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Leishmaniasis
From WikEM
Contents
Background
- Vector: sandfly
- Occurs sporadically in rural Africa, Asia, Mediterranean, Central/South America
- Wide variety of symptoms given numerous species of protozoa
- 500,000 new cases and 60,000 deaths each year
Clinical Features
Cutaneous
- Single to diffuse nodules/plagues with central clearing/eschar/fibrinous exudate
Mucocutaneous
- Mucosal destruction, deformity nasal blockage, bleeding, increased secretions, sloughing of dead tissue, dysphonia, odynophagia, respiratory distress
Visceral (Kala-azar)
- Darkening of skin, malaise, fever, weight lost, splenomegaly with advanced disease causing hepatic dysfunction, jaundice, ascites, thrombocytopenia, and hemorrhagic complications
- Anemia, neutropenia, thrombocytopenia, hypoalbuminemia, hyperbilirubinemia
Differential Diagnosis
- Cutaneous/Mucocutaneous-bacterial skin infection
- Malignancy
- Sarcoidosis
- Spider bite
- Tropical ulcer
- Yaws
- Cutaneous anthrax
- Nocardia and actinomycosis
- Cutaneous tuberculosis
Evaluation
- CBC
- Chem
- Histology
- Culture
- Bone marrow or spleen biopsy (for visceral form)
- PCR
Management
- Uncomplicated cutaneous leishmaniasis
- Topical Paromomycin
- Local injection of Stibogluconate or Meglumine antimoniate
- Debridement of necrotic tissue
- Complicated cutaneous leishmaniasis
- PO Fluconazole or Miltefosine.
- IV Stibogluconate, Meglumine, Amphotericin B, or Pentamidine
- Visceral leishmaniasis
- Amphotericin B, Stibogluconate
Disposition
- Discharge with infectious disease followup
