LEISHMANIASIS

By Gary M. White, MD

Leishmaniasis

Leishmaniasis is a term that covers a variety of patterns of infection by different species of Leishmania. Leishmaniasis in man is broadly divided into cutaneous and visceral. Leishmaniasis may be divided into Old World disease (the Mediterranean and the Northern part of Africa) and New World Disease (Central and South America). In Central and South America, L. brasiliensis is the main organism and lesions of the mucosa are common (mucocutaneous Leishmaniasis). Bites from the sand fly (Phlebotomus in the Old World) are how humans are infected. See also espundia and post kala azar dermal leishmaniasis.

Clinical-Old World

After a bite from the sand fly typically on an exposed part of the body, a nodule forms. The incubation period is usually 1-2 months. Crusting, ulceration and finally healing with scar formation is typical. Multiple lesions are caused by either multiple bites or sporotrichoid spread along lymphatics.

Clinical-New World

Inflammatory nodules which crust, ulcerate and heal with scars occur, but in addition, mucocutaneous leisons are common. Tremendous destruction of the nose, septum, upper lip and palate may occur. Any leg ulcer (Virtual Grand Rounds) in a person who lives or recently traveled to an endemic area should be evaluated for Leishmaniasis.

Treatment

The WHO guidelines for treatment should be consulted. L. major is generally thought to have a benign course with most lesions self-resolving within 2–4 months. Treatment may spead healing, decrease scarring and/or prevent dissemination or relapse.

Multiple doses of pentavalent antimonials may be needed, e.g. sodium stibogluconate (Pentostam) and meglumine antimoniate (Glucantim).

The FDA approved Impavido®, an oral alkylphosphocholine antiparasitic agent, in March 2014 for the treatment of three main types of leishmaniasis: visceral leishmaniasis (affects internal organs), cutaneous leishmaniasis (affects the skin) and mucosal leishmaniasis (affects the nose and throat). It is approved for patients ≥12 years of age.

Topical paromomycin cream proved effective in a pilot study of Leishmania major [NEJM 2013;368;524].

Chronic edema of the legs post Leishmaniasis of the legs has been reported. It may be that the infection damages the lymphatics [J Pak Assoc Derma 2009;19:208-12.].

Daylight PDT

Daylight activated PDT proved to be effective in the treatment of CL caused by L. major and L. tropica [BJD 2015;172;1364]. The overall cure rate was 89%.

Additional Pictures

Leishmaniasis

Leishmaniasis

Several ulcers developed on the arms of this man 3 months after a trip to Central America.
Leishmaniasis

References

Indian J Dermatol Venereol Leprol 2014;80:247-9

Dermatology Online Journal 15;3 for a non-healing perianal ulcer caused by Leishmaniasis.

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