Protozoa and Worms | Figure 4.36
Cutaneous leishmaniasis
(Courtesy of Dr. Shyam B.
Verma, Vadodara, India) |
| Figure 4.37
Cutaneous leishmaniasis
(Courtesy of Dr. Shyam B.
Verma, Vadodara, India) |
(Figures 4.36 and 4.37) - Leishmania spp., intracellular parasite with >17 species
- Transmitted by sandfly (Lutzomyia and Phlebotomus) and endemic in South America, Africa, Asia, and Mediterranean countries
- Infection with Leishmania species classified as either Old World (Africa, Asia, Middle East, Mediterranean) or New World (Central/South America, Texas)
- Three clinical forms:
- Cutaneous: small red papule or papules → ulcerate with raised edges → spontaneously heals with scarring; lesions may be wet or dry; L. major, L. mexicana, L. braziliensis
- Mucocutaneous: cutaneous ulcer at inoculation site which heals → mutilating mucosal infection with perforation of nasal septum; L. braziliensis, L. aethiopica
- Visceral : recurrent fever, hepatosplenomegaly, hyperpigmented patches (“black fever”), diarrhea, death within 2 years if untreated
- Diagnosis: culture unreliable; standard culture medium is Novy-McNeal-Nicolle; PCR sensitive diagnostic test
- Treatment:
- Cutaneous or mucocutaneous: pentavalent antimonial such as sodium stibogluconate or meglumine antimonite
- Visceral leishmaniasis: amphotericin B
| | | | | | Of note, pentavalent antimony causes QT prolongation, flattened T wave, and/or arrhythmia | | | | | |
|
| | | | | | | | Cutaneous
leishmaniasis | | Old World
(vector Phlebotomus):
L. major
L. donovani
L. infantum
L. tropica
L. aethiopica
L. chagasi | | New World
(vector Lutzomyia):
L. mexicana,
L. amazonensis,
L. braziliensis,
L. peruviana | | | Mucocutanous
leishmaniasis | | Old World
(vector
Phlebotomus):
L. aethiopica | | New World
(vector Lutzomyia)
L. braziliensis,
L peruviana | | | Visceral
(Kala-azar) | | L. donovani,
L. infantum, | | L. chagasi |
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