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.
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Cutaneous Leishmaniasis |
Cutaneous anthrax |
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* 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 |
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