Infectious Disease Book

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Cutaneous Leishmaniasis

Aka: Cutaneous Leishmaniasis, Sporotrichoid Cutaneous Leishmaniasis, Old World Cutaneous Leishmaniasis, New World Cutaneous Leishmaniasis, Mucocutaneous Leishmaniasis, Diffuse Cutaneous Leishmaniasis, Leishmania tropica, Leishmania major, Leishmania leishmania, Leishmania viannia
  1. See Also
    1. Visceral Leishmaniasis
  2. Epidemiology
    1. See Leishmaniasis
  3. Pathophysiology
    1. See Leishmaniasis
    2. Incubation: 2-8 weeks
  4. Types
    1. See Visceral Leishmaniasis
    2. Old World Cutaneous Leishmaniasis
      1. Acquired in Africa, Asia and Europe
      2. Causes
        1. Leishmania tropica (urban)
        2. Leishmania major (desert)
        3. Leishmania aethiopica
      3. Description
        1. Incubation 2-24 months
        2. Skin lesion on face or leg
        3. Papule becomes necrotic than hypopigmented scar
    3. New World Cutaneous and Mucocutaneous Leishmaniasis
      1. Acquired in latin america
      2. Causes
        1. Leishmania leishmania (e.g. mexicana, chagasi)
        2. Leishmania viannia (e.g. panamensis, braziliensis)
      3. Description
        1. Nodular or ulcers that heal on hands, ears, face
        2. Metastatic lesions may develop in nose years later
          1. Especially in untreated cases
        3. Mucosal lesion onset at nose and Palate
        4. Lesions are locally destructive of mucosa
    4. Diffuse Cutaneous Leishmaniasis
      1. Description
        1. Massive cutaneous dissemination
        2. No visceral involvement
  5. Signs
    1. See Nodular Lymphangitis
    2. Primary Lesion 2 to 8 weeks after sandfly bite
      1. Erythematous Papule forms at sandfly bite site
      2. Papule grows into small Nodule
      3. Forms painless well demarcated ulcer
      4. Ulcer forms overlying crust
    3. Secondary Lesions
      1. Nodular Lymphangitis may occur
      2. Ascending Nodules along lymph chain
    4. Systemic signs (rare in cutaneous disease)
      1. See Visceral Leishmaniasis for systemic disease
      2. Occurs in immunosuppressed patients (e.g. HIV)
      3. Fever
      4. Regional adenopathy
    5. Scarring
      1. Skin lesions spontaneously resolve in months
      2. Healing delayed in some forms (e.g. L. brazilensis)
      3. Round depressed scar forms on healing
  6. Differential Diagnosis
    1. Skin lesions: Nodular Lymphangitis
    2. Mucosal lesions
      1. See Oral Ulcer
  7. Diagnosis
    1. Skin scraping (5 slides)
      1. Remove crust before scraping
      2. Scrape lesion margin and central ulcer
    2. Punch Biopsy ulcer edge
    3. Needle aspirate
      1. Inject saline into border via skin
      2. Aspirate while inserting and withdrawing needle
      3. Culture aspirate on Nicolle-Novy-MacNeal media
  8. Management
    1. See Visceral Leishmaniasis for systemic Leishmaniasis
    2. Cutaneous Leishmaniasis
      1. Treatment duration: 20 days
      2. Apply Local Heat to area for 2-3 hours per day
      3. Preferred agents: Pentavalent antimony
        1. Stibogluconate Sodium (Pentostam)
          1. Dose: 20 mg/kg/day for 20 days
        2. Meglumine antimonate (Glucantime)
          1. Dose: 20 mg/kg/day for 20 days
      4. Other antimicrobial options (unproven or toxic)
        1. Amphotericin B
          1. Dose: 0.5-1.0 mg/kg PO every other day x8 weeks
          2. Indicated for cases refractory to antimony
        2. Pentamidine isoethionate (Pentam 300)
          1. Significant toxicity
        3. Topical paromomycin
          1. Effective for L. major and L. mexicana
        4. Allopurinol
          1. Not currently recommended due to unclear data
          2. Synergistic effect with antimonial agents
        5. Azole Antifungals
        6. Consider intralesional injection
    3. Diffuse or Mucocutaneous Leishmaniasis
      1. Treatment duration: 30 days
      2. Sodium Antimony Gluconate 20 mg/kg IV/IM qd
  9. Prevention
    1. See Prevention of Vector-borne Infection
    2. Insect Repellant
  10. References
    1. Herwaldt (1999) Lancet 354:1191-9 [PubMed]
    2. Pearson (1996) Clin Infect Dis 22:1-13 [PubMed]
    3. Tobin (2001) Am Fam Physician 63(2):326-32 [PubMed]
    4. Markle (2004) Am Fam Physician 69(6):455-60 [PubMed]

