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Leishmaniasis 

Leishmaniasis

Chapter:
Leishmaniasis
Author(s):

A.D.M. Bryceson

and Diana N.J. Lockwood

DOI:
10.1093/med/9780199204854.003.070812_update_001

July 30, 2015: This chapter has been re-evaluated and remains up-to-date. No changes have been necessary.

Update:

Epidemiology and treatment—publication of WHO Expert Committee Report 2010.

Treatment—short course multidrug regimen trials in Indian subcontinent.

Diagnosis—increasing use of PCR-based methods.

Imported visceral leishmaniasis in immunosuppressed patients—problems with clinical recognition and laboratory diagnosis.

Updated on 31 May 2012. The previous version of this content can be found here.
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date: 30 March 2017

Leishmaniasis is caused by parasites of the genus Leishmania, which are transmitted to humans from human or animal reservoirs by the bites of phlebotomine sandflies. In places the disease is common and important, with perhaps 500 000 cases of visceral leishmaniasis and 1.5–2 million cases of cutaneous leishmaniasis worldwide each year. As an imported disease, cutaneous leishmaniasis is common in travellers, military personnel, and immigrants coming from endemic areas, while the diagnosis of the less common visceral leishmaniasis is frequently overlooked.

Cutaneous leishmaniasis

Clinical features—at the site of the infected sandfly bite, an erythematous nodule typically develops into a sore which fails to heal spontaneously in (1) diffuse cutaneous leishmaniasis; (2) leishmaniasis recidivans; and (3) American mucosal leishmaniasis (espundia)—a condition in which mucosal lesions develop in 4 to 40% of patients with untreated cutaneous ulcers due to L. brasiliensis; the nose is most commonly involved, and eventually the whole nose and mouth may be destroyed.

Diagnosis and treatment—diagnosis is by demonstration of leishmania organisms in tissue smears or biopsy material by microscopy, culture, or polymerase chain reaction (PCR). Many leishmanial sores can be left to heal naturally, but treatment is indicated for those that are severe, or failing to heal spontaneously, or due to particular species (e.g. L. brasiliensis). Treatment may be (1) local—e.g. surgery/curettage; infiltration with a pentavalent antimonial; or (2) systemic—most cutaneous species of leishmania are sensitive to pentavalent antimonials.

Visceral leishmaniasis

Zoonotic disease is common around the Mediterranean littoral, across the Middle East and central Asia, in northern and eastern China, and in South and Central America. Anthroponotic disease causes large outbreaks in North Eastern India and the Sudan.

Clinical features—most infections are subclinical, but clinical presentation is with gradual onset of fever, discomfort from an enlarged spleen, abdominal swelling, weight loss, cough, or diarrhoea. The illness may be associated with HIV infection.

Diagnosis and treatment—diagnosis is by isolation of leishmania from spleen, bone marrow, liver, lymph node, or buffy coat. Serology is useful for diagnosis, and may replace direct demonstration of parasites in remote areas. The best treatment is intravenous liposomal amphotericin B, but (much cheaper) pentavalent antimonials are most often used in countries where visceral leishmaniasis is endemic.

Prevention

Prevention is by controlling reservoir hosts and sandfly vectors, or by avoiding bites by vectors. There is no vaccine.

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