7808 - Old World leishmaniasis (cutaneous, Oriental sore)
DBQ: Link to Index of DBQ/Exams by Disability for DC 7808
Acronym: LSHR
Definition
Leishmaniasis (cutaneous) is an infectious ulcerating, chronic, nodular skin lesion (see Diagnostic Code: 6301 Visceral leishmaniasis).
Etiology
Cutaneous leishmaniasis caused by the Leishmaniasis (L.) species is found mainly in tropical and subtropical zones: e.g., the Middle East, especially Iran, Iraq, Eastern Saudi Arabia, Israel, and Jordan, as well as the Sinai Peninsula. The causative agents are as follows: L. infantum - Mediterranean rim; L. major - Near East and Africa; L. tropica - Near East and Soviet Union; and L. aethiopica - Ethiopia and Kenya. New world forms of cutaneous leishmaniasis are caused by L. mexicana complex which is endemic to Mexico and Central America. L. braziliensis complex is endemic to Brazil and Bolivia, and the L. amazonensis species is endemic to Brazil.
Signs & Symptoms
The signs and symptoms include a sharply, demarcated skin lesion which develops at the site of an infected sandfly bite after 1 to 4 weeks. The lesion begins as a painless papule that enlarges, ulcerates centrally, and becomes a raised, hyperpigmented border where the intracellular parasites are concentrated. The ulcers cause no systemic symptoms unless they are infected. Multiple lesions may occur after multiple infective bites, accidental autoinoculation, or metastatic spread. The skin ulcers usually heal spontaneously leaving a depressed scar. The eventual course depends on the strain of the infecting organism, and the immune status of the infected host. An uncommon form of the disease is diffuse cutaneous leishmaniasis which features widespread nodular skin lesions of leprosy.
Tests
Tests include smears and cultures of scrapings from the lesions, which show the causative parasite. The different parasite species are identified by isoenzyme determinations, or with specific monoclonal antibodies and DNA probes on cultures or smears from the lesions. Skin tests and blood tests are also done.
Treatment
Susceptible people may be inoculated with live vaccine to provide immunity. This may prevent scar formation. Experimental vaccines are under investigation. Drug therapy is the treatment of choice. A topical antifungal or metallic compounds may also be applied. Diffuse cutaneous leishmaniasis is resistant to treatment.
Residuals
Scar formation may occur. The person may experience side effects from the drugs. Some anti-fungal drugs are highly toxic and renal functional impairment is the main toxic risk. Creatinine and blood urea nitrogen (BUN) levels should be monitored during treatment. There may be a change in the person's body image if the nose is destroyed by the parasite, and reconstructive surgery is required. Counseling may be necessary.
Special Considerations
Notes
Evaluate non-cutaneous (visceral) leishmaniasis under DC 6301 (visceral leishmaniasis).