Leishmania braziliensis (C0023271)

Definition (MSH) A parasitic hemoflagellate of the subgenus Leishmania viannia that infects man and animals. It causes cutaneous (LEISHMANIASIS, CUTANEOUS), diffuse cutaneous (LEISHMANIASIS, DIFFUSE CUTANEOUS), and mucocutaneous leishmaniasis (LEISHMANIASIS, MUCOCUTANEOUS) depending on the subspecies of this organism. The sandfly, Lutzomyia, is the vector. The Leishmania braziliensis complex includes the subspecies braziliensis and peruviana. Uta, a form of cutaneous leishmaniasis in the New World, is caused by the subspecies peruviana.
Concepts Eukaryote (T204)
MSH D007892
SnomedCT 7400004
English Leishmania brasiliensis, Leishmania braziliensis, Leishmania viannia, Leishmania (Viannia) brasiliensis, Leishmania viannia brasiliensis, Leishmania viannia braziliensis, Leishmania (Viannia) braziliensis, viannia brasilienses, Leishmania, brazilienses, Leishmania viannia, viannia braziliensis, Leishmania, Leishmania brazilienses, brazilienses, Leishmania, Leishmania brasilienses, brasilienses, Leishmania, braziliensis, Leishmania viannia, Leishmania viannia brasilienses, viannia brasiliensis, Leishmania, viannia brazilienses, Leishmania, brasiliensis, Leishmania viannia, brasiliensis, Leishmania, Leishmania viannia brazilienses, braziliensis, Leishmania, brasilienses, Leishmania viannia
French Leishmania viannia braziliensis, Leishmania braziliensis, Leishmania viannia brasiliensis, Leishmania brasiliensis
Swedish Leishmania braziliensis
Czech Leishmania braziliensis, ničivka brazilská
Finnish Leishmania braziliensis
Russian VOZBUDITEL' LEISHMANIOZA AMERIKANSKOGO, LEISHMANIA BRAZILIENSIS, LEISHMANIA AMERICANA, ВОЗБУДИТЕЛЬ ЛЕЙШМАНИОЗА АМЕРИКАНСКОГО
Japanese ブラジル・リーシュマニア, ブラジル型ブラジルリーシュマニア, ブラジルリーシュマニア
Italian Leishmania viannia brasiliensis, Leishmania viannia braziliensis, Leishmania (Viannia) braziliensis, Leishmania (Viannia) brasiliensis, Leishmania brasiliensis, Leishmania braziliensis
Polish Leishmania brasiliensis
Norwegian Leishmania viannia brasiliensis, Leishmania brasiliensis, Leishmania viannia braziliensis, Leishmania braziliensis
German Leishmania brasiliensis, Leishmania (Viannia) brasiliensis
Dutch Leishmania (Viannia) braziliensis, Leishmania braziliensis
Portuguese Leishmania braziliensis, Leishmania (Viannia) braziliensis
Spanish Leishmania braziliensis, Leishmania (Viannia) braziliensis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Leishmania major (C0023276)

