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Leishmaniasis

Last updated: December 3, 2020

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Leishmaniasis is a parasitic disease caused by protozoans of the Leishmania genus, which are transmitted by infected phlebotomine sand flies. Depending on the parasite subtype and the strength of the host's immune system, the disease manifests in a cutaneous or visceral form. Cutaneous leishmaniasis is characterized by skin ulcers. The most important clinical manifestation of visceral leishmaniasis is kala-azar (Hindi for “black fever”), which presents with fever, weight loss, hepatosplenomegaly, and immunosuppression. Leishmaniasis is diagnosed by microscopic visualization of macrophages containing amastigotes in blood smears or tissue. Local treatment (cryotherapy, topical paromomycin) suffices for most cases of cutaneous leishmaniasis. Visceral leishmaniasis requires systemic treatment with amphotericin B.

  • Distribution: endemic in the Mediterranean region, Africa, India, southwest and central Asia, South and Central America
  • Incidence (worldwide):
    • Visceral: 50,000– 90,000 infections/year
    • Cutaneous: 600,000–1,000,000 infections/year

References:[1][2][3]

Epidemiological data refers to the US, unless otherwise specified.

Clinical features [6][7]

Diagnostics

Treatment [8]

The objective of treatment is to manage clinical symptoms.

Prognosis

Treatment reduces the recurrence rate of cutaneous leishmaniasis, accelerates the healing of lesions, and reduces the risk of dissemination and incidence of mucosal leishmaniasis.

Without treatment, localized cutaneous leishmaniasis heals over months to years with a scar or keloid. Reactivation may occur years after initial symptoms resolve.

Clinical features [6][9]

Diagnostics

Treatment [10]

  • Amphotericin B is the preferred monotherapy in Europe, North America, and South America.
  • Other drugs that may be used include:

Kala-azar is highly fatal without treatment!

  1. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Harrison's Principles of Internal Medicine. McGraw-Hill Education ; 2015
  2. Aronson N, Weller PF, Baron EL. Cutaneous Leishmaniasis: Clinical Manifestations and Diagnosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/cutaneous-leishmaniasis-clinical-manifestations-and-diagnosis.Last updated: January 4, 2017. Accessed: December 18, 2017.
  3. Jones TC, Johnson WD Jr, Barretto AC, et al. Epidemiology of American cutaneous leishmaniasis due to Leishmania braziliensis braziliensis.. J Infect Dis. 1987; 156 (1): p.73-83. doi: 10.1093/infdis/156.1.73 . | Open in Read by QxMD
  4. Aronson N, Weller PF, Baron EL. Cutaneous Leishmaniasis: Treatment. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/cutaneous-leishmaniasis-treatment.Last updated: June 29, 2017. Accessed: December 18, 2017.
  5. Bern C, Weller PF, Baron EL. Visceral Leishmaniasis: Clinical Manifestations and Diagnosis. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/visceral-leishmaniasis-clinical-manifestations-and-diagnosis.Last updated: December 6, 2016. Accessed: December 18, 2017.
  6. Bern C, Weller PF, Baron EL. Visceral Leishmaniasis: Treatment. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/visceral-leishmaniasis-treatment.Last updated: December 5, 2017. Accessed: December 18, 2017.
  7. Bern C, Weller PF, Baron EL. Visceral Leishmaniasis: Epidemiology and Control. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/visceral-leishmaniasis-epidemiology-and-control.Last updated: July 25, 2017. Accessed: December 18, 2017.
  8. Aronson N, Weller PF, Baron EL. Cutaneous Leishmaniasis: Epidemiology and Control. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/cutaneous-leishmaniasis-epidemiology-and-control.Last updated: September 26, 2017. Accessed: December 18, 2017.
  9. Leishmaniasis. https://www.who.int/en/news-room/fact-sheets/detail/leishmaniasis. Updated: March 2, 2020. Accessed: April 20, 2020.
  10. Parasites - Leishmaniasis. https://www.cdc.gov/parasites/leishmaniasis/health_professionals/index.html. Updated: June 8, 2020. Accessed: December 3, 2020.