infectious diseases
Leishmaniasis
Introduction
Leishmaniasis is caused by species ofLeishmania. Manifestations include cutaneous, mucosal, and visceral syndromes. Cutaneous leishmaniasis causes painless chronic skin lesions ranging from nodules to large ulcers that can persist for months to years but eventually heal. Mucosal leishmaniasis affects nasopharyngeal tissues and can cause gross mutilation of the nose and palate. Visceral leishmaniasis causes irregular fever, hepatosplenomegaly, pancytopenia, and polyclonal hypergammaglobulinemia with high mortality in untreated patients. Diagnosis is by demonstrating parasites in smears or cultures and increasingly by polymerase chain reaction (PCR)–based assays at reference centers. Serologic testing can be helpful in diagnosing visceral but not cutaneous leishmaniasis. Treatment of visceral leishmaniasis is with liposomalamphotericin Bormiltefosine, depending on the infectingLeishmaniaspecies and the geographic area of acquisition. Alternatives includeamphotericin Bdeoxycholate and pentavalent antimony compounds (sodium stibogluconateor meglumine antimoniate) if disease was acquired in areas whereLeishmaniaspecies are likely to be susceptible. A variety of topical and systemic treatments are available for cutaneous leishmaniasis depending on the causative species and clinical manifestations. Leishmaniasis is present in scattered areas worldwide. Human infection is caused by 20Leishmaniaspecies that are morphologically indistinguishable but can be differentiated by laboratory analysis. 