Continuing medical educationCutaneous and mucocutaneous leishmaniasis: Differential diagnosis, diagnosis, histopathology, and management
Section snippets
Differential diagnosis
Key points Leishmaniasis may mimic other infectious diseases and a variety of malignancies A second or third infection may coexist with cutaneous leishmaniasis
Leishmaniasis has many clinical manifestations and may appear similar to a wide variety of other conditions1, 2, 3 (Table I; Fig 1). Differentiation between conditions that mimic cutaneous leishmaniasis may require microbiologic, cytologic, and/or histologic evaluation.4 These include disorders that are infectious, malignant, or other disorders such
Diagnosis
Key points World travel has brought leishmaniasis to nonendemic regions The US Centers for Disease Control and Prevention accepts submissions for leishmaniasis testing worldwide Diagnosis may also be made via polymerase chain reaction studies, serologic assays, isoenzyme analysis, monoclonal antibody analysis RMPI media, and NNN media
An increase in international travel has brought leishmaniasis to nonendemic regions, where it often creates diagnostic dilemmas. A detailed history, including that of travel in
Histopathology
Key points Cutaneous leishmaniasis may feature amastigotes, a polycellular infiltrate, and/or granuloma formation Mucocutaneous leishmaniasis has 4 stages on histopathology: edematous, granulomatous, proliferative, and granulomatous necrotizing Chronic ulcers have fewer amastigotes compared to newer ones Diagnostic sensitivity is only about 60% in cases of Old World cutaneous leishmaniasis Amastigotes, known as Leishman–Donovan bodies, may sometimes be evident within macrophages
Histologic examination is an
Immunoprophylaxis
Key points Leishmania evades the immune system by inhibiting phagolysosome biogenesis Intentional infection on unexposed skin may prevent disfiguring facial lesions Live organism vaccination is still practiced in rural areas and has been a formal program in a few countries Killed parasite vaccines are not effective in leishmaniasis prevention
Leishmania is known to have many virulence factors enhancing infection and its spread. Metalloprotease GP63 is a highly active protease produced by Leishmania that
Treatment
Key points Systemic treatment is indicated if the lesions are large, multiple, affect the joints, hands, or feet, or the patient is immunosuppressed Intralesional antimonial drugs are less toxic than systemic therapy Liposomal amphotericin B is used in the developed world because it reduces hospitalization stays Sensitivity to treatment varies by nation and region
The numerous local and systemic treatments available for leishmaniasis are indicative of the difficulty in finding a successful remedy (Table VI).
References (154)
American mucocutaneous leishmaniasis
Dermatol Clin
(1994)- et al.
Aspects of the association between leishmaniasis and malignant disorders
Trans R Soc Trop Med Hyg
(2007) Laboratory tests for the diagnosis and evaluation of leishmaniasis
Dermatol Clin
(1994)- et al.
A clinico-pathological study of cutaneous leishmaniasis in British troops from Belize
Trans R Soc Trop Med Hyg
(1994) - et al.
Leishmanin test in post–kala-azar dermal leishmaniasis
Trans R Soc Trop Med Hyg
(1990) - et al.
Cutaneous leishmaniasis due to Leishmania (Leishmania) amazonensis in Amazonian Brazil, and the significance of a negative Montenegro skin-test in human infections
Trans R Soc Trop Med Hyg
(1991) - et al.
Quantitative real time PCR assays for the detection of Leishmania (Viannia) braziliensis in animals and humans
Mol Cell Probes
(2013) - et al.
Leishmania virulence factors: focus on the metalloprotease GP63
Microbes Infect
(2012) - et al.
Leishmania evades host immunity by inhibiting antigen cross-presentation through direct cleavage of the SNARE VAMP8
Cell Host Microbe
(2013) - et al.
