Introduction
Leishmaniasis is a complex of diseases caused by the protozoa Leishmania
-it is transmitted by the bite of infected phlebotomine sandflies
Leishmania species are
-in the sandfly: extracellular, flagellated promastigotes
-in the humans: obligate intracellular, nonflagellated amastigotes
Symptoms & Signs
Three major human diseases: Cutaneous leishmaniasis, mucocutaneous leishmaniasis, and visceral leishmaniasis
Cutaneous leishmaniasis
-Lesions start as small papules and develop into nonulcerated dry plaques or large encrusted ulcers with raised and indurated margins
-Ulcerated nodules look similar to volcanoes seen from above (volcano sign)
-they are mostly seen over face and ears
Mucocutaneous leishmaniasis (espundia)
-it is characterized by the chronic and progressive spread of lesions to the nasal, pharyngeal,laryngeal and buccal mucosa
-ulceration of the nasal mucosa and septum, septal perforation, collapse of the nasal bridge and free hanging nose (tapir nose or parrot beak)
-partial/total naso oropharyngeal mutilating ulceration (espundia)
Visceral leishmaniasis (kala azar)
it most commonly presents with an abrupt onset of moderate- to high-grade persistent, undulating fever associated with rigor and chills
-Splenomegaly, hepatomegaly, lymphadenopathy
-Anemia, leukopenia, thrombocytopenia, hypergammaglobulinemia
-Hyperpigmentation of the skin, jaundice, ascites
Diagnosis
Due to low sensitivity of individual tests, the best approach is to use several diagnostic methods: impression smear, histology, and culture
Characteristic histological features: tuberculoid granulomatous dermatitis with multinucleated giant cells surrounded by lymphoplasmacytic infiltrate
Treatment
Local therapy: Excision, laser ablation, cryotherapy, electrotherapy, Paromomycin ointment
Medications: Sodium stibogluconate, Megluminee, Miltefosine, Pentoxifylline,
Pentamidine, Amphotericin B, Paromomycin, Zinc sulfate