Clinical and Diagnostic Considerations in Laryngeal Leishmaniasis: A Systematic Review.

Objective: Laryngeal leishmaniasis is a rare, insidious manifestation of Leishmania infection with potential for life-threatening complications. Awareness is critical for efficient and timely diagnosis. This systematic review of laryngeal leishmaniasis focuses on presentation, treatment, and the role of serological studies in the work up of these patients. Data Sources: PubMed, Scopus, and EMBASE. Review Methods: A systematic review of English literature was conducted via PubMed, Scopus, and EMBASE. Studies with both systemic and isolated laryngeal leishmaniasis 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. Among patients who received serological testing for leishmaniasis, 77.2% tested positive, and those with isolated disease showed lower sensitivity. The most common treatment modalities were amphotericin (35.8%) and meglumine antimoniate (30.9%), whereas surgical treatment was pursued in only 6.7%. Most patients achieved symptom resolution (78.3%) at last follow-up (mean 12.7 months). 12.3% of patients required a tracheostomy-time from symptom onset to diagnosis did not differ in patients with tracheostomy versus no tracheostomy (29.4 vs 16.3 months, Conclusion: Laryngeal leishmaniasis is a difficult diagnosis, particularly in nonendemic regions. In fact, there is often a delay in diagnosis. Serological studies may play an important role in supporting the diagnosis.