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Leishmaniasis Differential Diagnoses

  • Author: Craig G Stark, MD; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
 
Updated: Apr 06, 2016
 
 

Diagnostic Considerations

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.[15]

Cutaneous leishmaniasis

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:

Mucocutaneous leishmaniasis

Other conditions to consider in the differential diagnosis for mucocutaneous leishmaniasis include the following:

  • Polymorphic reticulosis
  • Wegener granulomatosis
  • Lymphoma (eg, angiocentric NK/T-cell lymphoma)
  • Nasopharyngeal carcinoma
  • Lethal midline granuloma
  • Other destructive lesions

Visceral leishmaniasis

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:

Differential Diagnoses

 
 
Contributor Information and Disclosures
Author

Craig G Stark, MD Regional Medical Director, International SOS

Craig G Stark, MD is a member of the following medical societies: American College of Physicians-American Society of Internal Medicine, International Society of Travel Medicine, Phi Beta Kappa, Society of US Army Flight Surgeons

Disclosure: Nothing to disclose.

Coauthor(s)

Conjivaram Vidyashankar, MD, MRCP Specialty Doctor in Pediatrics, Dumfries and Galloway Royal Infirmary, Scotland

Conjivaram Vidyashankar, MD, MRCP is a member of the following medical societies: International AIDS Society, Royal College of Paediatrics and Child Health, Indian Academy of Pediatrics, European Society for Paediatric Infectious Diseases

Disclosure: Nothing to disclose.

Chief Editor

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Chief of Infectious Disease, Program Director of Infectious Disease Fellowship, Department of Internal Medicine, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, International Immunocompromised Host Society, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Acknowledgements

Ruchir Agrawal, MD Chief, Allergy and Immunology, Aurora Sheboygan Clinic

Ruchir Agrawal, MD, is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Academy of Pediatrics, American College of Allergy, Asthma and Immunology, and American Medical Association

Disclosure: Nothing to disclose.

Pranatharthi Haran Chandrasekar, MBBS, MD Professor, Department of Internal Medicine, Director of Infectious Disease Fellowship, Harper Hospital, Wayne State University School of Medicine

Pranatharthi Haran Chandrasekar, MBBS, MD is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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.

John Halpern, DO, FACEP Clinical Assistant Professor, Department of Family Medicine, Nova Southeastern University College of Osteopathic Medicine; Medical Director, Health Career Institute; Medical Director Emergency Department, Palms West Hospital

John Halpern, DO, FACEP is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Edmond A Hooker II, MD, DrPH, FAAEM Associate Professor, Department of Health Services Administration, Xavier University, Cincinnati, Ohio; Assistant Professor, Department of Emergency Medicine, University of Cincinnati College of Medicine

Edmond A Hooker II, MD, DrPH, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American Public Health Association, Society for Academic Emergency Medicine, and Southern Medical Association

Disclosure: Nothing to disclose.

Renee Y Hsia, MD, MSc Clinical Instructor, Division of Emergency Medicine, University of California at San Francisco School of Medicine; Attending Physician, Department of Emergency Medicine, San Francisco General Hospital

Disclosure: Nothing to disclose.

Julie R Kenner, MD, PhD Private Practice, Kenner Dermatology Center

Julie R Kenner, MD, PhD is a member of the following medical societies: American Academy of Dermatology and American Society for Dermatologic Surgery

Disclosure: Nothing to disclose.

Thomas M Kerkering, MD Chief of Infectious Diseases, Virginia Tech Carilion School of Medicine

Thomas M Kerkering, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Public Health Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Medical Society of Virginia, and Wilderness Medical Society

Disclosure: Nothing to disclose.

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

Disclosure: Nothing to disclose.

Jennifer J Lee MD, Assistant Professor, Division of Dermatology, Department of Medicine, Vanderbilt University Medical Center

Jennifer J Lee is a member of the following medical societies: American Academy of Dermatology

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.

