Dermatologic Manifestations of Leishmaniasis Differential Diagnoses

  • Author: Peter J Weina, MD, PhD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 24, 2012
 
 

Differential Diagnoses

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Contributor Information and Disclosures
Author

Peter J Weina, MD, PhD  Colonel, US Army; Director, Leishmania Diagnostics Laboratory, Walter Reed Army Institute of Research

Peter J Weina, MD, PhD is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, Association of Military Surgeons of the US, and International Society of Travel Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Abdul-Ghani Kibbi, MD  Professor and Chair, Department of Dermatology, American University of Beirut Medical Center, Lebanon

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Glen H Crawford, MD  Assistant Clinical Professor, Department of Dermatology, University of Pennsylvania School of Medicine; Chief, Division of Dermatology, The Pennsylvania Hospital

Glen H Crawford, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, Phi Beta Kappa, and Society of USAF Flight Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Additional Contributors

The author and editors of eMedicine gratefully acknowledge the contributions of previous author, Julie R. Kenner, MD, PhD, to the development and writing of this article.

References

  1. Coleman RE, Burkett DA, Putnam JL, et al. Impact of phlebotomine sand flies on U.S. Military operations at Tallil Air Base, Iraq: 1. background, military situation, and development of a "Leishmaniasis Control Program". J Med Entomol. Jul 2006;43(4):647-62. [Medline].

  2. Myles O, Wortmann GW, Cummings JF, et al. Visceral leishmaniasis: clinical observations in 4 US army soldiers deployed to Afghanistan or Iraq, 2002-2004. Arch Intern Med. Sep 24 2007;167(17):1899-901. [Medline].

  3. Oliveira DM, Saraiva EM, Ishikawa EA, Sousa AA, Silva EO, Silva IM. Distribution of phlebotomine fauna (Diptera: Psychodidae) across an urban-rural gradient in an area of endemic visceral leishmaniasis in northern Brazil. Mem Inst Oswaldo Cruz. Dec 2011;106(8):1039-44. [Medline].

  4. Martin-Ezquerra G, Fisa R, Riera C, et al. Role of Leishmania spp. infestation in nondiagnostic cutaneous granulomatous lesions: report of a series of patients from a Western Mediterranean area. Br J Dermatol. Aug 2009;161(2):320-5. [Medline].

  5. Valderrama A, Tavares MG, Andrade Filho JD. Report of Lutzomyia longipalpis (Lutz & Neiva, 1912) (Diptera: Psychodidae: Phlebotominae) in a cutaneous-leishmaniasis-endemic area of Panama. Mem Inst Oswaldo Cruz. Dec 2011;106(8):1049-51. [Medline].

  6. Cardo LJ, Rentas FJ, Ketchum L, et al. Pathogen inactivation of Leishmania donovani infantum in plasma and platelet concentrates using riboflavin and ultraviolet light. Vox Sang. Feb 2006;90(2):85-91. [Medline].

  7. Cardo LJ, Salata J, Harman R, Mendez J, Weina PJ. Leukodepletion filters reduce Leishmania in blood products when used at collection or at the bedside. Transfusion. Jun 2006;46(6):896-902. [Medline].

  8. Wortmann G, Hochberg L, Houng HH, et al. Rapid identification of Leishmania complexes by a real-time PCR assay. Am J Trop Med Hyg. Dec 2005;73(6):999-1004. [Medline].

  9. Wall EC, Watson J, Armstrong M, Chiodini PL, Lockwood DN. Epidemiology of imported cutaneous leishmaniasis at the hospital for tropical diseases, london, United kingdom: use of polymerase chain reaction to identify the species. Am J Trop Med Hyg. Jan 2012;86(1):115-8. [Medline]. [Full Text].

  10. Hartzell JD, Aronson NE, Weina PJ, Howard RS, Yadava A, Wortmann GW. Positive rK39 serologic assay results in US servicemen with cutaneous leishmaniasis. Am J Trop Med Hyg. Dec 2008;79(6):843-6. [Medline].

  11. Singh D, Pandey K, Das VN, et al. Novel noninvasive method for diagnosis of visceral leishmaniasis by rK39 testing of sputum samples. J Clin Microbiol. Aug 2009;47(8):2684-5. [Medline].

  12. Ozcan D, Seckin D, Allahverdiyev AM, et al. Liver transplant recipient with concomitant cutaneous and visceral leishmaniasis. Pediatr Transplant. Mar 2007;11(2):228-32. [Medline].

  13. [Guideline] Kaplan JE, Benson C, Holmes KH, Brooks JT, Pau A, Masur H. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. MMWR Recomm Rep. Apr 10 2009;58:1-207; quiz CE1-4. [Medline].

