Leishmaniasis

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 

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