Gary J Noel, MD Professor, Department of Pediatrics, Weill Cornell Medical College; Attending Pediatrician, New York-Presbyterian Hospital

Gary J Noel, MD is a member of the following medical societies: Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

William G Stebbins, MD Assistant Professor of Medicine, Division of Dermatology, Vanderbilt University

William G Stebbins, MD is a member of the following medical societies: American Academy of Dermatology, American Society for Dermatologic Surgery, and Dermatology Foundation

Disclosure: Nothing to disclose.

Russell W Steele, MD Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Jeter (Jay) Pritchard Taylor III, MD Compliance Officer, Attending Physician, Emergency Medicine Residency, Department of Emergency Medicine, Palmetto Health Richland, University of South Carolina School of Medicine; Medical Director, Department of Emergency Medicine, Palmetto Health Baptist

Jeter (Jay) Pritchard Taylor III, MD is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

N Ewen Wang, MD Consulting Staff, Department of Surgery, Division of Emergency Medicine, Stanford University Hospital

Disclosure: Nothing to disclose.

Peter J Weina, MD, PhD Colonel, US Army; Deputy Commander/Deputy Director, Medical Director of the 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.

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.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Acknowledgments

The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

References
  1. World Health Organization. Leishmaniasis: the disease and its epidemiology. Available at http://www.who.int/leishmaniasis/disease_epidemiology/en/. Accessed: April 10, 2014.

  2. Centers for Disease Control and Prevention. Parasites home: leishmaniasis. Epidemiology & risk factors. Available at http://www.cdc.gov/parasites/leishmaniasis/epi.html. Accessed: April 11, 2014.

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

  4. 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. 2006 Jun. 46(6):896-902. [Medline].

  5. McHugh CP, Melby PC, LaFon SG. Leishmaniasis in Texas: epidemiology and clinical aspects of human cases. Am J Trop Med Hyg. 1996 Nov. 55(5):547-55. [Medline].

  6. Centers for Disease Control and Prevention. Parasites home: leishmaniasis. Resources for health professionals. Available at http://www.cdc.gov/parasites/leishmaniasis/health_professionals/. Accessed: April 10, 2014.

  7. Magill AJ, Grogl M, Gasser RA Jr, Sun W, Oster CN. Visceral infection caused by Leishmania tropica in veterans of Operation Desert Storm. N Engl J Med. 1993 May 13. 328(19):1383-7. [Medline].

  8. Coleman RE, Burkett DA, Putnam JL, Sherwood V, Caci JB, Jennings BT, 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. 2006 Jul. 43(4):647-62. [Medline].

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

  10. Centers for Disease Control and Prevention. Update: Cutaneous leishmaniasis in U.S. military personnel--Southwest/Central Asia, 2002-2004. MMWR Morb Mortal Wkly Rep. 2004 Apr 2. 53(12):264-5. [Medline].

  11. Leishmaniasis Fact Sheet. World Health Organization. Available at http://www.who.int/mediacentre/factsheets/fs375/en/. 2016 Mar 01; Accessed: 2016 Mar 31.

  12. Leishmaniasis - Global Health Observatory Data. World Health Organization. Available at http://apps.who.int/gho/data/node.main.NTDLEISH?lang=en. 2016 Mar 01; Accessed: 2016 Mar 31.

  13. South-East Asia poised to defeat visceral leishmaniasis (kala-azar). WORLD HEALTH ORGANIZATION. Available at http://www.who.int/neglected_diseases/news/SEARO_poised_to_defeat_VL/en/. 2015 OCT 15; Accessed: 2016 MAR 31.

  14. World Health Organization. Essential leishmaniasis maps: visceral and mucocutaneous leishmaniasis. April 10, 2014. [Full Text].

  15. Martín-Ezquerra G, Fisa R, Riera C, Rocamora V, Fernández-Casado A, Barranco 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. 2009 Aug. 161(2):320-5. [Medline].

