Leishmaniasis in Emergency Medicine Follow-up

  • Author: Jennifer J Lee, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: Aug 16, 2010
 

Further Inpatient Care

If the case is not advanced with serious GI, hematologic, or infectious issues, care can be accomplished on an outpatient basis; however, daily visits to a physician for medication may be required.

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Further Outpatient Care

  • Response to treatment varies.
  • Nonspecific measures, such as local heat and cleanliness, contribute to the spontaneous healing of the ulcers.
  • Progression and resolution of the disease should be monitored carefully.
  • Wound care is important.
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Inpatient & Outpatient Medications

  • The antimony sodium stibogluconate (known as Pentostam in the United States) is the current antiparasitic treatment of choice in the United States, although miltefosine holds a great deal of promise and is available in India.
  • Antistaphylococcal antibiotic may be needed for secondary bacterial infection.
  • Fluconazole has also been shown to have some effect against cutaneous leishmaniasis.
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Deterrence/Prevention

  • Protective immunity following medical treatment for infection is 97-98% effective for disease caused by the same species of Leishmania.
  • Deliberate scarification (ie, making numerous superficial incisions) of the extremities with material from human lesions was once practiced to prevent facial scarring that might result from a later natural infection.
  • The treatment of infected persons and elimination of diseased reservoir vertebrates can reduce the source of infection.
  • Sandfly control (fine-mesh bed netting must be used, because sandflies are small enough to pass through ordinary mosquito netting) impregnated with an insecticide such as permethrin or deltamethrin, and use of insect repellent can prevent disease.
  • Because leishmaniasis can be transmitted through blood, patients who have been infected should not donate blood or organs.
  • General precautions, such as protective clothing, and minimizing outdoor exposures at peak times (eg, dusk) should also be used.
  • Current efforts are being made by organizations such as the Tropical Disease Research branch of the World Health Organization and other vaccine initiatives to develop second-generation vaccines against leishmaniasis.
  • Survival after visceral leishmaniasis is thought to be protective against all forms of leishmaniasis by conferring immunity.
  • Efforts have been made to develop a vaccine against leishmaniasis, but, currently, no effective methods of immunization are available.
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Complications

Complications of leishmaniasis may include the following:

  • Secondary bacterial infection
  • Disfigurement of nose, lips, and palate
  • Bleeding
  • Splenic rupture
  • Edema, cachexia, and hyperpigmentation in late stages
  • Metastatic lesions in the nasopharynx with tissue destruction
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Prognosis

Prognosis depends on nutritional and overall immune status of the host and on the precise species of infection.

  • With early treatment, the cure rate is higher than 90%.
  • The mortality rate is 15-25% in untreated cases.
  • If untreated, death occurs in 3-20 months.
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Patient Education

Education about sandfly control can reduce incidence of disease.

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Contributor Information and Disclosures
Author

Jennifer J Lee, MD  Attending Physician, Department of Dermatology, Beth Israel Deaconess Medical Center, Boston; Instructor, Department of Dermatology, Harvard Medical School

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

Disclosure: Nothing to disclose.

Coauthor(s)

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

Renee Y Hsia, MD, MSc is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, American College of Emergency Physicians, American College of Surgeons, American Heart Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

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.

Specialty Editor Board

Edmond A Hooker II, MD, DrPH, FAAEM  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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine 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.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD 

Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: WebMD Salary Employment

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Leishmaniasis. Image courtesy of the CDC Public Health Image Library.
Leishmaniasis. Photo courtesy of Robert Norris, MD, Stanford University Medical Center.
Leishmaniasis. Photo courtesy of Robert Norris, MD, Stanford University Medical Center.
Leishmaniasis. Image courtesy of the CDC Public Health Image Library.
Leishmaniasis. Ethiopian woman with 1-year history of asymptomatic pink-erythematous infiltrative plaque with overlying scale and central crust.
 
 
 
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