Department of Dermatology, Habib Thameur Hospital, Tunis, Tunisia.
Research Lab "Parasitoses médicales, Biotechnologie & Biomolécules" LR 11 IPT 06, Pasteur Institute of Tunis, Tunis, Tunisia.
J Eur Acad Dermatol Venereol. 2015 Jun;29(6):1212-5. doi: 10.1111/jdv.12580. Epub 2014 Jun 9.
Mucosal leishmaniasis (ML), which mostly occurs in the New World, is mainly associated with Leishmania braziliensis. Primary lip ML is very rare in the Mediterranean basin and particulary in Tunisia despite the endemicity of both cutaneous and visceral leishmaniasis in this area.
To highlight a recent emergence of primary lip ML in Tunisia, to describe its epidemiological and clinical features and to identify the causative Leishmania species.
Epidemiological, clinical and therapeutic data of 10 cases presenting a ML of the lip were collected. Diagnosis confirmation of leishmaniasis was obtained by microscopic examination of Leishmania parasites in Giemsa stained smears of the lesion sampling and in cutaneous biopsies. Polymerase chain reaction (PCR) detecting Leishmania DNA directly from dermal scraping was also performed for diagnosis and species identification.
Seven men and three women with lip ML were diagnosed during the last 6 years (2008-2013). The mean age was 29.7 years. Clinical presentation was characterized by an infiltrated and ulcerated plaque leading to macrocheilitis involving the upper lip in eight cases and the lower lip in two cases. Mean diagnosis delay was 6.9 months. PCR identified L. infantum in seven cases and L. major in two cases. Seven patients received intramuscular injections of meglumine antimoniate (MA) and three patients received both MA intralesional injections of MA and cryotherapy. A clinical remission was rapidly observed in all cases (on average in 2.2 months).
Primary lip ML is emerging in Tunisia. Macrocheilitis of the upper lip is the main clinical presentation. PCR revealed more sensitive than direct examination in the diagnosis of such form (P < 0.01). Leishmania infantum was the most identified species (7 cases) while L major was involved in only two lesions. A benign local evolution and a rapid recovery were observed in all cases after MA treatment.
黏膜利什曼病（ML）主要发生在新大陆，主要与巴西利什曼原虫有关。尽管该地区存在皮肤利什曼病和内脏利什曼病的流行，但在地中海盆地，特别是在突尼斯，原发性唇 ML 非常罕见。
突尼斯最近出现了原发性唇 ML，描述其流行病学和临床特征，并确定引起疾病的利什曼原虫种。
收集了 10 例唇部 ML 的流行病学、临床和治疗数据。通过对病变取样的 Giemsa 染色涂片和皮肤活检中利什曼寄生虫的显微镜检查，获得了利什曼病诊断的确证。还直接从皮肤刮片中进行聚合酶链反应（PCR）检测利什曼原虫 DNA，用于诊断和种鉴定。
在过去的 6 年（2008-2013 年）诊断出 7 例男性和 3 例女性唇部 ML。平均年龄为 29.7 岁。临床表现为浸润性溃疡斑块，导致 8 例上唇和 2 例下唇出现巨唇炎。平均诊断延迟为 6.9 个月。PCR 在 7 例中鉴定出婴儿利什曼原虫，在 2 例中鉴定出主要利什曼原虫。7 例患者接受了肌内注射葡甲胺锑（MA），3 例患者接受了 MA 皮内注射和冷冻疗法。所有病例均迅速出现临床缓解（平均 2.2 个月）。
原发性唇 ML 在突尼斯出现。上唇巨唇炎是主要的临床表现。PCR 比直接检查更敏感，可用于诊断这种疾病（P < 0.01）。婴儿利什曼原虫是最常见的鉴定种（7 例），而主要种仅涉及 2 个病变。在 MA 治疗后，所有病例均观察到良性局部进展和快速恢复。
