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Key Points

  • Leishmania spp.
    • Characteristics
      • Family of obligate intracellular protozoan parasites
    • Transmission
      • Transmitted by bite of sandfly
        • Mostly in Afghanistan, Algeria, Brazil, Colombia, Pakistan, and Syria
        • May be seen in military men deployed to Middle East
    • Presentation: Leishmaniasis
      • Visceral leishmaniasis
        • Non-specific malaise, fever and weight loss
        • Darkened skin
          • Also known as kala-azar or “black fever” in Hindi
          • Common to subtypes seen in SE Asia
        • Splenomegaly
          • Due to replication of parasites in macrophages of spleen
        • Hepatomegaly
          • Due to infection of macrophages in liver
        • Pancytopenia
          • Due to infection of macrophages and macrophage precursors in bone marrow
          • May present with severe anemia
        • Almost always fatal without treatment
      • Cutaneous leishmaniasis
        • Painless ulcers
          • Skin papules that progress to nodule, plaque, or ulcer
          • May be covered with eschar or white-yellow fibrinous material
    • Diagnosis
      • Biopsy of lesions or infected organs
        • Macrophages filled with amastigotes
          • Macrophage ingestion an important part of life cycle
      • Molecular analysis by PCR also used
    • Treatment
      • Often depends on strain and region
        • Regional antimicrobial resistances may differ
        • Most treatments are combinatory (2 or more agents)
      • Amphotericin B
        • Used for both cutaneous and visceral leishmaniasis
      • Paromomycin, Pentamidine
        • Mainly used for cutaneous leishmaniasis
      • Sodium stibogluconate, miltefosine
        • Mainly used for visceral leishmaniasis