Continuing medical educationTropical dermatology: Tropical diseases caused by protozoa
Section snippets
Leishmaniasis
Key points Many species of Leishmania are found worldwide and are transmitted by sandflies, producing cutaneous, mucocutaneous, or visceral disease. Coinfection with HIV may result in an atypical presentation of leishmaniasis, a lower response rate to treatment, a higher relapse rate, and a higher mortality rate. Clinically, CL can present as ulcers, nodules, papules, or as papulotuberous, verrucous, and lymphatic lesions. Diagnosis may be from detection of amastigotes in a tissue smear from a lesion or from
Cutaneous diseases caused by amebas
Key points Balamuthia mandrillaris is geographically restricted but causes potentially fatal disease; Entamoeba histolytica is found worldwide but primarily causes gastrointestinal disease with rare mucocutaneous manifestations. Clinically, cutaneous amebiasis usually presents as anogenital ulcers; Balamuthia usually presents as a granulomatous plaque of the central face. Diagnosis can be confirmed with biopsy with identification of trophozoites, or by serology, culture, or molecular techniques. Touch
Trypanosomiasis
Key points Three subspecies of Trypanosoma brucei are transmitted by the tsetse fly and cause sleeping sickness with occasional cutaneous manifestations in Africa; T cruzi is transmitted by reduviid bugs in the tropical Americas and causes Chagas disease. Clinically, African trypanosomiasis presents as a chancre followed by an eschar at the site of the bite. Lymphadenopathy progresses during the disease, and trypanids occur within 6 to 8 weeks. Cutaneous manifestations of Chagas disease include chagomas,
Toxoplasmosis
Key points Toxoplasma gondii is common worldwide; it usually causes systemic disease with rare cutaneous manifestations only in pregnant women and immunocompromised patients. Cutaneous manifestations of toxoplasmosis include hemorrhagic or necrotic papules. Diagnosis is made via biopsy and serology. Treatment includes sulfadiazine with pyrimethamine.
Toxoplasmosis is a worldwide infection caused by the protozoan parasite T gondii that belongs to the phylum Apicomplexa, subclass Coccidia. T gondii is an
Pneumocystosis
Key points Pneumocystis carinii (jirovecii) was once considered a protozoan but is now classified as a fungus; it primarily causes pneumonia and very rare cutaneous manifestations in immunocompromised patients. Cutaneous manifestations include erythematous or skin-colored papules or nodules usually in the ear or external auditory canal. Diagnosis of cutaneous pneumocystosis is obtained by biopsy. Therapy is usually with trimethoprin-sulfamethoxazole but can include pentamidine and atovaquone.
Pneumocystosis
Conclusion
Protozoan infections constitute public health and economic problems in many parts of the world, especially in tropical countries. In light of the significant morbidity and mortality of these infections, the WHO has acknowledged the importance of such diseases and has urged tropical countries to recognize the impact of such infections and improve the protozoan awareness, prevention, and treatment of them. Dermatologists should be familiar with protozoan infections because a recognition of the
References (199)
Leishmaniasis: current situation and new perspectives
Comp Immunol Microbiol Infect Dis
(2004)Leishmaniasis
Lancet
(1999)- et al.
Efficacy of a weekly cryotherapy regimen to treat Leishmania major cutaneous leishmaniasis
J Am Acad Dermatol
(2008) - et al.
Cutaneous leishmaniasis in soldiers from Fort Campbell, Kentucky returning from Operation Iraqi Freedom highlights diagnostic and therapeutic options
J Am Acad Dermatol
(2005) - et al.
Cutaneous leishmaniasis in Texas: a northern spread of endemic areas
J Am Acad Dermatol
(2008) - et al.
The current status of zoonotic leishmaniases and approaches to disease control
Int J Parasitol
(2005) - et al.
Leishmaniasis
- et al.
Infection-induced respiratory burst in BALB/c macrophages kills Leishmania guyanensis amastigotes through apoptosis: possible involvement in resistence to cutaneous leishmaniasis
Microbes Infect
(2006) Cutaneous leishmaniasis: clinical aspects
Clin Dermatol
(1996)- et al.