  14. Rubiano LC, Miranda MC, Muvdi Arenas S, Montero LM, Rodríguez-Barraquer I, Garcerant D, et al. Noninferiority of Miltefosine Versus Meglumine Antimoniate for Cutaneous Leishmaniasis in Children. J Infect Dis. Jan 11 2012;[Medline].

  15. Alam MS, Wagatsuma Y, Mondal D, Khanum H, Haque R. Relationship between sand fly fauna and kala-azar endemicity in Bangladesh. Acta Trop. Oct 2009;112(1):23-5. [Medline].

  16. Berman JD. Human leishmaniasis: clinical, diagnostic, and chemotherapeutic developments in the last 10 years. Clin Infect Dis. Apr 1997;24(4):684-703. [Medline].

  17. Herwaldt BL. Leishmaniasis. Lancet. Oct 2 1999;354(9185):1191-9. [Medline].

  18. Kenner JR, Aronson NE, Benson PM. The United States military and leishmaniasis. Dermatol Clin. Jan 1999;17(1):77-92, viii. [Medline].

  19. Kenner JR, Aronson NE, Bratthauer GL, et al. Immunohistochemistry to identify Leishmania parasites in fixed tissues. J Cutan Pathol. Mar 1999;26(3):130-6. [Medline].

  20. Lesho EP, Wortmann G, Neafie RC, Aronson NE. Cutaneous leishmaniasis: battling the Baghdad boil. Fed Pract. Oct 2004;59-67.

  21. Magill AJ. Cutaneous leishmaniasis in the returning traveler. Infect Dis Clin North Am. Mar 2005;19(1):241-66, x-xi. [Medline].

  22. Magill AJ. Leishmaniasis. In: Strickland GT, ed. Hunter's Tropical Medicine and Emerging and Infectious Diseases. 8th ed. Philadelphia, Pa: WB Saunders; 2000:665-87.

  23. Webb JG Jr. Memorandum: Guidance for the Management of Suspected Cutaneous Leishmaniasis in Operation Iraqi Freedom and Operation Enduring Freedom. Fort Sam Houson, Tex: United States Army Medical Command; September 10, 2004.

  24. Weina PJ, Neafie RC, Wortmann G, Polhemus M, Aronson NE. Old world leishmaniasis: an emerging infection among deployed US military and civilian workers. Clin Infect Dis. Dec 1 2004;39(11):1674-80. [Medline].

 
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Taxonomy of some of the medically important protozoans showing the relative relationship of the Kinetoplastida parasites generally, and Leishmania specifically.
Life cycles of the medically important Kinetoplastida illustrating the similarities and differences between the trypanosomes and Leishmania.
Sandfly. Courtesy of Kenneth F. Wagner, MD.
Comparison of a sandfly (left) and a mosquito (right). Their small size affects the efficacy of bed nets when used without permethrin treatment.
Cutaneous leishmaniasis. Courtesy of Kenneth F. Wagner, MD.
Classic Leishmania major lesion from a case in Iraq shows a volcanic appearance with rolled edges.
Atypical appearance of Leishmania major lesion with local spread beyond the borders of the primary lesion. Many of the lesions in cases from Iraq show an atypical appearance.
Cutaneous leishmaniasis with sporotrichotic spread.
While cutaneous leishmaniasis is generally considered to be an innocuous disease, this illustrates that in some parts of the world, especially in tribal areas, even cutaneous disease can have a life altering effect on a person's life.
Disseminated cutaneous leishmaniasis. Courtesy of Jacinto Convit, National Institute of Dermatology in Caracas, Venezuela.
Recidivans leishmaniasis. Courtesy of Kenneth F. Wagner, MD.
Post–kala azar dermal leishmaniasis. Courtesy of R. E. Kuntz and R. H. Watten, Naval Medical Research Unit, Taipei, Taiwan.
Mucocutaneous leishmaniasis. Courtesy of Kenneth F. Wagner, MD.
Mucocutaneous leishmaniasis. Courtesy of Kenneth F. Wagner, MD.
Visceral leishmaniasis. Courtesy of Kenneth F. Wagner, MD.
Amastigotes in a macrophage at 1000X magnification. Inset shows the cell membrane and points out the nucleus and kinetoplast, which are required to confirm that the inclusion seen in a macrophage is indeed an amastigote.
Free amastigotes near a disrupted macrophage. On touch preparations like this (Giemsa stain, original magnification X1000), the amastigotes are easier to identify than on other preparations. These stains clearly demonstrate the cell membrane, nucleus, and kinetoplast; all 3 are required for definitive diagnosis.
Free amastigote in a touch preparation (Giemsa stain, original magnification X1000).
Illustration of one form of the rK39 test for the serologic diagnosis of visceral leishmaniasis. It is an easy, very sensitive, and specific test for visceral disease. In this case, the dipstick second from the left shows a positive result and all the rest show reaction only at the control line.
 
 
 
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