Leishmaniasis

From WikEM
Jump to: navigation, search

Background

  • Vector: sandfly
  • Occurs sporadically in rural Africa, Asia, Mediterranean, Central/South America
  • Wide variety of symptoms given numerous species of protozoa
  • 500,000 new cases and 60,000 deaths each year

Clinical Features

Cutaneous

  • Single to diffuse nodules/plagues with central clearing/eschar/fibrinous exudate

Mucocutaneous

  • Mucosal destruction, deformity nasal blockage, bleeding, increased secretions, sloughing of dead tissue, dysphonia, odynophagia, respiratory distress

Visceral (Kala-azar)

  • Darkening of skin, malaise, fever, weight lost, splenomegaly with advanced disease causing hepatic dysfunction, jaundice, ascites, thrombocytopenia, and hemorrhagic complications
    • Anemia, neutropenia, thrombocytopenia, hypoalbuminemia, hyperbilirubinemia

Differential Diagnosis

  • Cutaneous/Mucocutaneous-bacterial skin infection
  • Malignancy
  • Sarcoidosis
  • Spider bite
  • Tropical ulcer
  • Yaws
  • Cutaneous anthrax
  • Nocardia and actinomycosis
  • Cutaneous tuberculosis

Evaluation

  • CBC
  • Chem
  • Histology
  • Culture
  • Bone marrow or spleen biopsy (for visceral form)
  • PCR

Management

  • Uncomplicated cutaneous leishmaniasis
    • Topical Paromomycin
    • Local injection of Stibogluconate or Meglumine antimoniate
  • Complicated cutaneous leishmaniasis
  • Visceral leishmaniasis

Disposition

See Also

References