II. Epidemiology
- See Leishmaniasis
III. Pathophysiology
- See Leishmaniasis
- Incubation: 2-8 weeks
IV. Types
- See Visceral Leishmaniasis
- Old World Cutaneous Leishmaniasis
- Acquired in Africa, Asia and Europe
- Causes
- Leishmania tropica (urban)
- Leishmania major (desert)
- Leishmania aethiopica
- Description
- Incubation 2-24 months
- Skin lesion on face or leg
- Papule becomes necrotic than hypopigmented scar
- New World Cutaneous and Mucocutaneous Leishmaniasis
- Acquired in latin america
- Causes
- Leishmania leishmania (e.g. mexicana, chagasi)
- Leishmania viannia (e.g. panamensis, braziliensis)
- Description
- Nodular or ulcers that heal on hands, ears, face
- Metastatic lesions may develop in nose years later
- Especially in untreated cases
- Mucosal lesion onset at nose and Palate
- Lesions are locally destructive of mucosa
- Diffuse Cutaneous Leishmaniasis
- Description
- Massive cutaneous dissemination
- No visceral involvement
- Description
V. Signs
- See Nodular Lymphangitis
- Primary Lesion 2 to 8 weeks after sandfly bite
- Secondary Lesions
- Nodular Lymphangitis may occur
- Ascending Nodules along lymph chain
- Systemic signs (rare in cutaneous disease)
- See Visceral Leishmaniasis for systemic disease
- Occurs in immunosuppressed patients (e.g. HIV)
- Fever
- Regional adenopathy
- Scarring
- Skin lesions spontaneously resolve in months
- Healing delayed in some forms (e.g. L. brazilensis)
- Round depressed scar forms on healing
VI. Differential Diagnosis
- Skin lesions: Nodular Lymphangitis
- Mucosal lesions
- See Oral Ulcer
VII. Diagnosis
- Skin scraping (5 slides)
- Remove crust before scraping
- Scrape lesion margin and central ulcer
- Punch Biopsy ulcer edge
- Needle aspirate
- Inject saline into border via skin
- Aspirate while inserting and withdrawing needle
- Culture aspirate on Nicolle-Novy-MacNeal media
VIII. Management
- See Visceral Leishmaniasis for systemic Leishmaniasis
- Cutaneous Leishmaniasis
- Treatment duration: 20 days
- Apply Local Heat to area for 2-3 hours per day
- Preferred agents: Pentavalent antimony
- Stibogluconate Sodium (Pentostam)
- Dose: 20 mg/kg/day for 20 days
- Meglumine antimonate (Glucantime)
- Dose: 20 mg/kg/day for 20 days
- Stibogluconate Sodium (Pentostam)
- Other antimicrobial options (unproven or toxic)
- Amphotericin B
- Dose: 0.5-1.0 mg/kg PO every other day x8 weeks
- Indicated for cases refractory to antimony
- Pentamidine isoethionate (Pentam 300)
- Significant toxicity
- Topical Paromomycin
- Effective for L. major and L. mexicana
- Allopurinol
- Not currently recommended due to unclear data
- Synergistic effect with antimonial agents
- Azole Antifungals
- Consider intralesional injection
- Amphotericin B
- Diffuse or Mucocutaneous Leishmaniasis
- Treatment duration: 30 days
- Sodium Antimony Gluconate 20 mg/kg IV/IM qd
IX. Prevention
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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 |
Ontology: 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 |
Ontology: 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 |
Ontology: 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) |
Ontology: 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 |