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Chapter 27 : Leishmaniasis

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Abstract:

  • Cutaneous Leishmaniasis: General Comments
  • Old World (Eastern) Leishmaniasis: Cutaneous Leishmaniasis
  • New World (Western) Leishmaniasis: Cutaneous Leishmaniasis
  • Visceral Leishmaniasis: General Comments
  • Old World (Eastern) Leishmaniasis: Visceral Leishmaniasis
  • New World (Western) Leishmaniasis: Visceral Leishmaniasis

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.1
Figure 27.1

Geographic distribution of the agents of cutaneous leishmaniasis (courtesy of ). doi:10.1128/9781555819002.ch27.f1

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.2
Figure 27.2

life cycle. doi:10.1128/9781555819002.ch27.f2

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.3
Figure 27.3

Sandfly vector of leishmaniasis taking a blood meal through human skin; note the “V” position of wings over the thorax, erythema around bite site, and hairy body and wings (courtesy of WHO, S. Stammers). doi:10.1128/9781555819002.ch27.f3

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Figure 27.4

stages found in human and insect hosts. (Illustration by Nobuko Kitamura.) doi:10.1128/9781555819002.ch27.f4

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.5
Figure 27.5

(Top) Child with cutaneous leishmaniasis (CL) awaiting treatment in Kabul, Afghanistan (courtesy of WHO, C. Black). Kabul, Afghanistan harbors the largest number of CL patients in the world. (Middle and bottom) CL lesions. doi:10.1128/9781555819002.ch27.f5

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.6
Figure 27.6

Leishmaniasis recidivans (LR) is a rare complicating form of cutaneous leishmaniasis caused by . After healing of the initial lesion, a few soft red papules may appear at or around the scar of the previously healed lesion that spread peripherally with no tendency for spontaneous healing. Few parasites are found in the skin smear or biopsy. (Courtesy of the Global Skin Atlas, submitted by Nameer Al-Sudany; http://www.globalskinatlas.com/imagedetail.cfm?TopLevelid=2268&ImageID=5064&did=458.) doi:10.1128/9781555819002.ch27.f6

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.7
Figure 27.7

Diffuse cutaneous leishmaniasis seen in an HIV-positive patient (courtesy of Purohit HM et al, 62–64, 2012). doi:10.1128/9781555819002.ch27.f7

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.8
Figure 27.8

Cutaneous leishmaniasis. Smear of skin lesion with amastigotes with the macrophage; Giemsa stain. In these types of preparations, often some of the amastigotes will appear outside of the cells (arrow). (Courtesy of the Armed Forces Institute of Pathology.) doi:10.1128/9781555819002.ch27.f8

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.9
Figure 27.9

sp. promastigotes in culture. (Upper) Wet mount. (Lower) Stained organisms; note promastigotes dividing by longitudinal binary fission (arrow). (Courtesy of WHO, images from Jorge Alvar.) doi:10.1128/9781555819002.ch27.f9

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.10
Figure 27.10

LST (Montenegro skin test); positive test result (courtesy of , University of California, Davis, eScholarship http://escholarship.org/uc/item/9ct3h710). doi:10.1128/9781555819002.ch27.f10

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.11
Figure 27.11

New World cutaneous leishmaniasis: multiple ulcers and scarring, Peru (from : a cooperative collection prepared and/or edited by H. Zaiman). doi:10.1128/9781555819002.ch27.f11

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.12
Figure 27.12

New World cutaneous leishmaniasis: six examples of cutaneous lesions. (From : a cooperative collection prepared and/or edited by H. Zaiman.) doi:10.1128/9781555819002.ch27.f12

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.13
Figure 27.13

Large erythematous nodule with early ulceration on the left wrist, due to . (Courtesy of Bonnie B. Furner.) doi:10.1128/9781555819002.ch27.f13

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.14
Figure 27.14

Mucocutaneous leishmaniasis, several examples of typical lesions (from : a cooperative collection prepared and/or edited by H. Zaiman). (Bottom image courtesy of Yoshihisa Hashiguchi.) doi:10.1128/9781555819002.ch27.f14

