Leishmaniasis
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
Source
- Uptodate
- Tintinalli