Progressive Perforation of the Nasal Septum Due to Leishmania major: A Case of Mucosal Leishmaniasis in a Traveler.

This report describes a case of mucosal leishmaniasis caused by Leishmania major with destructive perforation of the nasal septum illustrating the diagnostic challenges of a rare clinical presentation of L. major infection in a traveler. The atypical presentation may have been associated with the use of cortisone as a potential trigger for the progressive destruction of the nasal septum.

Nasal septal lipoma in a child: Pai syndrome or not?

Lipoma is the most common soft tissue mass in adults but it is uncommon in children. Nasal septal lipoma is an even more rare entity. In this report, a 12-year-old girl was presented with congenital nasal septal lipoma. She had permanent partial nasal obstruction on her right side and disfigurement of her right upper lip. CT scan revealed a lipoma-like mass in the septum plus an additional incidental finding of an intracranial lipoma. Further workup with MRI demonstrated corpus callosum agenesis with interhemispheric lipoma. To remove the mass, septoplasty, nasal lipoma excision and nasal vestibule V-Y advancement flap were performed. To close the lip a rotational advancement flap was required. Our case seemed to be a variety of Pai syndrome. We recommend imaging of the central nervous system in newborns with congenital lipomas located in the craniofacial midline to rule out the Pai syndrome.

A proposed new clinical staging system for patients with mucosal leishmaniasis.

Mucosal leishmaniasis (ML) occurs mainly in areas where Leishmania braziliensis is transmitted. It affects predominantly the nasal mucosa and, in more severe forms, can lead to significant tissue destruction. There is no standard method for grading the severity of disease. We categorised 50 patients with ML according to a proposed new clinical staging system. Their age ranged from 10 to 86 y (mean ± SD: 36 ± 16 y) and 43 (86%) patients were male. The different degrees of evolution of mucosal disease, from the initial stage to the more severe long-term cases, enabled ML to be graded into five stages. Stage I is characterised by nodular lesions of the mucosa without ulceration. Stage II is represented by superficial mucosal ulcerations with concomitant fine granular lesions. Stage III is characterised by deep mucosal ulcerations with granular tissue formation. In stage IV there are irreversible lesions leading to perforation of the cartilaginous nasal septum with necrosis. In stage V the nasal pyramid is compromised with alterations of facial features as a consequence of severe tissue destruction. These stages may be useful in characterising the severity of the lesion and optimising therapeutic outcome.

[Mast cells and eosinophils of the respiratory mucosa of sheep with Oestrus ovis (Linné, 1761) infection]. / Mastocytes et eosinophiles de la muqueuse respiratoire du mouton infesté par Oestrus ovis (Linné, 1761).

Mast cells and eosinophils have been identified by differential stainings and counted in mucous membrane of nasal septum, turbinates and sinus of 77 ewes naturally infected with Oestrus ovis. Results have been compared with those of nine parasite free lambs. Anova tests indicate significant differences between infected and parasite-free sheep for the cell numbers and their distribution among the septum, the turbinates and the sinus and according to their position in mucous membrane, interglandular chorion of sub-mucosa. In infected sheep, the mean number of mast cells is twice the number present in parasite free animals. The burdens of eosinophils are multiplied by 17 for the septum, 29 for the turbinates and 58 for the sinus. The hypothesis of the development of an hypersensitivity phenomenon in ovine oestrosis is sustained by these results.

Identification of Leishmania from mucosal leishmaniasis by recombinant DNA probes.

Three cases of mucosal leishmaniasis are described. Parasites isolated from mucosal lesions were identified by Southern blot analysis of their genomic deoxyribonucleic acids (DNAs) using recombinant DNA probe pDK20. Parasites from 2 patients were identified as Leishmania donovani s.l. One of the patients had pure mucosal lesions, while in the second patient there was dissemination of the parasite to other organs. The spectrum of the disease caused by L. donovani is discussed. The parasite from the third patient was identified as L. major.

Epidemiology of Oestrus ovis in southwest France.

From July 1989 to June 1990, 555 heads of adult sheep obtained from Pamiers slaughterhouse (southwest France) were examined for infestation by Oestrus ovis. Infestation was present in 65% of the heads and the mean larval burden per positive case over the year was 24.8. The monthly prevalence rate varied from 44% in April to 88.2% in November. There are usually three generations of O. ovis each year: the first in March-April, the second in June-July and the last in September-October. There was no fly activity in winter and during the hottest months of summer. On the other hand, nearly all the larvae overwintered as the first stage. This study emphasizes the seriousness of the problem in the region and the authors recommend three strategic treatments per year during periods of high fly activity.