinical Pharmacology. 11th ed. New Delhi:McGraw-Hill. 2009:919.
[8]   | Kumar B, Ghimire A, Karki S, Upadhyaya P. Primary laryngeal leishmaniasis: A rare case report. Indian J Pathol Microbiol. 2009; 52: 62-4
[9]   | Cox FEG: History of human Parasitology: Clinical Microbiology Reviews. 2002; 15: 595-612.
[10]   | Kamran Iqbal, Ziaul Islam Abbasi, Habib-ullah Khan: Leishmania of the vocal cord: An Unusual Site: Gomal Journal of Medical Sciences: Jan-June, 2005, Vol. 3, No. 1: 25-6.
[11]   | Finch RG, Moss P, Jeffries DJ, Anderson J. infection diseases. Leishmaniasis. 5th edition. Clinical Medicine by Kumar and Clark. 2002 pp 105.
[12]   | Di Lella F, Vincenti V, Zennaro D, Afeltra A, Baldi A, Giordano D, et al. Mucocutaneous leishmaniasis: Report of a case with massive involvement of nasal, pharyngeal and laryngeal mucosa. Int J Oral Maxillofac Surg. 2006 sept; 35 (9): 870-2.
[13]   | Grant A, Spraggs PD, Grant HR, Bryceson AD. Laryngeal leishmaniasis. J Laryngol Otol 1994 dec; 108 (12): 1086-8.
[14]   | Osorio LE, Castillo CM, Ochoa MT. Mucosal leishmaniasis due to Leishmania (Viannia) panamensis in Colombia: Clinical characteristics. Am J Trop Med Hyg. 1998; 59: 49-52.
[15]   | Herwaldt BL. Infectious disease-Leishmaniasis. In: Kasper DL,. Braunwald E, Fauci AS, Hauser SL, Longo DL, Jameson JL, editors. Harrison’s Principles of Internal Medicine. 16th ed. McGraw-Hill; 2005: 196: 1233-8.