Dermatologic Manifestations of Leishmaniasis Follow-up

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

Further Inpatient Care

In the United States, patients are sometimes monitored as inpatients when pentavalent antimony is administered, but more accepted is the use of infusion centers that complete full evaluations prior to use of the drug. Periodic evaluation of cardiac conduction with ECG monitoring is prudent. Perform laboratory assessments of CBC counts; renal function; and amylase, lipase, and serum transaminases levels.

Alternate drug regimens require variable monitoring levels commensurate with their known adverse effects.

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Further Outpatient Care

Disease varies in its response to treatment. Careful monitoring of disease progression/regression and resolution for up to 6 months after successful treatment is wise and routinely performed.

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Deterrence/Prevention

Leishmaniasis is preventable by avoiding contact with the vector. The sandfly is most active from dawn to dusk, it is small enough to fit through standard mosquito netting, it makes no audible noise, and it is a relatively poor flyer. Effective prevention may be achieved by avoiding nighttime outdoor activities, by using topical insecticides (eg, diethyltoluamide [DEET]) on exposed skin surfaces, by using insecticide-impregnated clothing (permethrin stays in or on the material for many washings), by using fine-mesh mosquito netting treated with permethrin, and by sleeping with a fan on.

Protective immunity after infection is 97-98% effective against disease caused by the same species of Leishmania. Abortive infections due to therapy with effective agents are felt to reduce the protective immunity often seen with full course, self-resolving infections. Deliberate scarification of the extremities with material from human lesions was once practiced to prevent scarring that may result from a later natural infection of the face.

The treatment of infected persons and elimination of diseased reservoir vertebrates can reduce the source of infections.

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Complications

Secondary bacterial infection may occur. Additionally, leishmaniasis may be disfiguring.

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Prognosis

Most individuals respond exceedingly well to therapy for cutaneous disease and rapid, complete resolution of the lesion(s), with decreased potential for secondary bacterial infections and diminished scarring, is the rule. In well-nourished individuals with intact immune systems, full recovery is expected after treatment with the appropriate medication for visceral disease.

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Patient Education

Behavior modification to avoid vector contact, combined with insect control measures, significantly diminishes the risk of acquiring infection.

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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

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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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