  16. Monno R, Giannelli G, Rizzo C, De Vito D, Fumarola L. Recombinant K39 immunochromatographic test for diagnosis of human leishmaniasis. Future Microbiol. 2009 Mar. 4(2):159-70. [Medline].

  17. Kubar J, Fragaki K. Recombinant DNA-derived leishmania proteins: from the laboratory to the field. Lancet Infect Dis. 2005 Feb. 5(2):107-14. [Medline].

  18. Zijlstra EE, Nur Y, Desjeux P, Khalil EA, El-Hassan AM, Groen J. Diagnosing visceral leishmaniasis with the recombinant K39 strip test: experience from the Sudan. Trop Med Int Health. 2001 Feb. 6(2):108-13. [Medline].

  19. Kumar R, Pai K, Pathak K, Sundar S. Enzyme-linked immunosorbent assay for recombinant K39 antigen in diagnosis and prognosis of Indian visceral leishmaniasis. Clin Diagn Lab Immunol. 2001 Nov. 8(6):1220-4. [Medline].

  20. Lemos EM, Carvalho SF, Corey R, Dietze R. [Evaluation of a rapid test using recombinant k39 antigen in the diagnosis of visceral leishmaniasis in Brazil]. Rev Soc Bras Med Trop. 2003. 36 Suppl 2:36-8. [Medline].

  21. 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. 2008 Dec. 79(6):843-6. [Medline].

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

  23. Alam MZ, Shamsuzzaman AK, Kuhls K, Schönian G. PCR diagnosis of visceral leishmaniasis in an endemic region, Mymensingh district, Bangladesh. Trop Med Int Health. 2009 May. 14(5):499-503. [Medline].

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

  25. 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. 2012 Jan. 86(1):115-8. [Medline]. [Full Text].

  26. Ozcan D, Seçkin D, Allahverdiyev AM, Weina PJ, Aydin H, Ozçay F, et al. Liver transplant recipient with concomitant cutaneous and visceral leishmaniasis. Pediatr Transplant. 2007 Mar. 11(2):228-32. [Medline].

  27. [Guideline] Kaplan JE, Benson C, Holmes KK, 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. 2009 Apr 10. 58:1-207; quiz CE1-4. [Medline].

  28. [Guideline] AIDSinfo.com. Clinical guidelines portal. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: what’s new in the guidelines. July 8, 2013. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed: April 14, 2014.

  29. Navin TR, Arana BA, Arana FE, Berman JD, Chajon JF. Placebo-controlled clinical trial of sodium stibogluconate (Pentostam) versus ketoconazole for treating cutaneous leishmaniasis in Guatemala. J Infect Dis. 1992 Mar. 165(3):528-34. [Medline].

  30. Wortmann G, Miller RS, Oster C, Jackson J, Aronson N. A randomized, double-blind study of the efficacy of a 10- or 20-day course of sodium stibogluconate for treatment of cutaneous leishmaniasis in United States military personnel. Clin Infect Dis. 2002 Aug 1. 35(3):261-7. [Medline].

  31. Sundar S, Chakravarty J, Agarwal D, Rai M, Murray HW. Single-dose liposomal amphotericin B for visceral leishmaniasis in India. N Engl J Med. 2010 Feb 11. 362(6):504-12. [Medline].

  32. Sundar S, Sinha PK, Rai M, et al. Comparison of short-course multidrug treatment with standard therapy for visceral leishmaniasis in India: an open-label, non-inferiority, randomised controlled trial. Lancet. 2011 Feb 5. 377(9764):477-86. [Medline].

  33. Sundar S, Agrawal G, Rai M, Makharia MK, Murray HW. Treatment of Indian visceral leishmaniasis with single or daily infusions of low dose liposomal amphotericin B: randomised trial. BMJ. 2001 Aug 25. 323(7310):419-22. [Medline].

  34. Avasthi R, Chaudhary SC, Khanna S. Visceral leishmaniasis simulating chronic liver disease: successful treatment with miltefosine. Indian J Med Microbiol. 2009 Jan-Mar. 27(1):85-6. [Medline].