Definition (MSH) A parasitic hemoflagellate of the subgenus Leishmania leishmania that infects man and animals and causes cutaneous leishmaniasis (LEISHMANIASIS, CUTANEOUS) of the Old World. Transmission is by Phlebotomus sandflies.
Definition (CSP) intracellular parasitic hemoflagellate of the subgenus Leishmania leishmania that infects man and animals and causes cutaneous ulcer form of leishmaniasis; transmission is by Phlebotomus sandflies; found in north and central Africa, Middle East, and southern Asia.
Concepts Eukaryote (T204)
MSH D018320
SnomedCT 51278002
English Leishmania tropica major, Leishmania leishmania major, Leishmania (Leishmania) major, Leishmania major, majors, Leishmania, tropica major, Leishmania, Leishmania tropica majors, Leishmania majors, major, Leishmania, leishmania major, Leishmania, leishmania majors, Leishmania, major, Leishmania leishmania, major, Leishmania tropica, Leishmania leishmania majors, majors, Leishmania tropica, majors, Leishmania leishmania, tropica majors, Leishmania, leishmania major, Leishmania major (organism)
French Leishmania leishmania major, Leishmania major, Leishmania tropica major
Swedish Leishmania major
Czech Leishmania major
Finnish Leishmania major
Russian LEISHMANIIA BOL'SHAIA, LEISHMANIIA TROPICHESKAIA BOL'SHAIA, LEISHMANIA MAJOR, LEISHMANIA (LEISHMANIA) MAJOR, LEISHMANIA TROPICA MAJOR, ЛЕЙШМАНИЯ БОЛЬШАЯ, ЛЕЙШМАНИЯ ТРОПИЧЕСКАЯ БОЛЬШАЯ
Japanese 森林型熱帯リーシュマニア, 森林型熱帯リーシュマニア(リーシュマニア属)
Italian Leishmania tropica major, Leishmania (Leishmania) major, Leishmania leishmania major, Leishmania major
Polish Leishmania tropica major, Leishmania major, Leishmania (leishmania) major
Norwegian Leishmania major, Leishmania leishmania major, Leishmania tropica major
Spanish Leishmania major (organismo), Leishmania major, Leishmania (Leishmania) major, Leishmania tropica major
German Leishmania (Leishmania) major, Leishmania major, Leishmania tropica major
Dutch Leishmania (Leishmania) major, Leishmania major, Leishmania tropica major
Portuguese Leishmania (Leishmania) major, Leishmania major, Leishmania tropica major
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Leishmania tropica (C0023280)

Definition (MSH) A parasitic hemoflagellate of the subgenus Leishmania leishmania that infects man and rodents. This taxonomic complex includes species which cause a disease called Oriental sore which is a form of cutaneous leishmaniasis (LEISHMANIASIS, CUTANEOUS) of the Old World.
Concepts Eukaryote (T204)
MSH D007895
SnomedCT 359786001, 53241007, 243653005, 359783009
LNC LP18313-4
English Leishmania tropica, Leishmania leishmania tropica, Leishmania (Leishmania) tropica, tropica minor, Leishmania, tropica minors, Leishmania, minor, Leishmania tropica, minors, Leishmania tropica, tropica, Leishmania leishmania, tropicas, Leishmania leishmania, tropica, Leishmania, leishmania tropica, Leishmania, leishmania tropicas, Leishmania, Leishmania leishmania tropicas, Leishmania tropicas, tropicas, Leishmania, Leishmania tropica minors, Leishmania tropica (living organism) (organism), Leishmania tropica (organism), Leishmania tropica minor (organism), Leishmania tropica (living organism) [Ambiguous], Leishmania tropica (living organism), Leishmania tropica minor
French Leishmania leishmania tropica, Leishmania tropica
Swedish Leishmania tropica
Czech Leishmania tropica
Finnish Leishmania tropica
Russian LEISHMANIIA TROPICHESKAIA, LEISHMANIIA MALAIA, LEISHMANIA TROPICA, ЛЕЙШМАНИЯ МАЛАЯ, ЛЕЙШМАНИЯ ТРОПИЧЕСКАЯ
Japanese 熱帯リーシュマニア, 熱帯リーシュマニア(リーシュマニア属)
Italian Leishmania leishmania tropica, Leishmania tropica minor, Leishmania (Leishmania) tropica, Leishmania tropica
Spanish Leishmania tropica (concepto no activo), Leishmania tropica (organismo vivo), Leishmania tropica, Leishmania tropica minor (organismo), leishmania tropica (organismo), leishmania tropica, Leishmania tropica minor, Leishmania (Leishmania) tropica
Polish Leishmania tropica
Norwegian Leishmania leishmania tropica, Leishmania tropica, Leishmania tropica minor
German Leishmania tropica
Dutch Leishmania (Leishmania) tropica, Leishmania tropica, Leishmania tropica minor
Portuguese Leishmania (Leishmania) tropica, Leishmania tropica minor, Leishmania tropica
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Leishmaniasis, Cutaneous (C0023283)

