Cutaneous Leishmaniasis

Leishmaniasis is an infection caused by the protozoan parasite belonging to the genus Leishmania. Natural reservoirs are rodents and domesticated dogs, and the vector is the sandfly, a small mosquito-like insect. Ninety percent of all cases of leishmaniasis occur in Saudi Arabia, Iran, Afghanistan, Brazil, and Peru.

The disease begins as a small, red, painless papule, usually 2 to 4 weeks after the sandfly bite. The papule enlarges to approximately 2 cm over the next 2 to 4 weeks and becomes dusky red to violaceous in color. The lesion becomes crusted over, and if the crust is removed, a shallow ulcer can be found with a raised, indurated border. Cutaneous leishmaniasis may be associated with small satellite lesions and nodules along the course of the draining lymphatics. After the lesion has been present for 2 months, it ceases expanding and after 3 to 6 months begins to heal, leaving a depressed scar. The number of lesions can range from 1 to 100 or more. Diagnosis depends upon finding the parasites in the skin.

Differential Diagnosis: Cutaneous leishmaniasis can be distinguished from cutaneous anthrax in the following manner.

Cutaneous Leishmaniasis

 

Cutaneous anthrax

* Patient has traveled to or resides in an endemic area

* Lesions slowly evole from papule to ulcer

*Nodular lymphangitis may be an associated sign

* Eschar is absent

 

* Ulcer and eschar are surrounded by characteristic non-pitting edema

* Lesion undergoes rapid progression from papule, vesicle, or bulla, to formation edema, necrotic ulcer, and eschar

 

Leishmaniasis

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