  35. Ritmeijer K, Ter Horst R, Chane S, Aderie EM, Piening T, Collin SM, et al. Limited Effectiveness of High-Dose Liposomal Amphotericin B (AmBisome) for Treatment of Visceral Leishmaniasis in an Ethiopian Population With High HIV Prevalence. Clin Infect Dis. 2011 Oct 19. [Medline].

  36. Prasad R, Kumar R, Jaiswal BP, Singh UK. Miltefosine: an oral drug for visceral leishmaniasis. Indian J Pediatr. 2004 Feb. 71(2):143-4. [Medline].

  37. Impavido (miltefosine) prescribing information. [package insert]. Wilmington, DE: Paladin Therapeutics, Inc. 2014.

  38. Sundar S, Jha TK, Thakur CP, et al. Oral miltefosine for the treatment of Indian visceral leishmaniasis. Trans R Soc Trop Med Hyg. 2006 Dec. 100 Suppl 1:S26-33. [Medline].

  39. Rahman M, Ahmed BN, Faiz MA, Chowdhury MZ, Islam QT, Sayeedur R, et al. Phase IV trial of miltefosine in adults and children for treatment of visceral leishmaniasis (kala-azar) in Bangladesh. Am J Trop Med Hyg. 2011 Jul. 85(1):66-9. [Medline]. [Full Text].

  40. Investigational Drug Available Directly from CDC for the Treatment of Infections with Free-Living Amebae. MMWR Morb Mortal Wkly Rep. 2013 Aug 23. 62(33):666. [Medline].

  41. Nacher M, Carme B, Sainte Marie D, Couppie P, Clyti E, Guibert P, et al. Influence of clinical presentation on the efficacy of a short course of pentamidine in the treatment of cutaneous leishmaniasis in French Guiana. Ann Trop Med Parasitol. 2001 Jun. 95(4):331-6. [Medline].

  42. Dogra J. Current therapies for treatment of cutaneous leishmaniasis in India. Infection. 1992 Jul-Aug. 20(4):189-91. [Medline].

  43. Ozgoztasi O, Baydar I. A randomized clinical trial of topical paromomycin versus oral ketoconazole for treating cutaneous leishmaniasis in Turkey. Int J Dermatol. 1997 Jan. 36(1):61-3. [Medline].

  44. Alrajhi AA, Ibrahim EA, De Vol EB, Khairat M, Faris RM, Maguire JH. Fluconazole for the treatment of cutaneous leishmaniasis caused by Leishmania major. N Engl J Med. 2002 Mar 21. 346(12):891-5. [Medline].

  45. Machado PR, Ampuero J, Guimarães LH, Villasboas L, Rocha AT, Schriefer A, et al. Miltefosine in the treatment of cutaneous leishmaniasis caused by Leishmania braziliensis in Brazil: a randomized and controlled trial. PLoS Negl Trop Dis. 2010 Dec 21. 4(12):e912. [Medline]. [Full Text].

  46. Soto J, Toledo JT. Oral miltefosine to treat new world cutaneous leishmaniasis. Lancet Infect Dis. 2007 Jan. 7(1):7. [Medline].

  47. Ben Salah A, Ben Massaoud N, Guedri E, et al. Topical paromomycin with or without gentamicin for cutaneous leishmaniasis. N Engl J Med. 2013. 368:524-32.

  48. Keller DM. Novel noninvasive method for diagnosis of visceral leishmaniasis by rK39 testing of sputum samples. Medscape Medical News. February 7, 2013. Available at http://www.medscape.com/viewarticle/778974. Accessed: February 18, 2013.

  49. El-On J, Livshin R, Even-Paz Z, Hamburger D, Weinrauch L. Topical treatment of cutaneous leishmaniasis. J Invest Dermatol. 1986 Aug. 87(2):284-8. [Medline].