Leishmania proteins derived from recombinant DNA: current status and next steps
Trends Parasitol
(2006)
Protective immunity against cutaneous leishmaniasis achieved by partly purified vaccine in a volunteer
Lancet
Immunoprophylaxis in cutaneous leishmaniasis
Lancet
Topical treatment of American cutaneous leishmaniasis with paramomycin and methylbenzethonium chloride: a clinical study under field conditions in Ecuador
Trans R Soc Trop Med Hyg
Treatment of cutaneous leishmaniasis with an intralesional antimonial drug (Pentostam)
J Am Acad Dermatol
Oral miltefosine to treat new world cutaneous leishmaniasis
Lancet Infect Dis
Comparison of miltefosine and meglumine antimoniate for the treatment of zoonotic cutaneous leishmaniasis (ZCL) by a randomized clinical trial in Iran
Acta Trop
Efficacy of ketoconazole against Leishmania braziliensis panamensis cutaneous leishmaniasis
Am J Med
Itraconazole and leishmaniasis: a randomised double-blind trial in cutaneous disease
Int J Parasitol
Treatment of cutaneous leishmaniasis with allopurinol
J Am Acad Dermatol
Liposomal amphotericin B in comparison to sodium stibogluconate for Leishmania braziliensis cutaneous leishmaniasis in travelers
J Am Acad Dermatol
Efficacy of a weekly cryotherapy regimen to treat Leishmania major cutaneous leishmaniasis
J Am Acad Dermatol
Cutaneous furuncular myiasis: Human infestation by the botfly
Can J Plast Surg
Cutaneous myiasis: a review of the common types of myiasis
Int J Dermatol
Tungiasis
Leishmaniasis cutánea del pene en un paciente de Venezuela
Medicina Cutánea Ibero-Latino-Americana
American cutaneous leishmaniasis in U.S. travelers
Ann Intern Med
Report of a WHO Expert Committee
World Health Organ Tech Rep Ser
Lupoid cutaneous leishmaniasis: a report of 16 cases
Indian J Dermatol Venereol Leprol
Prevalence of and factors associated with visceral leishmaniasis in human immunodeficiency virus type 1-infected patients in southern Spain
J Clin Microbiol
Incidence of and risk factors for symptomatic visceral leishmaniasis among human immunodeficiency virus type 1-infected patients from Spain in the era of highly active antiretroviral therapy
J Clin Microbiol
Disseminated anergic American leishmaniasis; report of three cases of a type clinically resembling lepromatous leprosy
AMA Arch Derm
Diffuse cutaneous leishmaniasis in an HIV-positive patient in western Africa
Australas J Dermatol
Leishmaniasis: new approaches to disease control
BMJ (Clin Res Ed)
Dermoscopy of cutaneous leishmaniasis
Br J Dermatol
Cutaneous leishmaniasis: new dermoscopic findings
Int J Dermatol
The case of cutaneous leishmaniasis - diagnostic difficulties
Przegl Dermatol
A comparative study of the diagnosis of Old World cutaneous leishmaniasis in Iraq by polymerase chain reaction and microbiologic and histopathologic methods
Int J Dermatol
Diagnosis of cutaneous leishmaniasis
Curr Opin Infect Dis
Histopathological spectrum in cutaneous leishmaniasis: a study in Oman
Indian J Dermatol Venereol Leprol
Histopathology of cutaneous leishmaniasis
Gulf J Dermatol Venereol
Histopathological and immunohistochemical aspects of American cutaneous leishmaniasis before and after different treatments
An Bras Dermatol
Histopathological features in leprosy, post–kala-azar dermal leishmaniasis, and cutaneous leishmaniasis
Indian J Dermatol Venereol Leprol
Protozoan and helminth infections
Parasitism of epidermal Langerhans cells in experimental cutaneous leishmaniasis with Leishmania major
J Infect Dis
Clinical and histopathological features of zoonotic cutaneous leishmaniasis in Saudi Arabia
J Eur Acad Dermatol Venereol
Polar and subpolar diffuse cutaneous leishmaniasis in Brazil: clinical and immunopathologic aspects
Int J Dermatol
Cutaneous leishmaniasis in Guatemala: comparison of diagnostic methods
Am J Trop Med Hyg
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Funding sources: None.
Conflicts of interest: None declared.
Date of release: December 2015
Expiration date: December 2018