cutaneous leishmaniasis (oriental sore)
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Etiology
- Old World cutaneous leishmaniasis:
- New World cutaneous leishmaniasis:
Epidemiology
- transmitted to humans by at least 30 species or subspecies of sandfly
- Old World cutaneous leishmaniasis:
- occurs in southern Europe, northern & eastern Africa, the Middle East, Iran, Afghanistan, India, southern Russia
- New World cutaneous leishmaniasis:
- tropical & subtropical New World
- southern Texas in USA
- dogs are reservoirs of L. peruviana
- wild animals are reservoirs for most species of Leishmania
Pathology
- infection produces long-lasting immunity
- lymphatic spread & local lymphadenopathy are common
- scarring
Microscopic pathology
- dense infiltrate of lymphocytes & histiocytes containing intracellular organisms consistent with leishmania amastigotes
* image[5]
Clinical manifestations
- General
- begins as an erythematous papule at the site of sandfly bite
- enlarges to nodules or plaques & ulcerates over 2 weeks to 6 months
- a dusky, violaceous hue may develop, & central crusting can overlie an ulcer
- typical presentation is a single lesion, but smaller surrounding papules &/or numerous, widespread lesions may be present
- local lymphadenopathy is common
- lesion usually resolves spontaneously in a few months, resulting in a lifelong scar
- Old World cutaneous leishmaniasis:
- ulcers develop on an exposed area of the skin & heal spontaneously
- L. tropica produces urban or dry ulcer that persists longer than the rural or wet ulcer due to L. major
- L. aethiopica causes a more severe cutaneous infection which may produce mucosal lesions or diffuse cutaneous
- New World cutaneous leishmaniasis:
- leishmaniasis resembling leprosy
- lesions involving L. mexicana involve the earlobe (chiclero ulcer), are self-limiting & do not involve mucosa
- L. mexicana & L. amazonensis may produce diffuse cutaneous lesions similar to those produced by L. aethiopica
* image[5]
Laboratory
- biopsy border of most active lesion
- make imprints
- smear prepared from tissue cut from surface at border or lesion
- Giemsa staining
- Leishmania DNA, Leishmania rRNA
Management
- meglumine antimoniate may be treatment of choice[4]
- unclear whether FDA-approved for use in U.S.
- sodium stibogluconate
- available from CDC (404 639-3670)
- 20 mg Sb[V]/kg IM/IV for 20-28 days
- intralesional injections is alternative[3]
- pentamidine 3 mg/kg IM QOD for 4 doses
- ketoconazole 600 mg PO QD for 28 days
- itraconazole 200 mg PO BID for 28 days
- miltefosine (Impavido) 50 mg TID for 28 days[5]
More general terms
Additional terms
References
- ↑ Clinical Diagnosis & Management by Laboratory Methods, 19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia, PA. 1996, pg 1266-68
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1192
- ↑ 3.0 3.1 Reithinger R et al. Cutaneous leishmaniasis. Lancet Infect Dis 2007 Sep; 7:581. (review) PMID: https://www.ncbi.nlm.nih.gov/pubmed/17714672
- ↑ 4.0 4.1 Chaabane H, Turki H Cutaneous Leishmaniasis with a Paronychia-like Lesion. N Engl J Med 2014; 371:1736. October 30, 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25354107 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMicm1314869
- ↑ 5.0 5.1 5.2 5.3 Knapp AP, Alpern JD Images in Clinical Medicine. Cutaneous Leishmaniasis. N Engl J Med 2020; 382:e2. Jan 9 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31914245 https://www.nejm.org/doi/full/10.1056/NEJMicm1908092