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Espundia (Brazilian cutaneous leishmaniasis).
Last reviewed: 05.07.2025
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Espundio (Synonym: Brazilian mucocutaneous leishmaniasis).
Mucocutaneous American leishmaniasis has several nosological forms, the causative agents of which belong to the L. brasiliensis complex.
The most severe form is Brazilian leishmaniasis (espundia), in which in 80% of cases, in addition to ulcers on the skin at the site of introduction of the pathogen, extensive lesions of the mucous membranes of the nasopharynx, larynx, as well as cartilage of soft tissues and even bones also occur.
Distribution of Brazilian mucocutaneous leishmaniasis
Mucocutaneous leishmaniasis (espundia) is found mainly in South America. Cases of this disease are known in some countries of Asia and Africa (Sudan, Somalia, Kenya, India).
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Epidemiology of espundia
The spread of the disease is related to climate conditions, season and terrain. High temperature and high humidity are necessary conditions for the occurrence of diseases. Espundija is more often observed in autumn, rainy season. The altitude of the area is important (no more than 2000 m above sea level). The disease is more often observed in rural, wooded areas and is related to the density of mosquitoes. The cutaneous-mucous form of leishmaniasis often occurs in people working in forests, especially those collecting resinous substances for the production of "chewing" rubber, therefore espundija is also called "chewing gum" disease.
The carriers of the disease are mosquitoes, the natural reservoirs are rodents and, possibly, dogs. In 1946, Kiri observed experimental espundia after infecting monkeys with Sudanese kala-azar. Of all the experimentally infected animals, only monkeys were able to reproduce lesions of the oral and nasal cavity.
Causes of espundia
Espundia (Brazilian mucocutaneous leishmaniasis) is caused by L. brasiliensis. The vectors are more than 12 species of sandflies of the genus Lutzomya, but the most common is Lu. wilcomei.
Pathogenesis of Brazilian mucocutaneous leishmaniasis
Mucocutaneous lesions begin as a perivascular infiltrate, then develop into endarteritis, which may lead to destruction of the surrounding tissue. The microscopic nature of the skin lesions may be similar to oriental ulcer. Parasites can penetrate through macrophages circulating in the blood into the nose, mouth, and soft palate, where they multiply in macrophages of cartilaginous or connective tissues, causing destructive inflammation. The process can spread to the pharynx and larynx; sometimes the external genitalia are also affected. The frequency of this severe (sometimes fatal) complication depends on the parasite strain and ranges from 5 to 85%; strains circulating in southern Brazil and Paraguay are distinguished by particularly frequent dissemination. Metastatic lesions may appear even before the formation of the primary focus; in other cases, they can occur even 30 years after "recovery".
Symptoms of espundia
Symptoms of espundia classica, which occurs in Brazil, Peru, Chile, Ecuador, Bolivia, Paraguay, consist of the appearance of papulopustular skin lesions that are noted on the face, ears and shins. Lesions of the mucous membranes either accompany skin lesions or appear several years later. Congestion is observed in the mucous membrane of the nasal cavity, which later ulcerates. When parasites penetrate into the area of the lips, soft palate, pharynx, destruction can be observed here, which leads to severe suffering and deformations. The nose usually thickens, deforms, bends downwards, and the upper lip, as a result of edema and deformation, noticeably protrudes forward and upwards ("tapir nose"). The duration of the disease is from 4 months to 4 years.
In addition to espundia, several endemic forms of cutaneous leishmaniasis are known in South America, which differ in landscape confinement, epidemiology and clinical course. For example, in the high-mountain valleys of the Andes in Peru and Bolivia, cutaneous leishmaniasis is known, which occurs without damage to the mucous membrane. Infection occurs at an altitude of about 2800 m. Dogs are the reservoir of the pathogen Leishmania peruana. In most cases, the ears are affected, the disease can last for many years. Lesions begin in the form of small painful pimples (papules - pimles).
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Treatment of Brazilian mucocutaneous leishmaniasis
Espundija (Brazilian mucocutaneous leishmaniasis) is difficult to treat. A long course of therapy with 5-valent antimonials is administered. Recovery is observed in only 20%.