Leishmaniasis has a range of clinical presentations; cutaneous leishmaniasis is more common, but visceral leishmaniasis is more serious and can be fatal if left untreated.
Diagnosis is confirmed by various tests, including microscopic examination, culture, or molecular testing, depending on the type of leishmaniasis and test availability.
Possible treatments depend on clinical presentations, parasite species and strain, and the country in which infection was acquired.
Treatment is less effective and sometimes more toxic in people who are immunocompromised than in those who are immunocompetent.
The leishmaniases are a group of protozoan diseases infecting humans and other animals, causing either skin lesions; mucosal involvement; or infiltration of the spleen, liver, and bone marrow. They are caused by obligate intracellular (macrophage) protozoa of the genus Leishmania, and the main route of transmission is via the bite of an infected phlebotomine sand fly. Occasionally, infection occurs congenitally, through a blood transfusion or organ/tissue transplantation, or by laboratory infection.
The leishmaniases can be broadly classified into two major clinicopathological presentations: cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL). CL is the more common form and may be subclassified into a range of different presentations, such as localised CL, diffuse CL, leishmaniasis recidivans, disseminated leishmaniasis, and mucosal leishmaniasis (ML); ML is sometimes classified as a separate subtype on its own. VL occurs when parasites disseminate through the reticuloendothelial system. It is potentially life-threatening without treatment. Post-kala-azar dermal leishmaniasis may present months or years following treatment of VL. This condition exhibits a macular, maculopapular, or nodular rash.
History and exam
Key diagnostic factors
- previous stay in endemic area
- prolonged fever
- weight loss
- ulcerative skin lesions
- presence of risk factors
- multiple non-ulcerative skin nodules
- destructive mucosal inflammation
- skin darkening
Other diagnostic factors
- enlarged lymph nodes
- previous anti-leishmanial treatment
- abdominal pain
- high exposure to sand fly bites
- proximity to a patient with a history of infection
- ownership of domestic animals
1st investigations to order
- liver function tests and urea/creatinine
- serum human chorionic gonadotrophin (hCG)
Investigations to consider
- microscopic examination of relevant specimen
- blood (buffy coat) or tissue culture
- polymerase chain reaction (PCR)
- leishmanin skin test (Montenegro skin test)
- serum HIV testing
cutaneous leishmaniasis (CL)
mucosal leishmaniasis (ML)
visceral leishmaniasis (VL)
post-kala-azar dermal leishmaniasis (PKDL)
- Hyper-reactive malarial splenomegaly (HMS)
- Malaria infection
- Guideline for the treatment of visceral leishmaniasis in HIV co-infected patients in East Africa and South-East Asia
- Guideline for the treatment of leishmaniasis in the Americas
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