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Chapter 8 : Leishmaniasis

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Abstract:

Leishmaniasis refers to a diverse group of diseases, with the spectrum of disease depending on the infecting species. , , , and, rarely, cause cutaneous disease in the Old World; disease manifestations include nodular and ulcerative skin lesions. Lesions usually occur on exposed parts of the body such as the face, hands, feet, arms, and legs; uncommon sites include the ears, tongue, and eyelids. Lymphatic spread may occur in infections, with subcutaneous nodules in a linear distribution and regional lymphadenopathy; if the initial lesion is on the hand, this clinical presentation may resemble sporotrichosis. The majority of AIDS patients present with the classical picture of visceral leishmaniasis (VL), but asymptomatic cutaneous leishmaniasis (CL), mucocutaneous leishmaniasis, “disseminated” CL (DCL), and post-kala-azar dermal leishmaniasis can be seen. The RK39 strip test is ideal for rapid reliable field diagnosis of VL. The test has high sensitivity and specificity; however, it remains positive long after treatment. causes subclinical infections and American visceral leishmaniasis (AVL), which is potentially fatal if not treated, and it has recently been associated with atypical cutaneous leishmaniasis (ACL) in Central America, particularly in Honduras. PCR will probably become the test of choice, as with other types of leishmaniasis, but the practicality and cost issues mean that routine methods will continue to be the most likely approach, particularly since the majority of cases are seen in more remote rural areas.

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8

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Infectious Diseases
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Cutaneous Leishmaniasis
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Visceral Leishmaniasis
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Mucocutaneous Leishmaniasis
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Figures

Image of Figure 8.1
Figure 8.1

Geographic distribution of the agents of Old World cutaneous leishmaniasis.

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Image of Figure 8.2
Figure 8.2

life cycle.

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Image of Figure 8.3
Figure 8.3

stages found in human and insect hosts. (Illustration by Nobuko Kitamura.)

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Image of Figure 8.4
Figure 8.4

(Top) Cutaneous leishmaniasis facial lesion. (Armed Forces Institute of Pathology photograph.) (Middle) Examples of cutaneous lesions on the hand and arm. (Bottom) Extensive cutaneous lesion on the hand.

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Image of Figure 8.5
Figure 8.5

Geographic distribution of the agents of Old World visceral leishmaniasis.

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Image of Figure 8.6
Figure 8.6

(Upper) amastigotes in a macrophage. (Lower) The nucleus and kinetoplast are visible within many of the amastigotes (arrows). (Courtesy of the Centers for Disease Control and Prevention.)

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Image of Figure 8.7
Figure 8.7

(A) amastigotes in bone marrow (illustration by Sharon Belkin); (B and C) amastigotes in touch preparations (tissue imprints).

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Image of Figure 8.8
Figure 8.8

Cachexia (wasting) seen in severe visceral leishmaniasis. (Courtesy of Richard D. Pearson.)

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Image of Algorithm 8.1
Algorithm 8.1

Visceral leishmaniasis.

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Image of Figure 8.9
Figure 8.9

Healed facial scar, “Seal of the Forest” (Costa Rica). (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Image of Figure 8.10
Figure 8.10

Facial lesion on a 9-month-old girl. (Courtesy of Yoshihisa Hashiguchi.)

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Image of Figure 8.11
Figure 8.11

Large erythematous nodule with early ulceration on the right wrist, due to (Courtesy of Bonnie B. Furner.)

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Image of Figure 8.12
Figure 8.12

Mucocutaneous lesions on a 7-year-old girl with disseminated leishmaniasis. (Courtesy of Yoshihisa Hashiguchi.)

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Image of Figure 8.13
Figure 8.13

Two erythematous facial lesions on the right cheek of a 5-month-old boy infected with (Courtesy of Yoshihisa Hashiguchi.)

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Image of Figure 8.14
Figure 8.14

Diffuse anergic cutaneous leishmaniasis due to in a patient of Dr. Convit (Venezuela). (From A Pictorial Presentation of Parasites: A cooperative collection prepared and/or edited by H. Zaiman.)

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
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Tables

Generic image for table
Table 8.1

Taxonomic classification of parasites pathogenic for humans

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
Generic image for table
Table 8.2

Old World cutaneous leishmaniasis, subgenus

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
Generic image for table
Table 8.3

Features of Old World human leishmanial infections related to demonstration of the parasite

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
Generic image for table
Table 8.4

Old World visceral leishmaniasis

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
Generic image for table
Table 8.5

New World cutaneous leishmaniasis subgenus , complex

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
Generic image for table
Table 8.6

New World cutaneous leishmaniasis, subgenus complex

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
Generic image for table
Table 8.7

New World cutaneous leishmaniasis, subgenus , complex

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
Generic image for table
Table 8.8

Features of New World human leishmanial infections related to demonstration of the parasite

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
Generic image for table
Table 8.9

New World (American) visceral leishmaniasis

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8
Generic image for table
Table 8.10

Specific drugs for the treatment of visceral leishmaniasis (see also chapter 25)

Citation: Garcia L. 2007. Leishmaniasis, p 190-217. In Diagnostic Medical Parasitology, Fifth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555816018.ch8

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