  50. Braunwald E, Fauci AS, Hauser SL, et al. Leishmaniasis. 15th ed. Harrison's Manual of Medicine. 2001: McGraw-Hill;

  51. Masmoudi A, Dammak A, Chaaben H, Maalej N, Akrout F, Turki H. Doxycycline for the treatment of cutaneous leishmaniasis. Dermatol Online J. 2008 Aug 15. 14(8):22. [Medline].

  52. Reithinger R, Mohsen M, Wahid M, Bismullah M, Quinnell RJ, Davies CR, et al. Efficacy of thermotherapy to treat cutaneous leishmaniasis caused by Leishmania tropica in Kabul, Afghanistan: a randomized, controlled trial. Clin Infect Dis. 2005 Apr 15. 40(8):1148-55. [Medline].

  53. Singh OP, Singh B, Chakravarty J, Sundar S. Current challenges in treatment options for visceral leishmaniasis in India: a public health perspective. Infect Dis Poverty. 2016 Mar 8. 5 (1):19. [Medline].

  54. Sindermann H, Engel KR, Fischer C, Bommer W; Miltefosine Compassionate Use Program. Oral miltefosine for leishmaniasis in immunocompromised patients: compassionate use in 39 patients with HIV infection. Clin Infect Dis. 2004 Nov 15. 39(10):1520-3. [Medline].

  55. Tiuman TS, Santos AO, Ueda-Nakamura T, Filho BP, Nakamura CV. Recent advances in leishmaniasis treatment. Int J Infect Dis. 2011 Aug. 15(8):e525-32. [Medline].

  56. Lemesre JL, Holzmuller P, Cavaleyra M, Gonçalves RB, Hottin G, Papierok G. Protection against experimental visceral leishmaniasis infection in dogs immunized with purified excreted secreted antigens of Leishmania infantum promastigotes. Vaccine. 2005 Apr 22. 23(22):2825-40. [Medline].

  57. 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. 2012 Feb 15. 205(4):684-92. [Medline]. [Full Text].

  58. Brooks M. FDA Clears Miltefosine (Impavido) for Leishmaniasis. Medscape Medical News. Mar 20 2014. [Full Text].

  59. Alvar J, Cañavate C, Gutiérrez-Solar B, Jiménez M, Laguna F, López-Vélez R, et al. Leishmania and human immunodeficiency virus coinfection: the first 10 years. Clin Microbiol Rev. 1997 Apr. 10(2):298-319. [Medline].

  60. World Health Organization. Essential leishmaniasis maps: cutaneous leishmaniasis. Available at http://www.who.int/leishmaniasis/leishmaniasis_maps/en/index1.html. Accessed: April 10, 2014.

