70
Protozoa and Worms
Leishmaniasis
• Three major forms: (1) cutaneous (Fig. 70.1); (2) mucocutaneous (Fig. 70.2); and (3) visceral (e.g. liver, spleen).
Fig. 70.1 Variable presentations of cutaneous leishmaniasis. Ulcerated plaques with rolled border (A) and central crusting (A, B). Plaque with translucent borders containing telangiectasias and central scarring (C). Cutaneous leishmaniasis is sometimes mistaken for a basal cell carcinoma in adults. A, C, Courtesy, Julie V. Schaffer, MD.
• Caused by more than 15 different species of Leishmania (Table 70.1).
• Vector = sandfly (Phlebotomus and Lutzomyia spp.) (Fig. 70.3).
• Disease seen worldwide but endemic in areas of Asia, Africa, Latin America, and the Mediterranean basin (Fig. 70.4).
• Cutaneous disease affects skin only and is commonly a papule that expands and ulcerates (Fig. 70.5); pattern may be sporotrichoid (Fig. 70.6); lesion(s) may heal spontaneously (Fig. 70.7).
