Facial Structure Alterations and Abnormalities of the Paranasal Sinuses on Multidetector Computed Tomography Scans of Patients with Treated Mucosal Leishmaniasis.

Background/Objectives: Mucosal leishmaniasis (ML) is a progressive disease that affects cartilage and bone structures of the nose and other upper respiratory tract structures. Complications associated with ML have been described, but there is a lack of studies that evaluate the structural changes of the nose and paranasal sinuses in ML using radiological methods. In this study, we aimed to assess the opacification of the paranasal sinuses in patients with treated ML and any anatomical changes in the face associated with ML using multidetector computed tomography scans (MDCT) of the sinuses. We compared the findings with a control group. Methodology/Principal Findings: We evaluated 54 patients with treated ML who underwent CT scans of the sinuses and compared them with a control group of 40 patients who underwent orbital CT scans. The degree of sinus disease was assessed according to the Lund-Mackay criteria. Forty of the 54 patients with a history of ML (74.1%) had a tomographic score compatible with chronic sinusitis (Lund-Mackay ≥4). CT scans in the leishmaniasis and control groups demonstrated significant differences in terms of facial structure alterations. Patients from the ML group showed more severe levels of partial opacification and pansinus mucosal thickening (42.6%) and a greater severity of total opacification. Patients from the ML group with a Lund-Mackay score ≥4 presented longer durations of disease before treatment and more severe presentations of the disease at diagnosis. Conclusion/Significance: CT scans of the sinuses of patients with ML presented several structural alterations, revealing a prominent destructive feature of the disease. The higher prevalence in this study of chronic rhinosinusitis observed in CT scans of patients with treated ML than in those of the control group suggests that ML can be considered a risk factor for chronic rhinosinusitis in this population (p<0.05). Author Summary: Mucosal leishmaniasis (ML) is mainly caused by the agent Leishmania (V.) brasiliensis and usually occurs months or years after symptomatic or asymptomatic skin infection. Approximately 5% of patients with untreated cutaneous leishmaniasis will develop ML, a presentation that causes significant morbidity in patients. This important but often neglected anthropozoonosis also presents direct health care costs and several indirect losses in terms of impaired daily functioning. In this study, we aimed to assess the degree of opacification of the paranasal sinuses in patients with treated ML and any anatomical changes in the face associated with ML using multidetector computed tomography scans (MDCT) of the sinuses. We compared the findings in this population with those from a control group. We evaluated 54 patients with treated ML who were subjected to MDCT of the sinuses and compared them with a control group of 40 patients who underwent MDCT of the orbit. CT scans of the sinus of patients with ML presented several structural alterations, revealing a prominent destructive feature of the disease. The higher prevalence of chronic rhinosinusitis observed in CT scans of patients with treated ML in this study also suggests that ML can be considered a risk factor for chronic rhinosinusitis in this population. [ABSTRACT FROM AUTHOR]