Leishmaniasis

Figure 4.36 Cutaneous leishmaniasis (Courtesy of Dr. Shyam B. Verma, Vadodara, India)
Figure 4.36
Cutaneous leishmaniasis
(Courtesy of Dr. Shyam B.
Verma, Vadodara, India
)
Figure 4.37 Cutaneous leishmaniasis (Courtesy of Dr. Shyam B. Verma, Vadodara, India)
Figure 4.37
Cutaneous leishmaniasis
(Courtesy of Dr. Shyam B.
Verma, Vadodara, India
)
(Figures 4.36 and 4.37)
  • Leishmania spp., intracellular parasite with >17 species
  • Transmitted by sandfly (Lutzomyia and Phlebotomus) and endemic in South America, Africa, Asia, and Mediterranean countries
  • Infection with Leishmania species classified as either Old World (Africa, Asia, Middle East, Mediterranean) or New World (Central/South America, Texas)
  • Three clinical forms:
    • Cutaneous: small red papule or papules → ulcerate with raised edges → spontaneously heals with scarring; lesions may be wet or dry; L. major, L. mexicana, L. braziliensis
    • Mucocutaneous: cutaneous ulcer at inoculation site which heals → mutilating mucosal infection with perforation of nasal septum; L. braziliensis, L. aethiopica
    • Visceral : recurrent fever, hepatosplenomegaly, hyperpigmented patches (“black fever”), diarrhea, death within 2 years if untreated
  • Diagnosis: culture unreliable; standard culture medium is Novy-McNeal-Nicolle; PCR sensitive diagnostic test
  • Treatment:
    • Cutaneous or mucocutaneous: pentavalent antimonial such as sodium stibogluconate or meglumine antimonite
    • Visceral leishmaniasis: amphotericin B
   
 
Of note, pentavalent antimony causes QT prolongation, flattened T wave, and/or arrhythmia
 
   

   
 
 
Cutaneous
leishmaniasis
Old World
(vector Phlebotomus):


L. major
L. donovani
L. infantum
L. tropica
L. aethiopica
L. chagasi
New World
(vector Lutzomyia):



L. mexicana,
L. amazonensis,
L. braziliensis,
L. peruviana
 
Mucocutanous
leishmaniasis
Old World
(vector
Phlebotomus):


L. aethiopica
New World
(vector Lutzomyia)



L. braziliensis,
L peruviana
 
Visceral
(Kala-azar)
L. donovani,
L. infantum,
L. chagasi