Simple notes of cutenous leshmania

definition....
it's a parasitic infection caused by species of protozoa called leshmania .

Etiology...:
1-old world cutaneous leshmaniasis
1]leshmania tropica major
2]leshmania tropica minor
2-new world cutaneous leshmaniasis
1]leshmania maxican
2]leshmania amazonesis
3]leshmania colobiensis
Reservoir...
mainly dogs in the mediteranean area.

Vector...: female sand fly

season...:
*summer in leshmania trpoica major
*any time in leshmania trpoica minor

incubation period...:
*1-4 weeks in leshmania major
*2-8 weeks in leshmania minor

clinical description...:
*single or multiple localized or diffuse sores mainly on the arm or the face with multiple papules and nodules surrounded by depressed scar of healed papules and nodules *special signs :volcano sign,ice berg sign and satellite lesions.




Differential diagnosis ....:
1-pyoderma gangrenosum
2-deep fungal infection
3-mycobacterium infections
4-sarcoidosis
5-psoriasis
6-squamous cell carcinoma


investigations...:
1)skin scraping:
slit and smear giemsa or leshmania stain,scraping from the edge of the ulcer not from the centr because it healed by scar and not contain amastigoits.
2)serology and PCR[polymerase chain reaction] reveal lack of specifity
3)culture:NNNmedia(Novy Mac Neal Nicolle media)reveal a motile promastigoites.
4)dermatopatholgy:reveal macrophages filled with amastigoits mixed with lymphocytes ,plasma cells and other infiltrating cells.
5)needle aspiration:to visualize amastigoites.


Treatment...:
1- no specific threapy for traveler exist
2-specific treatment is delaed until ulceration occurs to allow the immunity to develop but if the lesin disfiguing or persists more than 6 months the treatment should be started.
3-small isolated lesions of leshmaniasis may be self limited and does not need a treatment.
4- the modules of treatment are :
a))local therapy for small lesions :-intralesional injection of antimonial
drug.[0.3-0.8ml]
-currtage, crysurgery, surgical excision
b))systemic therapy used for multiple lesions , facial lesions & visceral lesions,Using pentavalent antimonial [20mg/kg/day for 20 days IV or IM].
c))the antimonial drugs are :sodium stibogluconate(pentostam)--and meglumine antimonate.
The side effects of antimonial drugs are [chemical pacreatitis – arthralgia -elavetated serum transaminases – leukopenia – thrombocytopenia – peripheral neuropathy – cardiac conduction abnormality]