Leishmaniasis: Difference between revisions
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==Background== | ==Background== | ||
[[File:Leishmaniasis life cycle diagram en.png|thumb|Life cycle]] | |||
*Vector: sandfly | *Vector: sandfly | ||
*Occurs sporadically in rural Africa, Asia, Mediterranean, Central/South America | *Occurs sporadically in rural Africa, Asia, Mediterranean, Central/South America | ||
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==Clinical Features== | ==Clinical Features== | ||
[[File:Leishmaniasis ulcer.jpg|thumb|Cutaneous leishmaniasis ulcer]] | |||
===Cutaneous=== | ===Cutaneous=== | ||
*Single to diffuse nodules/plagues with central clearing/eschar/fibrinous exudate | *Single to diffuse nodules/plagues with central clearing/eschar/fibrinous exudate | ||
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===Visceral (Kala-azar)=== | ===Visceral (Kala-azar)=== | ||
*Darkening of skin, malaise, fever, weight lost, splenomegaly with advanced disease causing hepatic dysfunction, jaundice, ascites, thrombocytopenia, and hemorrhagic complications | *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 | **Anemia, neutropenia, [[thrombocytopenia]], [[hypoalbuminemia]], hyperbilirubinemia | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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*Nocardia and actinomycosis | *Nocardia and actinomycosis | ||
*Cutaneous [[tuberculosis]] | *Cutaneous [[tuberculosis]] | ||
{{Travel Skin Conditions DDX}} | |||
==Evaluation== | ==Evaluation== | ||
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**Topical [[Paromomycin]] | **Topical [[Paromomycin]] | ||
**Local injection of Stibogluconate or Meglumine antimoniate | **Local injection of Stibogluconate or Meglumine antimoniate | ||
**Debridement of necrotic tissue | |||
*Complicated cutaneous leishmaniasis | *Complicated cutaneous leishmaniasis | ||
**PO [[Fluconazole]] or Miltefosine. | **PO [[Fluconazole]] or Miltefosine. | ||
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==Disposition== | ==Disposition== | ||
* | *Discharge with infectious disease followup | ||
==See Also== | ==See Also== | ||
Latest revision as of 12:22, 12 December 2020
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
- Papules
- Insect bites
- Scabies
- Seabather's eruption
- Cercarial dermatitis (Swimmer's Itch)
- Macular
- Sub Q Swelling and Nodules
- Ulcers
- Tropical pyoderma
- Leishmaniasis
- Mycobacterium marinum
- Buruli ulcer
- Dracunculiasis (Guinea Worm disease)
- Linear and Migratory Lesions
- Cutaneous larvae migrans
- Photodermatitis
See also domestic U.S. ectoparasites
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