小结
定义
病史和体格检查
关键诊断因素
- 以往有在流行区内居住史
- 免疫抑制
- 持续性发热
- 体重减轻
- 溃疡性皮肤病变
- 存在的危险因素
- 多处产生非溃疡性皮肤结节
- 破坏性黏膜炎症
- 脾肿大
- 皮肤色素沉着
其他诊断因素
- 疲劳
- 咳嗽
- 头痛
- 消瘦
- 淋巴结肿大
- 肝肿大
- 既往抗利什曼原虫治疗
- 鼻衄
- 腹痛
危险因素
- 高度暴露于白蛉叮咬
- 贫穷
- 近距离接触有感染史的患者
- 家畜饲养者
- 免疫抑制
诊断性检查
首要检查
- 全血细胞计数 (FBC）
- 肝功能检查和尿素/肌酐
- 血清人绒毛膜促性腺激素（hCG）
需考虑的检查
- 相关标本的显微镜检查
- 血（血沉棕黄层）或组织培养
- 聚合酶链反应 (PCR)
- 血清学
- 利什曼素皮肤试验（蒙氏皮肤试验）
- 血清 HIV 检测
治疗流程
皮肤利什曼病（CL）
黏膜利什曼病（ML）
内脏利什曼病（VL）
黑热病后皮肤利什曼病（Post-kala-azar Dermal Leishmaniasis, PKDL）
复发
撰稿人
作者
Naomi E. Aronson, MD
Professor of Medicine
Director, Infectious Diseases Division
Uniformed Services University of the Health Sciences
Bethesda
MD
利益声明
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 has received honoraria from the Welcome Trust and the Leventis Foundation, University of Cyprus for programme and grant reviews. NEA's institution USU has received royalties for her writing and editorial work for Elsevier and UpToDate. Additionally USU has received funding for leishmaniasis grants that NEA applied for from Defense Health Agency, and an intent to fund from National Institutes of Health. NEA serves unpaid as a member of the NIH, CDC, HIVMA opportunistic infections/geographic infections section guideline writing committee. NEA has been invited to speak at IDWeek, Am Soc Trop Med Hygiene, WorldLeish 7, Center for Newcomer Health, University of Oklahoma, University of Iowa, National Institutes of Allergy and Infectious Diseases, and DC tropical rounds on topic leishmaniasis. NEA has assisted CDC with developing published FAQs regarding leishmaniasis in operation allied welcome (Afghanistan refugees). 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
利益声明
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.
鸣谢
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.
利益声明
RR and FC are authors of a number of references cited in this topic.
同行评议者
Roberto Arenas, MD
Chief of the Mycology Section
Dr. Manuel Gea Gonzalez General Hospital
Mexico
利益声明
RA is the author of an article cited in this topic.
鉴别诊断
- 超反应性疟疾性脾肿大 (HMS)
- 疟疾感染
- 血吸虫病
更多 鉴别诊断指南
- 东非和东南亚 HIV 合并感染患者的内脏利什曼病治疗指南
- 美洲利什曼病治疗指南
更多 指南
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