Overview
How is leishmaniasis categorized?
What are the signs and symptoms of cutaneous leishmaniasis?
What are the signs and symptoms of mucocutaneous leishmaniasis?
What are the signs and symptoms of visceral and viscerotropic leishmaniasis?
Which lab findings are diagnostic for leishmaniasis?
What is the drug therapy for leishmaniasis?
What is the local therapy for cutaneous leishmaniasis?
Which comorbidities should be addressed in the management of leishmaniasis?
What is leishmaniasis and how does it manifest?
What is the global incidence of leishmaniasis?
What is the taxonomy of leishmaniasis?
What are the categories of leishmaniasis?
How is leishmaniasis transmitted?
What are the hosts of leishmaniasis?
What is the life cycle of Leishmania, in relation to leishmaniasis?
How does infection occur in leishmaniasis?
What is the initial clinical course of leishmaniasis?
What is the pathogenesis of leishmaniasis?
What is the pathogenesis of visceral or diffuse (disseminated) cutaneous leishmaniasis?
How is post–kala-azar leishmaniasis (PKDL) characterized?
What is the geographic distribution of post–kala-azar leishmaniasis (PKDL)?
What are the risk factors for leishmaniasis?
Which age group has the highest risk for leishmaniasis?
What is the distribution of cutaneous leishmaniasis in the Old World?
What is the distribution of cutaneous leishmaniasis in the New World?
How is leishmaniasis recidivans characterized?
What is the geographic distribution of mucocutaneous leishmaniasis?
What is the geographic distribution of visceral leishmaniasis?
How is viscerotropic leishmaniasis spread in the Middle East?
How common is leishmaniasis in the US?
What is the role of military action in the incidence of leishmaniasis in the US soldiers?
Which countries have the highest incidence of leishmaniasis?
What are the demographics of leishmaniasis?
What is the prognosis of leishmaniasis?
What is the prognosis of cutaneous leishmaniasis?
What is the prognosis of mucocutaneous leishmaniasis?
What is the prognosis of visceral leishmaniasis?
What are the complications of leishmaniasis?
What education should be provided to patients with leishmaniasis?
Presentation
What is the clinical history in leishmaniasis?
What are the clinical manifestations of leishmaniasis recidivans?
What are the clinical manifestations of cutaneous leishmaniasis?
What are the clinical manifestations of localized cutaneous leishmaniasis?
What are the clinical manifestations of diffuse cutaneous leishmaniasis?
What are the clinical manifestations of post-kala-azar dermal leishmaniasis (PKDL)?
What are the clinical manifestations of mucocutaneous leishmaniasis?
What are the clinical manifestations of visceral leishmaniasis?
What are the clinical manifestations of viscerotropic leishmaniasis?
What are the physical findings in post–kala-azar dermal leishmaniasis (PKDL)?
What are the physical manifestations of cutaneous leishmaniasis?
What are the characteristics of lesions in cutaneous leishmaniasis?
What are the characteristics of mucocutaneous leishmaniasis?
What are the physical findings of mucocutaneous leishmaniasis?
What are the physical findings in visceral and viscerotropic leishmaniasis?
What are the characteristics of visceral leishmaniasis?
What are the uncommon findings in visceral leishmaniasis?
DDX
What are the diagnostic considerations in leishmaniasis?
What are the diagnostic considerations in cutaneous leishmaniasis?
What other conditions should be considered in the differential diagnosis of leishmaniasis?
What other conditions should be considered in the differential diagnosis of visceral leishmaniasis?
What are the differential diagnoses for Leishmaniasis?
Workup
What are the approach considerations in the workup of leishmaniasis?
What are the approach considerations in the workup of cutaneous leishmaniasis?
What are the approach considerations in the workup of systemic leishmaniasis?
What are the typical lab study findings in cutaneous and mucocutaneous leishmaniasis?
What are the CBC findings in leishmaniasis?
What are coagulation study findings in visceral leishmaniasis?
What are the peripheral blood smear findings in leishmaniasis?
What are the liver function test (LFT) findings in leishmaniasis?
Which ancillary lab tests are indicated in the workup of leishmaniasis?
How is a biopsy performed in the workup of cutaneous leishmaniasis?
How is a biopsy performed in the workup of mucocutaneous leishmaniasis?
How is a biopsy performed in the workup of visceral leishmaniasis?
Which human body system is involved in leishmaniasis?
How is leishmaniasis confirmed through histologic testing?
What are the hepatosplenic features of visceral leishmaniasis?
What are the histologic findings in cutaneous leishmaniasis?
What are the histologic findings in visceral leishmaniasis?
What is the role of tissue culture in the workup of leishmaniasis?
What is the role of serologic studies in the workup of leishmaniasis?
What are the findings of serologic studies in the workup of leishmaniasis?
What is the role of polymerase chain reaction (PCR) in the workup of leishmaniasis?
