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Leishmaniasis 

Leishmaniasis
Chapter:
Leishmaniasis
DOI:
10.1093/med/9780198729228.003.0084
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date: 17 June 2019

Leishmania species are intracellular protozoan parasites, with a dimorphic life cycle—amastigotes (intracellular form) in the host and promastigotes (extracellular form) in the vectors (sandflies). Leishmania causes three major types of clinical syndromes in humans and vertebrate hosts: cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis (MCL), and visceral leishmaniasis (VL). Globally, there are 1.5 million new cases of CL, 500 000 of VL, and about 70 000 deaths per year. In CL, caused by Leishmania major, tropica, and aethiopica in the Old World and numerous species in the New World, disease is limited to the skin, presenting with painless skin lesions/ulcers, which usually heal after 3–6 months, leaving a scar. In MCL, caused by New World species (e.g. Leishmania braziliensis), haematogenous spread from cutaneous lesions to the nasal or oropharyngeal mucosa results in serious and life-threatening manifestation. In VL (kala-azar), caused by Leishmania donovani/infantum, symptoms are non-specific, including fever, weakness, malaise, weight loss, and hepatosplenomegaly. Other manifestations include pancytopenia with bone marrow infiltration. Children may be misdiagnosed as having leukaemia or lymphoma. Without treatment, prognosis in VL is poor. Diagnosis is by direct microscopic visualization of amastigotes or promastigotes (culture) in biopsies from the skin (CL, MCL) or viscera (VL). Polymerase chain reaction diagnosis allows species identification. Serology is useful, mainly in VL. Systemic therapy with parenteral antimony or amphotericin B is indicated in all cases of VL and MCL. CL treatment relies on topical/local treatment and several systemic treatment options. Prevention focuses on vector control.

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