Grading & Level of Importance: B
Old World cutaneous leishmaniasis: oriental sore, Aleppo/Baghdad boil, Delhi boil.
New World cutaneous leishmaniasis: chiclero ulcer; uta; jungle yaws.
Mucocutaneous leishmaniasis: espundia.
Approximately 1 million new cases of cutaneous leishmaniasis worldwide per year. Geographical distribution: cutaneous leishmaniasis (CL): Middle East and South America; mucocutaneous leishmaniasis (MCL): Central and South America.
Infection with Leishmania; a protozoan. Three typical clinical forms (see Classification).
Aetiology & Pathogenesis
Transmission by the female phlebotomus sandflies only. Depending on species and different animal reservoirs (for example wild rabbits and dogs for L. infantum), different clinical patterns occur (see Classification).
- the Old World: L. major, L. tropica, L. aethiopica, L. infantum
- the New World: L. mexicana and L. brasiliensis
- MCL species: L. braziliensis
Signs & Symptoms
CL: an erythematous papule at the site of the sting progresses within weeks to months to an ulcerated hyperkeratotic plaque. Occasional satellite papules are present. Usually the lesion heals spontaneously over a period of months with scarring. MCL: mutilating mucosal lesions (the nose or mouth mainly in New World infections).
Usually on exposed sites (face, forearms, legs).
Different forms of cutaneous leishmaniasis include:
Self-healing localized cutaneous leishmaniasis.
anergic diffuse cutaneous leishmaniasis.
Post Kala-azar Dermal Leishmaniasis (PKDL): cutaneous manifestation observed in some visceral leishmaniasis patients after successful treatment (see 11.3.2).
Laboratory & other workups
Giemsa-stained smears (tissue impression smears, dermal scrapping or needle aspiration) or biopsy specimens: the presence of amastigote parasites; culture (Novy-MacNeal-Nicolle (NNN)medium); serology (ELISA and immunofluorescence studies), PCR assay.
Early lesions: amastigote parasites in dermal macrophages. The chronic form: granulomatous inflammation (tuberculoid-like granulomas).
CL may resolve spontaneously; MCL: progressive course; potentially lethal due to secondary infections and aspiration pneumonia; visceral leishmaniasis: serious and progressive disease; if untreated, lethal in 75-95% of patients.
Diffuse cutaneous leishmaniasis, persistence of the infection, relapses, involvement of mucous membranes (L. braziliensis ) and systemic spread (L. donovani, L. infantum), particularly in immunosuppressed patients.
Travel history and clinical features. Identification of a parasite in a smear preparation or skin biopsy, PCR assay or with culture.
Tropical ulcers: infiltrates due to other causes; ecthyma in travellers.
Prevention & Therapy
Prevention: vector control, use of insect repellents, protective clothing, fine-mesh screens.
Therapy includes cryosurgery, local heat therapy, excision, topical paromomycin, intralesional or systemic antimony compounds, oral miltefosine and oral itraconazole. Cutaneous leishmaniasis of Old World subtypes is often self-limited.
Further Images / DOIA
- H.J.C. de Vries, S.H. Reedijk, H.D.F.H. Schallig: Cutaneous Leishmaniasis: Recent Developments in Diagnosis and Management (2015)
- N.E. Aronson, C.A. Joya: Cutaneous Leishmaniasis: Updates in Diagnosis and Management (2018)
- S. Burza, S.L. Croft, M. Boelaert: Leishmaniasis (2018)
- R. Reithinger, J.C. Dujardin, H. Louzir, et al.: Cutaneous leishmaniasis (2007)
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