Definition (MSHCZE) Místní onemocnění charakteristické rozvojem jednotlivých nebo mnohonásobných lézí napadených částí kůže vředovitého vzhledu. Forma nemoci rozdělena dle místa výskytu – podle Starého a Nového světa. Leishmanióza Starého světa se dělí na tři odlišné typy podle epidemiologie a klinických příznaků a je způsobena prvoky rodu L. tropica and L. aethiopica, tak i L. major. Leishmanióza Nového světa, nazývaná též americká leishmanióza, se vyskytuje v Jižní a Střední Americe a způsobuje ji druh L. mexicana nebo L. braziliensis v souhrnu s L. major.
Definition (NCI) Leishmaniasis affecting the skin. It is the most common form of leishmaniasis. It presents with erythematous macules and papules, and nodules which may eventually ulcerate. The lesions appear in the bite site in the exposed skin areas.
Definition (MSH) An endemic disease that is characterized by the development of single or multiple localized lesions on exposed areas of skin that typically ulcerate. The disease has been divided into Old and New World forms. Old World leishmaniasis is separated into three distinct types according to epidemiology and clinical manifestations and is caused by species of the L. tropica and L. aethiopica complexes as well as by species of the L. major genus. New World leishmaniasis, also called American leishmaniasis, occurs in South and Central America and is caused by species of the L. mexicana or L. braziliensis complexes.
Concepts Disease or Syndrome (T047)
MSH D016773
ICD10 B55.1
SnomedCT 240637006
English Cutaneous Leishmaniases, Leishmaniases, Cutaneous, Leishmaniasis, Cutaneous, Leishmaniasis, Cutaneous [Disease/Finding], cutaneous leishmaniasis, leishmaniasis cutaneous, Cutaneous leishmaniasis (diagnosis), Cutaneous leishmaniasis, Cutaneous leishmaniasis (disorder), cutaneous; leishmaniasis, leishmaniasis; cutaneous, leishmaniasis; skin, skin; leishmaniasis, Cutaneous Leishmaniasis
Swedish Leishmaniasis, kutan
Japanese ヒフリーシュマニアショウ, リーシュマニア症-新世界, リーシュマニア症-アメリカ, 東邦腫, 東洋瘤腫, 東方腫, 皮膚リーシュマニア症, 旧世界リーシュマニア症, リーシュマニア症-旧世界, 東洋腫, 新世界リーシュマニア症, 熱帯リーシュマニア症, リーシュマニア症-皮膚, アメリカリーシュマニア症
Czech leishmanióza kožní, Kožní leishmanióza
Finnish Iholeishmaniaasi
Russian LEISHMANIOZ KOZHNYI, LEISHMANIOZ NOVOGO SVETA, LEISHMANIOZ STAROGO SVETA, LEISHMANIOZ AMERIKANSKII, ЛЕЙШМАНИОЗ АМЕРИКАНСКИЙ, ЛЕЙШМАНИОЗ КОЖНЫЙ, ЛЕЙШМАНИОЗ НОВОГО СВЕТА, ЛЕЙШМАНИОЗ СТАРОГО СВЕТА
German Kutane Leishmaniose, kutane Leishmaniase, Leishmaniose, kutane
Korean 피부 리슈만편모충증
Polish Leiszmaniozy skóry, Owrzodzenie orientalne, Leiszmanioza skórna, Leiszmanioza amerykańska, Leiszmanioza Starego Świata, Leiszmanioza Nowego Świata
Hungarian cutan leishmaniasis
Spanish Úlcera Oriental, leishmaniasis cutáneo (trastorno), leishmaniasis cutáneo, Leishmaniosis cutánea, Leishmaniasis Cutánea
Portuguese Botão Oriental, Leishmaniose cutânea, Leishmaniose Cutânea
Dutch cutaan; leishmaniasis, huid; leishmaniasis, leishmaniasis; cutaan, leishmaniasis; huid, cutane leishmaniasis, Cutane leishmaniasis, Leishmaniasis, cutane
French Bouton d'Orient, Leishmaniose cutanée
Italian Leishmaniosi cutanea
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Leishmania (Leishmania) (C0205817)

Concepts Eukaryote (T204)
MSH D007891
English Leishmania leishmania, Leishmanias (Leishmania), Leishmania leishmanias, leishmania, Leishmania, leishmanias, Leishmania, Leishmania (Leishmania)
Portuguese Leishmania (Leishmania)
Spanish Leishmania (Leishmania)
French Leishmania leishmania
German Leishmania leishmania
Czech Leishmania (Leishmania), Leishmania - podrod Leishmania
Italian Leishmania (Leishmania)
Norwegian Leishmania leishmania
Dutch Leishmania (Leishmania)
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Mucocutaneous leishmaniasis (C1328252)