  61. Zijlstra EE. Visceral leishmaniasis: a forgotten epidemic. Arch Dis Child. 2016 Feb 19. [Medline]. [Full Text].

 
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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.
Old World localized cutaneous leishmaniasis located on the trunk of a soldier stationed in Kuwait. This lesion was a 3-cm by 4-cm nontender ulceration that developed over the course of 6 months at the site of a sandfly bite. The patient reported seeing several rats around his encampment.
Old World cutaneous leishmaniasis located on the right arm of the same soldier stationed in Kuwait. This 2-cm by 3-cm lesion was located at the exposed area where the sleeve ended. Note the satellite lesions.
Active cutaneous leishmaniasis lesion with likely secondary infection in a soldier.
Cutaneous leishmaniasis with keloid formation in a black soldier.
Taxonomy of some of the medically important protozoans showing the relative relationship of the Kinetoplastida parasites generally, and Leishmania specifically.
Leishmania donovani is one of the main Leishmania species that infects humans.
Life cycles of the medically important Kinetoplastida illustrating the similarities and differences between the trypanosomes and Leishmania.
Distribution map of cutaneous leishmaniasis.
Geographical distribution of Old World cutaneous leishmaniasis due to L tropica and related species and L aethiopica. Source: World Health Organization, Department of Control of Neglected Tropical Diseases, Innovative and Intensified Disease Management (WHO/NTD/IDM) Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), Tuberculosis and Malaria (HTM) WHO, October 2010: http://www.who.int/leishmaniasis/leishmaniasis_maps/en/index1.html
Geographical distribution of Old World cutaneous leishmaniasis due to L major. Source: World Health Organization, Department of Control of Neglected Tropical Diseases, Innovative and Intensified Disease Management (WHO/NTD/IDM) Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), Tuberculosis and Malaria (HTM) WHO, October 2010: http://www.who.int/leishmaniasis/leishmaniasis_maps/en/index1.html.
Geographical distribution of cutaneous and mucocutaneous leishmaniasis in the New World. Source: World Health Organization, Department of Control of Neglected Tropical Diseases, Innovative and Intensified Disease Management (WHO/NTD/IDM) Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), Tuberculosis and Malaria (HTM) WHO, October 2010: http://www.who.int/leishmaniasis/leishmaniasis_maps/en/
Geographical distribution of visceral leishmaniasis in the Old and New world. Source: World Health Organization, Department of Control of Neglected Tropical Diseases, Innovative and Intensified Disease Management (WHO/NTD/IDM) Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS), Tuberculosis and Malaria (HTM) WHO, October 2010: http://www.who.int/leishmaniasis/leishmaniasis_maps/en/.
Distribution map of visceral leishmaniasis.
Distribution map of human immunodeficiency virus (HIV) and leishmaniasis coinfection.
The predominant mode of leishmaniasis transmission is a sandfly's bite.
Sandfly. Courtesy of Kenneth F. Wagner, MD.
Comparison of a sandfly (left) and a mosquito (right). The sandfly's small size affects the efficacy of bed nets when used without permethrin treatment.
Cutaneous leishmaniasis. Courtesy of Kenneth F. Wagner, MD.
Cutaneous leishmaniasis lesion. Image courtesy of the Centers for Disease Control and Prevention Public Health Image Library.
Cutaneous leishmaniasis with sporotrichotic spread.
Cutaneous leishmaniasis lesion. Image courtesy of the Centers for Disease Control and Prevention Public Health Image Library.
Cutaneous leishmaniasis is generally considered to be an innocuous disease; however, in some parts of the world, especially in tribal areas, even cutaneous disease can have a life altering effect on a person's life. Minimal facial disfiguring can condemn young girls to life without the prospect of marriage or acceptance in society.
Leishmaniasis in an Ethiopian woman with a 1-year history of asymptomatic pink-erythematous infiltrative plaque with overlying scale and central crust.
Healed cutaneous leishmaniasis lesions. Photo courtesy of Robert Norris, MD, Stanford University Medical Center.
Cutaneous leishmaniasis lesions. Photo courtesy of Robert Norris, MD, Stanford University Medical Center.
Diffuse (disseminated) cutaneous leishmaniasis. Courtesy of Jacinto Convit, National Institute of Dermatology in Caracas, Venezuela.
Leishmaniasis recidivans. 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.
Marked splenomegaly (enlargement/swelling of the spleen) in a patient in lowland Nepal who has visceral leishmaniasis. (Credit: C. Bern, CDC) Source: Centers for Disease Control and Prevention. Parasites home: leishmaniasis. Resources for health professionals: http://www.cdc.gov/parasites/leishmaniasis/health_professionals/.
Amastigotes in a macrophage at 1000× 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 × 1000), 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 × 1000).
Light-microscopic examination of a stained bone marrow specimen from a patient with visceral leishmaniasis—showing a macrophage (a special type of white blood cell) containing multiple Leishmania amastigotes (the tissue stage of the parasite). Note that each amastigote has a nucleus (red arrow) and a rod-shaped kinetoplast (black arrow). Visualization of the kinetoplast is important for diagnostic purposes, to be confident the patient has leishmaniasis. (Credit: CDC/DPDx) Source: Centers for Disease Control and Prevention. Parasites home: leishmaniasis. Resources for health professionals: http://www.cdc.gov/parasites/leishmaniasis/health_professionals/
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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