eMedicine Specialties > Dermatology > Parasitic Infections

Leishmaniasis: Follow-up

Author: Peter J Weina, MD, PhD, Colonel, US Army; Director, Leishmania Diagnostics Laboratory, Walter Reed Army Institute of Research
Contributor Information and Disclosures

Updated: Sep 25, 2009

Follow-up

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.

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.

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.

Complications

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

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.

Patient Education

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

Miscellaneous

Medicolegal Pitfalls

Failure to make a timely diagnosis may result in significant morbidity or in mortality.

 
Acknowledgments

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.



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References
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References

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Further Reading

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Keywords

leishmaniasis, leishmaniosis, tropical disease, localized cutaneous leishmaniasis, diffuse cutaneous leishmaniasis, recidivans cutaneous leishmaniasis, post–kala azar dermal leishmaniasis, mucocutaneous leishmaniasis, visceral leishmaniasis, leishmanin skin test, sandfly,

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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.

Medical Editor

Abdul-Ghani Kibbi, MD, Chairman and Professor, Department of Dermatology, American University of Beirut Medical Center, Lebanon
Disclosure: none None None

Pharmacy Editor

Michael J Wells, MD, Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center
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.

Managing Editor

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.

CME Editor

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, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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