Last reviewed: 1 Jul 2021
Last updated: 28 May 2020

Summary

Definition

History and exam

Key diagnostic factors

  • previous stay in endemic area
  • immunosuppression
  • prolonged fever
  • weight loss
  • ulcerative skin lesions
  • presence of risk factors
  • multiple non-ulcerative skin nodules
  • destructive mucosal inflammation
  • splenomegaly
  • skin darkening

Other diagnostic factors

  • fatigue
  • cough
  • headache
  • wasting
  • enlarged lymph nodes
  • hepatomegaly
  • previous anti-leishmanial treatment
  • epistaxis
  • abdominal pain

Risk factors

  • high exposure to sand fly bites
  • poverty
  • proximity to a patient with a history of infection
  • ownership of domestic animals
  • immunosuppression

Diagnostic investigations

1st investigations to order

  • FBC
  • LFTs and urea/creatinine
  • serum human chorionic gonadotrophin (hCG)

Investigations to consider

  • microscopic examination of relevant specimen
  • blood or tissue culture
  • polymerase chain reaction (PCR)
  • serology
  • leishmanin skin test (Montenegro skin test)
  • serum HIV testing

Treatment algorithm

Contributors

Authors

Naomi E. Aronson, MD

Professor of Medicine

Director, Infectious Diseases Division

Uniformed Services University of the Health Sciences

Bethesda

MD

Disclosures

NEA receives federal grants to study leishmaniasis, has given lectures on the topic of leishmaniasis at national and international meetings, was part of a committee that developed the US guidelines on the diagnosis and treatment of leishmaniasis, and has a patent on biomarkers for leishmaniasis. NEA receives royalties from Elsevier for editing Hunter’s textbook of Tropical Medicine and Emerging Infectious Diseases, and from UpToDate for writing on cutaneous leishmaniasis. NEA is an author of a number of references cited in this topic. The views expressed in this topic are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, the Department of Defense, or the US Government.

Nathanial K. Copeland, MD, MTM&H

Assistant Professor of Medicine

Uniformed Services University of the Health Sciences

Bethesda

MD

Disclosures

NKC is an author of a number of references cited in this topic. The views expressed in this topic are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, the Department of Defense, or the US Government.

Acknowledgements

Professor Naomi E. Aronson and Dr Nathanial K. Copeland would like to gratefully acknowledge Professor Richard Reithinger and Professor François Chappuis, previous contributors to this topic.

Disclosures

RR and FC are authors of a number of references cited in this topic.

Peer reviewers

Roberto Arenas, MD

Chief of the Mycology Section

Dr. Manuel Gea Gonzalez General Hospital

Mexico

Disclosures

RA is the author of an article cited in this topic.

Caryn Bern, MD

Medical Epidemiologist

Centers for Disease Control and Prevention

Atlanta

GA

Disclosures

CB is an author of a number of references cited in this topic.

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