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.15
Figure 27.15

Mucocutaneous leishmaniasis. (Upper) Patient prior to therapy; (lower) patient after therapy (from : a cooperative collection prepared and/or edited by H. Zaiman). doi:10.1128/9781555819002.ch27.f15

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.16
Figure 27.16

Diffuse anergic cutaneous leishmaniasis due to in a patient of Dr. Convit (Venezuela). (From : a cooperative collection prepared and/or edited by H. Zaiman.) doi:10.1128/9781555819002.ch27.f16

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.17
Figure 27.17

Geographic distribution of the agents of visceral leishmaniasis (courtesy of ). doi:10.1128/9781555819002.ch27.f17

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.18
Figure 27.18

(Top) amastigotes in bone marrow (illustration by Sharon Belkin). (Middle) Light-microscopic examination of a stained bone marrow specimen from a patient with visceral leishmaniasis, showing a macrophage containing multiple amastigotes. Note that each amastigote has a nucleus (red arrow) and a rod-shaped kinetoplast (black arrow). Visualization of the kinetoplast is important for diagnostic purposes, to be confident the patient has leishmaniasis. (Bottom) within bone marrow specimen. doi:10.1128/9781555819002.ch27.f18

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.19
Figure 27.19

(Upper) Marked splenomegaly in a patient in lowland Nepal who has visceral leishmaniasis (VL) (courtesy of the CDC Public Health Image Library, C. Bern). (Lower) Marked splenomegaly and hepatomegaly in a patient with VL (courtesy of WHO, image from Philippe Desjeux). doi:10.1128/9781555819002.ch27.f19

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.20
Figure 27.20

Cachexia (wasting) seen in severe visceral leishmaniasis (courtesy of Richard D. Pearson). doi:10.1128/9781555819002.ch27.f20

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.21
Figure 27.21

Post-kala azar dermal leishmaniasis (PKDL). (Upper) Notice the depigmented macules on the skin of a patient from India. This patient was treated for visceral leishmaniasis with miltefosine 7 years prior. He developed hypopigmented lesions about 3 years ago, which gradually became depigmented. With therapy the lesions disappeared. (Courtesy Koley S et al, 241, http://www.e-ijd.org/text.asp?2013/58/3/241/110848.) (Lower) Patient with rash all over her body, Eastern Sudan (courtesy of Reuters/Mohamed Nureldin Abdallah/Medecins Sans Frontières). doi:10.1128/9781555819002.ch27.f21

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Algorithm 27.1

Visceral leishmaniasis.doi:9781555819002.ch27.Alg1

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Image of Figure 27.22
Figure 27.22

(Top) Adult German shepherd with clinical appearance suspect of cutaneous leishmaniasis (courtesy of Global Health Vet, image by Gaël Lamielle, http://globalhealthvet.com/2010/10/05/working-in-morocco-recurring-leishmaniasis-in-a-canine-patient/). (Middle) Adult American foxhound. (Bottom) Adult American foxhound. Previously considered an exotic disease, canine leishmaniasis caused by has been detected within the foxhound population in the United States and parts of Canada. is the etiologic agent of visceral leishmaniasis in many areas of the world and dogs are considered a major reservoir host for human infections. doi:10.1128/9781555819002.ch27.f22

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
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Tables

Generic image for table
TABLE 27.1

Taxonomic classification of parasites pathogenic for humans

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
Generic image for table
TABLE 27.2

Old World cutaneous leishmaniasis, subgenus

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
Generic image for table
TABLE 27.3

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

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
Generic image for table
TABLE 27.4

New World cutaneous leishmaniasis subgenus , complex

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
Generic image for table
TABLE 27.5

New World cutaneous leishmaniasis, subgenus , complex

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
Generic image for table
TABLE 27.6

New World cutaneous leishmaniasis, subgenus , complex

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
Generic image for table
TABLE 27.7

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

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
Generic image for table
TABLE 27.8

Old World visceral leishmaniasis

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
Generic image for table
TABLE 27.9

New World (American) visceral leishmaniasis

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27
Generic image for table
TABLE 27.10

Specific drugs for the treatment of visceral leishmaniasis (see also chapter 36)

Citation: Garcia L. 2016. Leishmaniasis, p 778-809. In Diagnostic Medical Parasitology, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555819002.ch27

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