What is the role of electrophoresis in the workup of leishmaniasis?
What is the role of the Leishmanin skin test (Montenegro test) in the workup of leishmaniasis?
Treatment
What are the approach considerations in the timing of treatment of leishmaniasis?
What are the approach considerations for individualized management of leishmaniasis?
What are the management options for the treatment of leishmaniasis?
What is the role of immunization in the management of leishmaniasis?
What are the treatment guidelines for leishmaniasis?
Which agents are used for the treatment of leishmaniasis in the US?
What is the role of antiparasitic pentavalent antimonial agents in the treatment of leishmaniasis?
What is the role of amphotericin B in the treatment of leishmaniasis?
What is the role of oral miltefosine in the treatment of leishmaniasis?
What is the role of pentamidine in the management of leishmaniasis?
Which alternative medications are used in the treatment of leishmaniasis?
What is the role of antibiotics in the treatment of leishmaniasis?
What is the role of topical paromomycin in the treatment of cutaneous leishmaniasis?
What are the treatment options for cutaneous leishmaniasis?
What is the role of oral miltefosine in the treatment of cutaneous leishmaniasis?
How is mucocutaneous leishmaniasis treated?
What is the recommended regimen for the treatment of visceral leishmaniasis?
What alternative agents and modalities are used in the treatment of visceral leishmaniasis?
How is resistant visceral leishmaniasis treated?
What risks are associated with surgical treatment of leishmaniasis?
What long-term monitoring is indicated for patients with leishmaniasis?
What measures are used to control leishmaniasis?
What is the role of immunity in the prevention of leishmaniasis?
What is the role of vaccination in the prevention of leishmaniasis?
What strategies help prevent leishmaniasis?
Medications
What are the goals of drug therapy in leishmaniasis?
What is the role of antiparasitic pentavalent antimonials in the treatment of leishmaniasis?
What are the cure rates of different regimens for the treatment of leishmaniasis?
What is the role of liposomal amphotericin B in the treatment of leishmaniasis?
What is the role of miltefosine in the treatment of leishmaniasis?
Which medications in the drug class Immunomodulators are used in the treatment of Leishmaniasis?
Which medications in the drug class Antiprotozoal Agents are used in the treatment of Leishmaniasis?
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Classic Leishmania major lesion from a case in Iraq shows a volcanic appearance with rolled edges.
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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.
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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.
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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.
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Active cutaneous leishmaniasis lesion with likely secondary infection in a soldier.
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Cutaneous leishmaniasis with keloid formation in a black soldier.
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Taxonomy of some of the medically important protozoans showing the relative relationship of the Kinetoplastida parasites generally, and Leishmania specifically.
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Leishmania donovani is one of the main Leishmania species that infects humans.
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Life cycles of the medically important Kinetoplastida illustrating the similarities and differences between the trypanosomes and Leishmania.
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Distribution map of cutaneous leishmaniasis.
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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
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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.
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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/
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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/.
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Distribution map of visceral leishmaniasis.
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Distribution map of human immunodeficiency virus (HIV) and leishmaniasis coinfection.
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The predominant mode of leishmaniasis transmission is a sandfly's bite.
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Sandfly. Courtesy of Kenneth F. Wagner, MD.
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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.
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Cutaneous leishmaniasis. Courtesy of Kenneth F. Wagner, MD.
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Cutaneous leishmaniasis lesion. Image courtesy of the Centers for Disease Control and Prevention Public Health Image Library.
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Cutaneous leishmaniasis with sporotrichotic spread.
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Cutaneous leishmaniasis lesion. Image courtesy of the Centers for Disease Control and Prevention Public Health Image Library.
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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.
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Leishmaniasis in an Ethiopian woman with a 1-year history of asymptomatic pink-erythematous infiltrative plaque with overlying scale and central crust.
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Healed cutaneous leishmaniasis lesions. Photo courtesy of Robert Norris, MD, Stanford University Medical Center.
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Cutaneous leishmaniasis lesions. Photo courtesy of Robert Norris, MD, Stanford University Medical Center.
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Diffuse (disseminated) cutaneous leishmaniasis. Courtesy of Jacinto Convit, National Institute of Dermatology in Caracas, Venezuela.
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Leishmaniasis recidivans. Courtesy of Kenneth F. Wagner, MD.
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Post–kala-azar dermal leishmaniasis. Courtesy of R. E. Kuntz and R. H. Watten, Naval Medical Research Unit, Taipei, Taiwan.
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Mucocutaneous leishmaniasis. Courtesy of Kenneth F. Wagner, MD.
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Mucocutaneous leishmaniasis. Courtesy of Kenneth F. Wagner, MD.
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Visceral leishmaniasis. Courtesy of Kenneth F. Wagner, MD.
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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/.
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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.
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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.
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Free amastigote in a touch preparation (Giemsa stain, original magnification × 1000).
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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/
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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.