1. LEISHMANIASIS
Fatih Kökdere

2. Leishmaniasis is a protozoan disease caused by any severeal species of Leishmania. It is transmitted to humans and other mammals by the blood sucking Phelebotomine sand fly. Parasite, host and other factors affect whether the infection symptomatic and whether cutaneous or visceral leishmaniasis results. Cutaneous Leishmaniasis appears in two forms: Old World and New World
Old World Leishmaniasis
New World Leishmaniasis
Leishmania major
Leishmania aethiopica
Leishmania mexicana
Leishmania braziliensis

3. Old World Leishmaniasis : Middle East, Asia, Africa, and Southern Europe New World Leishmaniais: Latin and Central America
Most of the affected countries are in the tropics and subtropics. Cutaneous leishmaniasis is endemic in more than 70 countries, and 90% of cases occur in Saudi Arabia, Syria, Afghanistan, Algeria, Pakistan, Brazil, and Peru.

4. Leishmania Life Cycle

5. Clinical Features There are two forms of leishmaniasis disease:
Cutaneous leishmaniasis and visceral leishmaniasis (kala-azar).
The form of disease is determined by species, geographic distribution, and immune response

6. Cutenaous Leishmaniasis
Lesions appear on exposed skin surfaces, especially on the extremities and face.
The incubation period is variable. Lesions typically appear several weeks after a fly bite but lesions may appear days or months later.
A painless papule forms at the bite site, enlarges to a nodule, crusts in the center, and ulcerates over 1 to 3 months. The ulcer has raised edges and the surrounding skin is dusky red.
The lesion usually heals by involution within 6 months without treatment. On microscopic examination, the lesion is granulomatous, usually with many giant cells and few parasites.

7. Cutenaous Leishmaniasis
Cutaneous leishmaniasis. A red papule eventually ulcerates and forms raised edges with surrounding dusky red skin.

8. Cutenaous Leishmaniasis

9. Cutenaous Leishmaniasis

10. Diffuse Cutenaous Leishmaniasis
In diffuse cutaneous leishmaniasis, seen rarely in Ethiopia and adjacent East Africa and Latin America, parasite - laden nodules are widespread and do not ulcerate.
Diffuse cutaneous leishmaniasis begins as a single skin nodule, which continues spreading until the entire body is covered by bizarre nodular lesions.
Patients are usually immunologically unresponsive not only to leishmanin but also to other skin antigens, and the lesions often respond poorly to treatment.

11. Diffuse Cutenaous Leishmaniasis

12. Diffuse Cutenaous Leishmaniasis
These lesions, which resemble keloids or large verrucae, are frequently
confused with the nodules of lepromatous leprosy.

13. Mucocutaneous Leishmaniasis
Mucosal dissemination occurs in 1% to 10% of infections, developing 1 to 5 years after cutaneous leishmaniasis lesions have healed, but sometimes coincident with active skin lesions.
Mucocutaneous leishmaniasis is caused by L. brasiliensis in the Americas. L.aethiopica has been reported to cause this disease in the Old World.

14. Mucocutaneous Leishmaniasis
Mucosal disease begins with erythema and ulcerations at the nares
and progresses to nasal septum perforation with mutilation of the nose, mouth, oropharynx, and trachea

15. Mucocutaneous Leishmaniasis

16. Visceral Leishmaniasis (Kala – Azar)
Visceral leishmaniasis is caused by L. donovani in India and Kenya, L. infantum in South Europe and North Africa, and L. chagasi in the Americas.
The parasites invade macrophages throughout the mononuclear phagocyte system and cause severe systemic disease marked by hepatosplenomegaly, lymphadenopathy, pancytopenia, fever, night sweats, and weight loss.
Untreated disease results in profound cachexia, bleeding from thrombocytopenia, susceptibility to secondary infections and death.

17. Visceral Leishmaniasis (Kala – Azar)

18. Diagnosis
The diagnosis is made clinically and may be confirmed with smears and biopsy.
Examination of Giemsa-stained slides of tissue is the most commonly used diagnostic technique.
Polymerase chain reaction (PCR) techniques provide rapid diagnosis of Leishmania species. The test is becoming more widely available.

20. Treatment
Cutaneous leishmaniasis is treated to accelerate cure, to reduce scarring, and to attempt to prevent dissemination (e.g., mucosal disease) or relapse. Treatment is given for persistent lesions (6 months), for lesions that are located over joints, or for multiple (5 to 10 or more) or large (4 to 5 cm in diameter) lesions.

21. Treatment
The World Health Organization considers pentavalent antimony as the standard treatment.
The two compounds used are sodium stibogluconate and meglumine antimoniate.
CDC recommends a daily dose of 20 mg/kg body weight of sodium stibogluconate administered intravenously (IV) for 20 consecutive days.
The advantages of intralesional administration are higher drug concentration at the site of infection, reduced systemic toxicity, faster time to healing, and reduced cost.
Side effects are myalgias and arthralgias, cardiotoxicity, pancreatitis and renal failure. Most of these side effects are reversible.

22. Treatment
Alternative treatments include amphotericin B, especially for mucosal leishmaniasis or for HIV coinfected patients, pentamidine, miltefosine, and thermotherapy.
Other reported treatments include oral itraconazole and fluconazole, rifampicin, metronidazole and cotrimoxazole, IV or topical amphotericin B, oral dapsone, photodynamic therapy, and laser cryotherapy.

23. References
Habif, T.P. (2009) Clinical Dermatology: Expert consult - online and print, A color guide to diagnosis and therapy. 5th edn. Edinburgh: Elsevier Health Sciences.
WHO (2016) Leishmaniasis. Available at: (Accessed: 30 November 2016).
(No Date) Available at: (Accessed: 30 November 2016).
Yazdi, C.A., Narmani, M.R. and Sadri, B. (2002) ‘Cutaneous Leishmaniasis in Iran’, The Internet Journal of Infectious Diseases, 3(1).
Indian journal of Dermatology, Venereology and Leprology (IJDVL) (2003) Available at: (Accessed: 30 November 2016).
Introduction Leishmaniasis (no date) Available at: (Accessed: 30 November 2016).
Leishmaniasis: Practice essentials, background, Pathophysiology (2016) Available at: (Accessed: 30 November 2016).
Lab practical 1 (2016) Available at: (Accessed: 30 November 2016).
LEISHMANIOSIS o LEISHMANIASIS- Recursos en Parasitología (2012) Available at: (Accessed: 30 November 2016).