Author(s)
Joseph Celidonio, BS
Nicholas Hamilton, BS
Alexandra Filipowski, MPH
Raj Malhotra, BS
Samantha Shave, BS
Kenneth Yan, MD, PhD
Rachel Kaye, MD
Affiliation(s)
Rutgers New Jersey Medical School;
Abstract:
Background/Objectives: Laryngeal leishmaniasis (LL) is a rare, insidious manifestation of Leishmania infection with potential for life-threatening complications. Awareness is critical to allow efficient and timely diagnosis. Our aim is to provide a comprehensive systematic review of LL, with a focus on presentation, treatments, and the role of serological studies to support the diagnosis.
Methods: A systematic review of English literature was conducted via PubMed, Scopus, and EMBASE. Studies with original LL patient data were included. Data on demographics, symptoms, diagnosis, treatment, and outcomes were extracted.
Results: Of the 81 patients included, the majority were male (87.7%) and were exposed to a region endemic to Leishmania (97.3%). The mean age was 51.8 years. The most common symptoms were dysphonia (79.0%) and dysphagia (17.0%). Mean time from symptom onset to diagnosis was 18.4 months. Amongst patients who received serological testing for leishmaniasis, 78.3% tested positive. The most common treatment modalities were amphotericin (35.8%) and meglumine antimoniate (30.9%), whereas surgical treatment was utilized in only 6.7%. Most patients achieved symptom resolution (78.3%) at last follow-up (mean 12.7 months). 12.3% of patients required tracheostomy and these did not have significantly longer time from symptom onset to diagnosis compared to those without tracheostomy (29.4 vs. 16.3 months, p = 0.082).
Conclusions: LL is a difficult diagnosis, particularly in nonendemic regions, making awareness of its presentation of utmost importance. In fact, there is often a delay from symptom onset to diagnosis. Serological studies may play an important role in supporting the diagnosis in LL patients.