Leishmaniasis

Question 1

Subtypes of Leishmaniasis

Answer 1

• Old World Leishmaniasis (the Eastern Hemisphere)
• New World Leishmaniasis (Western Hemisphere)

Question 2

Predisposing factors for Leishmaniasis

Answer 2

• Chronic sand fly exposure
• Poverty
• Proximity to dogs/cats/rodents.

Question 3

Incubation period for Leishmaniasis

Answer 3

2 weeks to several months and in cases up to 3
years; some >20 years.

Question 4

• most common manifestation ischaracterized by gradual-onset cutaneous lesions
• Like other parasites, the protozoa has a primary vector (sand flies).
• Like other parasites, the protozoa has a primary vector (sand flies).

Answer 4

Cutaneous Leishmaniasis (CL)

Question 5

Presentation:
- Begin as a pink colored papule that enlarges to a nodule or plaque-like lesion
- Lesion ulcerates with indurated border and may have thick white-yellow fibrous material
- Lesions are often painless
- Multiple lesions may be present
- Lesions gradually heal over months to years with noticeable scarring at site

Answer 5

Cutaneous Leishmaniasis (CL)

Question 6

Dx of Leishmaniasis

Answer 6

• any patient with chronic (non-healing) skin lesions that has been to an area where CL is endemic & the patient reports a history of sandfly bites.
• Laboratory confirmation of the diagnosis is achieved by detecting Leishmania parasites (or DNA) in infected tissue, through microscopic examination of stained specimens, culture techniques, or molecular methods.

Question 7

IDC Treatment of Leishmaniasis

Answer 7

• Ulcer should be debrided and kept clean to avoid secondary infections from developing
• Bandaged & wrapped to avoid further wound contamination

Question 8

Medications for leishmaniasis

Answer 8

• Treatment of choice for visceral leishmaniasis: Amphotericin B deoxycholate.
• Pentavalent antimonials remain the most commonly used drug to treat leishmaniasis in most areas.
• Orally administered “azoles” (ketoconazole, itraconazole, & fluconazole), & topical formulations of paromomycin for CL.

Question 9

Where should a patient with Leishmansis ultimately be sent

Answer 9

MO and/or MTF Infectious Disease dept. as soon as operationally allowable

Question 10

Prevention of Leishmaniasis

Answer 10

• avoidance of being bitten by sand flies in endemic areas.
• sleep in screened areas
• Risk highest from dusk to dawn because sand flies typically feed (bite) at night and during twilight hours.
  Sand flies are less active during the hottest time of the day.
• Sand flies do not make any noise (“buzz”), they are small (1/3 the size of mosquitoes) & bites might not be noticed.
• Spraying quarters with insecticide might provide some protection.
• Fans or ventilators might inhibit the movement of sand flies.
• Protective clothing and application of an insect repellent with DEET to exposed skin and under the edges of clothing, such as sleeves and pant legs, according to the manufacturer’s instructions