Cutaneous leishmaniasis: Clinical manifestations and diagnosis
- Naomi Aronson, MD
Naomi Aronson, MD
- Professor of Medicine
- Uniformed Services University
Leishmaniasis consists of a complex of vector-borne diseases caused by a heterogeneous group of protozoa belonging to the genus Leishmania; it is transmitted by sand fly vectors. Clinical manifestations range from cutaneous ulcers to systemic multiorgan disease. Specific organisms are frequently associated with a typical clinical picture (table 1), although this can be variable.
The clinical manifestations and diagnosis of cutaneous leishmaniasis will be reviewed here. Issues concerning treatment, epidemiology, and control are discussed separately. (See "Cutaneous leishmaniasis: Treatment" and "Cutaneous leishmaniasis: Epidemiology and control".)
The incubation period for symptomatic cutaneous leishmaniasis (CL) ranges from weeks to months; mucosal involvement may occur years following initial infection [1,2]. Asymptomatic infection may occur in about 10 percent of patients; this has been suggested by delayed hypersensitivity skin testing .
Leishmania causes a spectrum of cutaneous disease. The range of clinical manifestations may be attributed to variability in parasite virulence (and other intrinsic characteristics) and variability in the host immune response. At one end of the spectrum, mucosal leishmaniasis (ML) and leishmaniasis recidivans (LR) are caused by oligoparasitic disease associated with a marked cellular immune response. The center of the spectrum consists of localized cutaneous leishmaniasis (LCL), which is the most common clinical presentation. At the opposite end of the spectrum, diffuse cutaneous leishmaniasis (DCL) is caused by polyparasitic disease with a predominance of parasitized macrophages and no granulomatous inflammation. This spectrum of clinical presentation and host immune response is similar to clinical manifestations observed in the setting of leprosy . (See "Epidemiology, microbiology, clinical manifestations, and diagnosis of leprosy".)
The cutaneous syndromes associated with Leishmania parasite infection include LCL, LR, DCL, and ML. These will be further described below; they are presented in order of relative clinical frequency.
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- CLINICAL MANIFESTATIONS
- Localized cutaneous leishmaniasis (LCL)
- - Differential diagnosis
- Leishmaniasis recidivans (LR)
- Diffuse cutaneous leishmaniasis (DCL)
- Mucosal leishmaniasis (ML)
- CL in immunocompromised hosts
- Clinical approach
- - Clinical history
- - Physical examination
- Specimen collection
- Diagnostic tools
- - Histology
- - Culture
- - Molecular diagnostic techniques
- Other assays
- - Serology
- - Skin test
- DIFFERENTIAL DIAGNOSIS