Definition (MSHCZE) Nemoc charakterizuje chronické a progresivní rozšíření lézí kožní leishmaniózy Nového světa, která je způsobená druhem L. braziliensis, napadá sliznici nosu, nosohltanu a dutiny ústní krátce po objevení první kožní léze. Časté symptomy jsou nosní obstrukce a krvácení z nosu.
Definition (MSH) A disease characterized by the chronic, progressive spread of lesions from New World cutaneous leishmaniasis caused by species of the L. braziliensis complex to the nasal, pharyngeal, and buccal mucosa some time after the appearance of the initial cutaneous lesion. Nasal obstruction and epistaxis are frequent presenting symptoms.
Concepts Disease or Syndrome (T047)
MSH D007897
ICD9 085.5
ICD10 B55.2
SnomedCT 39625001, 186810001, 403135004
English Leishmaniases, Mucocutaneous, Leishmaniasis, Mucocutaneous, Mucocutaneous Leishmaniases, Mucocutaneous Leishmaniasis, American mucocutan leishmania, Mucosal leishmaniasis, Mucocutan leishmaniasis, Leishmaniasis, Mucocutaneous [Disease/Finding], leishmaniasis mucocutaneous, Mucocutaneous leishmaniasis (diagnosis), Espundia, American mucocutaneous leishmaniasis, American mucocutaneous leishmaniasis (disorder), espundia, Breda, leishmaniasis; mucocutaneous, mucocutaneous; leishmaniasis, Mucocutaneous leishmaniasis, Mucocutaneous leishmaniasis, (American), Mucocutaneous leishmaniasis, American
Dutch mucocutane leishmaniasis, (Amerikaans), mucosale leishmaniasis, espundia, leishmaniasis; mucocutaan, mucocutaan; leishmaniasis, mucocutane leishmaniasis, Leishmaniasis mucocutaneus, Mucocutane leishmaniasis
French Leishmaniose muco-cutanée, (américaine), Leishmaniose muqueuse, Espundia, Leishmaniose cutanéomuqueuse, Leishmaniose cutanéo-muqueuse, Leishmaniose muco-cutanée, Leishmaniose mucocutanée
German Schleimhaut-Leishmaniase, mukokutane Leishmaniase, (amerikanisch), Mukokutane Leishmaniose, Espundia, Leishmaniose, mukokutane
Italian Espundia, Leishmaniosi mucosa, Leishmaniosi mucocutanea [americana], Leishmaniosi mucocutanea
Portuguese Leishmaníase das mucosas, Leishmaníase mucocutânea (americana), Espundia, Leishmaniose mucocutânea, Leishmaniose Mucocutânea
Spanish Leishmaniosis mucocutánea (americana), Leishmaniosis mucosa, Espundia, leishmaniasis mucocutánea americana, espundia, leishmaniasis americana, leishmaniasis mucocutánea norteamericana (trastorno), leishmaniasis mucocutánea norteamericana, leishmaniasis mucocutánea, Leishmaniasis mucocutánea, Leishmaniasis Mucocutánea
Japanese エスプンディア, アメリカ粘膜皮膚リーシュマニア症, 粘膜リーシュマニア症, 粘膜皮膚リーシュマニア症, エスプンディア, アメリカネンマクヒフリーシュマニアショウ, ネンマクヒフリーシュマニアショウ, ネンマクリーシュマニアショウ
Swedish Leishmaniasis, mukokutan
Czech leishmanióza mukokutánní, Slizniční leishmanióza, Leishmanióza mukokutánní, Espundia, Mukokutánní leishmanióza (americká)
Finnish Limakalvo- ja iholeishmaniaasi
Russian LEISHMANIOZ SLIZISTO-KOZHNYI, ЛЕЙШМАНИОЗ СЛИЗИСТО-КОЖНЫЙ
Korean 점막피부 리슈만편모충증
Polish Lejszmanioza śluzówkowoskórna, Leiszmanioza śluzówkowoskórna, Lejszmanioza amerykańska
Hungarian Nyálkahártya leishmaniasis, Espundia, Mucocutan leishmaniasis, (amerikai), mucocutan leishmaniasis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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