8
Diagnosis
11. Mucosal areas that have macroscopic abnormalities are recommended
for specimen collection; biopsy specimens, obtained by an
otolaryngologist, are useful for confirming the diagnosis by molecular
and traditional methods and for excluding other etiologies (S-L).
12. All persons at risk for ML—on the basis of the etiologic agent of
the Leishmania infection, if known, and the region in the New World
in which infection was acquired—should be questioned about and
examined for mucosal symptoms and signs, respectively, even during
the initial evaluation (S-L).
13. During all evaluations (ie, initial and subsequent), persons at risk for
ML should be questioned explicitly about the development, evolution,
and other characteristics of mucosal symptoms, and they should
have a thorough examination of the naso-oropharyngeal mucosa even
if they do not have any mucosal symptoms (S-L).
14. Persons at risk for ML should be educated and provided personalized
documentation about the importance of seeking medical attention
for possible ML if they ever develop persistent, atypical (unusual for
the person) naso-oropharyngeal/laryngeal manifestations that do not
have a clear etiology (S-L).
15. Persons at risk for ML who have persistent mucosal symptom(s) or
compatible abnormalities of the naso-oropharyngeal mucosa should
be referred to a specialist for an otorhinolaryngologic examination,
which typically should include fiberoptic endoscopy (S-L).
16. Clinicians might refer some at-risk persons without documented
mucosal symptoms or signs to an otolaryngologist, especially if
it was not possible to conduct a thorough review of systems and
mucosal examination or if the assessments may not have been
adequate or reliable (W-VL).
