Leishmaniasis: Difference between revisions
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*500,000 new cases and 60,000 deaths each year | *500,000 new cases and 60,000 deaths each year | ||
==Clinical Features== | ==Clinical Features== | ||
* | ===Cutaneous=== | ||
* | *single to diffuse nodules/plagues with central clearing/eschar/fibrinous exudate | ||
===Mucocutaneous=== | |||
*mucosal destruction, deformity nasal blockage, bleeding, increased secretions, sloughing of dead tissue, dysphonia, odynophagia, respiratory distress | |||
===Visceral (Kala-azar)=== | |||
*darkening of skin, malaise, fever, weight lost, splenomegaly with advanced disease causing hepatic dysfunction, jaundice, ascites, thrombocytopenia, and hemorrhagic complications | |||
**Anemia, neutropenia, thrombocytopenia, hypoalbuminemia, hyperbilirubinemia | **Anemia, neutropenia, thrombocytopenia, hypoalbuminemia, hyperbilirubinemia | ||
Revision as of 22:33, 9 June 2014
Background
- Vector: sandfly
- Occurs sporadically in rural Africa, Asia, Mediterranean, Central/South America
- Wide variety of symptoms given numerous species of protozoa
- 500,000 new cases and 60,000 deaths each year
Clinical Features
Cutaneous
- single to diffuse nodules/plagues with central clearing/eschar/fibrinous exudate
Mucocutaneous
- mucosal destruction, deformity nasal blockage, bleeding, increased secretions, sloughing of dead tissue, dysphonia, odynophagia, respiratory distress
Visceral (Kala-azar)
- darkening of skin, malaise, fever, weight lost, splenomegaly with advanced disease causing hepatic dysfunction, jaundice, ascites, thrombocytopenia, and hemorrhagic complications
- Anemia, neutropenia, thrombocytopenia, hypoalbuminemia, hyperbilirubinemia
Differential Diagnosis
- Cutaneous/Mucocutaneous-bacterial skin infection
- malignancy
- sarcoidosis
- spider bite
- tropical ulcer
- yaws
- cutaneous anthrax
- nocardia and actinomycosis
- cutaneous tuberculosis
Workup
- CBC
- Chem
- Histology
- Culture
- Bone marrow or spleen biopsy for VL
- PCR
- Contact CDC Parasitic Disease Public Inquiries (404)-718-4745 for transport medium and instructions
Management
- Uncomplicated CL-topical Paromomycin, local injection of Stibogluconate or Meglumine antimoniate
- Complicated CL- PO Fluconazole or Miltefosine. IV Stibogluconate, Meglumine, Amphotericin B, or Pentamidine
- Visceral- Amphotericin B, Stibogluconate
See Also
Source
- Uptodate
- Tintinalli