Leishmaniasis

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

Workup

• CBC
• Chem
• Histology
• Culture
• Bone marrow or spleen biopsy for VL
• PCR
• Contact CDC Parasitic Disease Public Inquiries (404)-718-4745 for transport medium and instructions

Management

• Uncomplicated CL
  • topical Paromomycin, local injection of Stibogluconate or Meglumine antimoniate
• Complicated CL
  • PO Fluconazole or Miltefosine. IV Stibogluconate, Meglumine, Amphotericin B, or Pentamidine
• Visceral
  • Amphotericin B, Stibogluconate

See Also

• Travel Skin Conditions

Source

• Uptodate
• Tintinalli