Leishmaniasis Differential Diagnoses
- Author: Craig G Stark, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD more...
As noted earlier, infection with different Leishmania species can lead to a remarkably broad range of disease states. The clinical spectrum can range from insignificant pustules to fatal systemic disease. General understanding of this clinical spectrum, although once believed to be quite predictable, continues to evolve as new diagnostic techniques contribute to the elucidation of the variety of clinical manifestations of an infection with even a single species of Leishmania.
Coexisting infectious diseases and/or nutritional deficiencies may significantly impact the severity and outcome of leishmanial infection. In southern Europe along the Mediterranean, visceral leishmaniasis is emerging most notably as a serious opportunistic infection in individuals with human immunodeficiency virus (HIV) infection, where most adult patients (< 70%) with visceral leishmaniasis have late-stage acquired immunodeficiency syndrome (AIDS). Individuals with HIV infection and leishmaniasis have higher parasite loads, poorer responses to skin testing, lower responses to pentavalent antimony, and higher posttreatment relapse rates than those of their immunocompetent counterparts.
Localized cutaneous leishmaniasis usually manifests as a nonspecific ulcer that can mimic many other infectious and noninfectious skin conditions. The vast majority of cases patients spontaneously with scarring and never come to the attention of clinicians. Even in US troops stationed in Iraq, it has been felt, by many most closely associated with the disease and familiar with the epidemiology in the military, that less than 25% of all disease ever concerns afflicted soldiers enough to seek medical attention.
Other conditions to consider in the differential diagnosis for leishmaniasis include the following:
Fungal: Chromoblastomycosis, lobomycosis, deep fungal infection
Malignant neoplasms: Metastases, psoriasis, keloids
Ulcers: Traumatic ulcers, stasis ulcers
Other conditions to consider in the differential diagnosis for mucocutaneous leishmaniasis include the following:
Lymphoma (eg, angiocentric NK/T-cell lymphoma)
Lethal midline granuloma
Other destructive lesions
Visceral leishmaniasis may be confused with a variety of other infectious diseases or febrile systemic illnesses. In endemic areas, the diagnosis of visceral leishmaniasis is often made based on the history and physical examination.
Other conditions to consider in the differential diagnosis for visceral leishmaniasis include the following:
Lymphoma, Cutaneous T-Cell
Squamous Cell Carcinoma
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