Adventure Doc
keeping you healthy for life's adventures
Erik McLaughlin MD, MPH
Affiliates
LEISHMANIA
Basics:
Two main types of this disease exist, cutaneous (aka Baghdad boil) and visceral (aka Kala Azar). Visceral disease primarily involves the liver and spleen with fever. Different species of Leismania are geographically based. Promastigotes invade reticuloendothelial cells and mature to amastigotes. Approximately 2 million new cases per year are estimated.
LEISHMANIA
Location:
New World Cutaneous Leishmaniasis is found in Central and South America (Mexico, Guatemala, Belize, Brazil, Venezuela, Ecuador, Peru, Hinduras, Colombia and Costa Rica) in rural forests. Old World Cutaneous Leishmaniasis is found in the Middle East, Mediterranean Basin, Southwest Asia, and Sub-Saharan Africa. Visceral Leishmaniasis can be seen in the Mediterranean basin, India, China, East Africa, Central and South America.
Transmission/ Incubation:
Acquired from the bite of an infected Phlebotamine Sandflies. Dogs and rodents are primary animal reservoirs. A 2-6 month incubation from infection to cutaneous nodules/lesions is observed. Visceral forms can have a 2-8 month incubation.
Prevention:
Vector and reservoir control, prevention of insect bites
PRODUCT REVIEWS
Diagnosis:
Demonstration of organism in smear of cutaneous lesion or bone marrow biopsy showing amastigotes in visceral form of disease. The Montenegro skin test is positive in chronic infection.
Treatment:
The drug class to know is “Pentavalent Antimonials”. Generally a self-limited disease, cutaneous leishmaniasis treatment has to be compared to the toxicity of the medicine. Stibogluconate (Pentosam) 20mg/kg/day for 3 weeks is standard and can be given IM or IV. Ketoconazole has also been shown to be effective as second line treatment, along with Pentamidine. Cryotherapy (freezing) and surgical excision for early lesions may reduce scarring. For visceral leismaniasis, stilboglucaonate is also used at the above dose but given IV for 28 days.
CUTANEOUS
VISCERAL
Cutaneous Lesihmaniasis effects the skin causing chronic ulcers. Lesions may heal spontaneously in weeks or last for years. Secondary skin infections must be prevented with topical antibiotic creams.
Espundia is a variation found primarily in South American and is known to involve the nose and mucous membranes.
Visceral Leishmaniasis is also know as Kala Azar (an Indian term meaning “the black fever”) effects primarily the liver and spleen causing massive hepatomegaly (enlarged liver) and fever. The organs are generally non-tender. Lymph node enlargement (lymphadenopathy) is also seen in Mediterranean forms. A skin nodule often develops at the bite site has generally cleared by time of diagnosis.
Left untreated, the disease may progress to a chronic form and begin to destroy bone marrow, causing anemia.
Symptoms may persist for months for symptoms to resolve and annual checks must be completed to assure total cure.
Leishmania Tropica
is known for causing a singular that heals much slower (1 year).
Leishmania Major
frequently causes multiple lesions and heals in a shorter time period (6 months).
Leishmania Donovani
is found in India and Africa.
Leishmania Aethiopica
Leishmania Infantum
usually produces a single ulcer and takes up to 2 years to heal.
can be seen in Mediterranean areas, the Middle East, and South Russia/ North China.
The Montenegro skin test is performed by intradermal injection of promastigote antigen, similar to a PPD for tuberculosis.
Leishmania Chagasi
is found exclusively in South America.
Visceral Leishmaniasis is a disease of rural environments.
Leishmania Donovani
in bone marrow
image from
VISCERAL
Phlebotomus species
"Sand fly"
Leishmania Donovani
Leishmania Infantum
Leishmania Chagasi
Responsible for both, Cutaneous and Visceral Leishmania
CUTANEOUS
Old World
New World
Leishmania Tropica
Leishmania Major
Leishmania Aethiopica
Leishmania Mexicana
Leishmania Amazonensis
Leishmania Braziliensis
Espundia (Mucous Membrane involvement)
Facial Sore with Cutaneous Leishmaniasis
Leishmania Amastigotes erupting from macrophage
Cutaneous Leishmaniasis
