This protocol addresses clinically manifest American mucosal leishmaniasis in patients who have laryngeal or pharyngeal involvement and an increased risk for respiratory obstruction, as indicated by symptoms and otolaryngologic or radiologic examination findings.
Laryngeal and pharyngeal mucosal disease creates potential for airway compromise that must be anticipated and managed proactively. Clinical assessment — including symptoms alongside otolaryngologic and radiologic findings — guides the determination of obstruction risk and shapes the treatment strategy accordingly.
Management involves prophylactic corticosteroid therapy administered before and during antileishmanial treatment, combined with systemic antileishmanial therapy. Several antileishmanial options exist — including parenteral agents and an oral alternative — but the choice, sequencing, and full regimen details go beyond what is summarised here.
Full regimen, agent selection, dosing, duration, and clinical decision points are in the structured protocol.
The primary goal is clinical cure of the mucosal disease — resolution of mucosal lesions assessed by clinical criteria. Follow-up over at least the first year is important, as the majority of relapses occur within that window.
DOI: 10.1093/cid/ciw670
We recommend inpatient monitoring and prophylactic corticosteroid therapy for persons with laryngeal/pharyngeal disease and increased risk for respiratory obstruction, as indicated by symptoms and otolaryngologic/radiologic examinations, because of the potential for inflammatory reactions after initiation of antileishmanial therapy.
The traditional options for ML include treatment with a pentavalent antimonial (SbV) compound or with amphotericin B deoxycholate. More recently, the armamentarium has expanded to include lipid formulations of amphotericin B, as well as the oral agent miltefosine.
Response to antileishmanial treatment of ML typically is assessed by clinical criteria. The majority of relapses occur within the first year, but they may occur later.
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