Detection and species identification of Old World Leishmania in clinical samples using a PCR-based method
Trans R Soc Trop Med Hyg
(2008)
Treatment options for visceral leishmaniasis: a systematic review of clinical studies done in India, 1980-2004
Lancet Infect Dis
A double-blind clinical trial of the treatment of cutaneous leishmaniasis with paromomycin ointment
Trans R Soc Trop Med Hyg
Heat therapy for cutaneous leishmaniasis elicits a systemic cytokine response similar to that of antimonial (Glucantime) therapy
Trans R Soc Trop Med Hyg
Randomized vaccine trial of single dose of killed Leishmania major plus BCG against anthroponotic cutaneous leishmaniasis in Bam, Iran
Lancet
Balamuthia amoebic encephalitis: an emerging disease with fatal consequences
Microb Pathog
Amoeba angeitic lesions of the central nervous system in Balamuthia mandrillaris amoebiasis
Hum Pathol
Leptomyxid amoeba encephalitis: report of the first case in Argentina
Trans R Soc Trop Med Hyg
Pediatric granulomatous cerebral amebiasis: a delayed diagnosis
Pediatr Neurol
Granulomatous encephalitis due to a leptomyxid amoeba
Trans R Soc Trop Med Hyg
Granulomatous amoebic encephalitis due to leptomyxid amoebae: report of the first Brazilian case
Trans R Soc Trop Med Hyg
Fatal granulomatous amebic encephalitis caused by Balamuthia mandrillaris presenting as a skin lesion
J Am Acad Dermatol
Free-living amebae opportunistic and non-opportunistic pathogens of humans and animals
Int J Parasitol
Leishmaniasis among soldiers of stabilization forces in Iraq. Review article
Int Marit Health
Infectious diseases during wartime
Curr Opin Infect Dis
Protozoa and worms
Leishmaniasis and malaria: new tools for epidemiologic analysis
Science
Turnover of neutrophils mediated by Fas ligand drives Leishmania major infection
J Infect Dis
The contribution of the Fas/FasL apoptotic pathway in ulcer formation during Leishmania major–induced cutaneous leishmaniasis
Am J Pathol
Decreased in situ expression of interleukin-10 receptor is correlated with the exacerbated inflammatory and cytotoxic responses observed in mucosal leishmaniasis
Infect Immun
Further observations on clinical, histopathological, and immunological features of borderline disseminated cutaneous leishmaniasis caused by Leishmania (leishmania) amazonensis
Mem Inst Oswaldo Cruz
Leishmaniose tegumentar Americana
The relationship between leishmaniasis and AIDS: the second 10 years
Clin Microbiol Rev
Visceral leishmaniasis in human immunodeficiency virus (HIV)-infected and non-HIV-infected patients. A comparative study
Medicine (Baltimore)
Leishmaniasis as an opportunistic infection in HIV-infected patients: determinants of relapse and mortality in a collaborative study of 228 episodes in a Mediterreanean region
Eur J Clin Microbiol Infect Dis
American cutaneous leishmaniasis: use of a skin test as a predictor of relapse after treatment
Bill WHO
Clinical value of anti-live Leishmania (Viannia) braziliensis immunoglobulin G subclasses detected by flow cytometry for diagnosing active localized cutaneous leishmaniasis
Trop Med Int Health
Immunochemotherapy for cutaneous leishmaniasis: a controlled trial using killed Leishmania (Leishmania) amazonensis vaccine plus antimonial
Int J Dermatol
Human leishmaniasis: clinical, diagnostic, and chemotherapeutic developments in the last 10 years
Clin Infect Dis
Cryosurgery in Old World cutaneous leishmaniasis
Br J Dermatol
Evaluation of sodium stibogluconate in the treatment of cutaneous leishmaniasis in Syria
Curr Med Res Opin
Cutaneous leishmaniasis: an overview
J Postgrad Med
The efficacy of treatment with intralesional meglumine antimoniate alone, compared with that of cryotherapy combined with meglumine antimoniate or intralesional sodium stibogluconate, in the treatment of cutaneous leishmaniasis
Ann Trop Med Parasitol
Efficacy of cryotherapy and intralesional pentostam in treatment of cutaneous leishmaniasis
J Egypt Soc Parasitol
A randomized, double-blind study of the efficacy of a 10- or 20-day course of sodium stibogluconate for treatment of cutaneous leishmaniasis in United States military personnel
Clin Infect Dis
Treatment of cutaneous leishmaniasis with antimony: intramuscular versus intralesional administration
Ann Trop Med Parasitol
Recommendations for treating leishmaniasis with sodium stibogluconate (Pentosam) and review of pertinent clinical studies
Am J Trop Med Hyg
A randomized, placebo-controlled trial of a two-week regimen of aminosidine (paromomycin) ointment for treatment of cutaneous leishmaniasis in Iran
Am J Trop Med Hyg
Treatment of cutaneous leishmaniasis with either topical paromomycin or intralesional meglumine antimoniate
Clin Exp Dermatol
Treatment of cutaneous leishmaniasis with aminosidine (paromomycin) ointment: double-blind, randomized trial in the Islamic Republic of Iran
Bull World Health Organ
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Funding sources: None.
Conflicts of interest: The authors, editors, and peer reviewers have no relevant financial relationships.