| Disease/Syndrome |
Leishmaniasis |
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| Category |
Infection, Travel |
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| Acute/Chronic |
Subacute |
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| Synonyms |
Visceral leishmaniasis (Kala-azar); Mucosal leishmaniasis (Espundia); Cutaneous Leishmaniasis; |
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| Biomedical References |
Search PubMed |
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| Comments |
FINDINGS: Visceral leishmaniasis may present abruptly with high fever simulating malaria and other acute infections. As a chronic disease, it presents with splenomegaly and weight loss. Some patients have peripheral lymphadenopathy. [Guerrant, p. 1095-1107, 1586] In visceral leishmaniasis, patients have splenomegaly, pancytopenia, hypergammaglobulinemia, and in some cases, fever spikes twice a day. In the New World, skin lesions caused by Leishmania brazilensis may metastasize to mucosal tissues. Mucosal lesions can spread to the nose and palate to cause tissue destruction and disfigurement. [Merck Manual, p. 1575] Kala-azar means black fever, and some patients have hyperpigmentation of the face and trunk. Some patients have abdominal pain, and some have diarrhea secondary to intestinal infiltration. Epistaxis related to thrombocytopenia, may occur. Elevated liver transaminases are common. [ID, p. 2312] Some patients with Kala-Azar have massively enlarged spleens, which are characteristically soft and nontender. Patients with advanced disease may have epistaxis, gingival bleeding, and petechiae of the extremities. Many become cachectic and die from pneumonia and other secondary bacterial infections. The incubation period for cutaneous leishmaniasis ranges from 2 weeks to several months or even years. In typical patients, cutaneous leishmaniasis develops slowly as a shallow, painless ulcer with raised borders. Satellite lesions may appear. Regional lymphadenopathy precedes or accompanies the skin ulcers in some cases. Mucosal leishmaniasis is limited to about 3% of people infected with L. brazilensis or related species. Mucosal lesions develop a median of 6 years after the primary skin lesion. [PPID, p. 3151-2] EPIDEMIOLOGY: Inapparent infections are activated by malnutrition and AIDS. Transmitted by sand flies, the reservoirs are mainly humans; also wild rodents, foxes, jackals, and dogs. Transmission by infected needles has been reported among IV drug users. [CCDM, p. 299-301] The main forms of leishmaniasis are: 1) new world cutaneous and mucosal; 2) old world cutaneous; and 3) visceral. Visceral leishmaniasis is a common opportunistic infection among AIDS patients in southern Europe. [Guerrant] |
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| Latency/Incubation |
Days to weeks, months, or years; Usually 2-6 months; |
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| Diagnostic |
Culture; Stained smears; In immunocompetent patients with visceral disease, ELISA and dipstick tests are sensitive and specific. Serology not usually helpful for diagnosis of cutaneous leishmaniasis; [PPID, p. 3149-52] |
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| ICD-9 Code |
085 |
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| Effective Antimicrobics |
Yes |
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| Scope |
>90% of visceral cases: Bangladesh, Brazil, India, Nepal, & Sudan. >90% of cutaneous cases: Afghanistan, Algeria, Brazil, Iran, Iraq, Peru, Saudi Arabia, & Syria. [CDC Travel, p. 205] 90% of mucocutaneous cases: Brazil, Bolivia, & Peru. [PPID, p. 3146] |
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| Reference Link |
CDC - Leishmaniasis |
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| Image |
U of Iowa - Cutaneous Leishmaniasis |
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| Related Information in Haz-Map |
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| Symptoms/Findings |
Symptoms/Findings associated with this disease:
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High risk job tasks associated with this disease:
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