Leishmania - Revision history

Aidan at 15:49, 2 April 2025

2025-04-02T15:49:41Z

← Older revision		Revision as of 15:49, 2 April 2025
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	==Clinical Manifestations==		==Clinical Manifestations==

	===Cutaneous ~~leishmaniasis~~ (CL)===		===Cutaneous Leishmaniasis (CL)===

	*Endemic in tropics worldwide		*Endemic in tropics worldwide
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	**''L. braziliensis'' tends to cause moist, exudative lesions with a granulating base		**''L. braziliensis'' tends to cause moist, exudative lesions with a granulating base

	=====Mucocutaneous ~~leishmaniasis~~=====		=====Mucocutaneous Leishmaniasis=====

	*A form of New World CL that also involves oral, nasal, pharyngeal, or laryngeal lesions		*A form of New World CL that also involves oral, nasal, pharyngeal, or laryngeal lesions
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	*Painless wet ulcer from the topics is mostly leishmaniasis vs. Buruli ulcer		*Painless wet ulcer from the topics is mostly leishmaniasis vs. Buruli ulcer
	*Infectious		*Infectious
	**Bacterial: ecthyma, impetigo, syphilis, pinta, cutaneous anthrax, ulceroglandular tularemia, cutaneous actinomycosis		**Bacterial: [[ecthyma]], [[impetigo]], [[syphilis]], [[pinta]], cutaneous [[anthrax]], ulceroglandular [[tularemia]], cutaneous [[actinomycosis]]
	**Fungal: including sporotrichosis, cutaneous blastomycosis/~~cryptococcus~~/histoplasmosis		**Fungal: including [[sporotrichosis]], cutaneous [[blastomycosis]]/[[cryptococcosis]]/[[histoplasmosis]]
	**Mycobacterial: ~~''M.~~ ulcerans'' (Buruli ulcer; with fat necrosis), ~~''M.~~ marinum'', and leprosy		**Mycobacterial: [[Mycobacterium ulcerans]] (Buruli ulcer; with fat necrosis), [[Mycobacterium marinum]], and [[leprosy]]
	*Non-infectious		*Non-infectious
	**Skin cancer		**Skin cancer
	**Spider ~~bites~~ (brown recluse, eschar)		**[[Spider bite]] (brown recluse, eschar)
	**Pyoderma gangrenosum		**[[Pyoderma gangrenosum]]

	====Diagnosis====		====Diagnosis====
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	====Management====		====Management====

	*For MCL ~~incolving~~ the pharynx or larynx, should get high-dose IV steroids for 1 to 2 days before starting antimicrobials		*For MCL involving the pharynx or larynx, should get high-dose IV steroids for 1 to 2 days before starting antimicrobials

	===Visceral ~~leishmaniasis~~ (VL)===		===Visceral Leishmaniasis (VL)===

	*Most common causative organism is the ''L. donovani'' complex, followed by ''L. infantum'' (''L. chagasi'')		*Most common causative organism is the ''L. donovani'' complex, followed by ''L. infantum'' (''L. chagasi'')
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	*Infantile splenomegaly is a Mediterranean VL caused by ''L. infantum''		*Infantile splenomegaly is a Mediterranean VL caused by ''L. infantum''
	*Incubation period 2 to 8 months (range 10 days to more than 1 year)		*Incubation period 2 to 8 months (range 10 days to more than 1 year)
	*Risk factors include HIV, chronic steroids, methotrexate, anti-TNF-α inhibitors, and solid organ transplant		*Risk factors include [[HIV]], [[Corticosteroids\|chronic steroids]], [[methotrexate]], [[anti-TNF-α inhibitors]], and [[solid organ transplant]]
	**Can also have late reactivation after starting immunosuppressive medication		**Can also have late reactivation after starting immunosuppressive medication
	*There is a range of severity, from asymptomatic or self-limited illness to classic VL and death		*There is a range of severity, from asymptomatic or self-limited illness to classic VL and death
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	**More rapid onset with worse outcomes		**More rapid onset with worse outcomes

	====Viscerotropic ~~leishmaniasis~~====		====Viscerotropic Leishmaniasis====

	*Caused by ''L. tropica'' infection in Middle East		*Caused by ''L. tropica'' infection in Middle East
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	*Mild splenomegaly		*Mild splenomegaly

	====Post-kala-azar ~~dermal~~ ~~leishmaniasis~~ (PKDL)====		====Post-kala-azar Dermal Leishmaniasis (PKDL)====

	*Following treatment of ''L. donovani'' leishmaniasis, many patients develop PKDL		*Following treatment of ''L. donovani'' leishmaniasis, many patients develop PKDL
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	====Differential Diagnosis====		====Differential Diagnosis====

	*'''Acute form:''' malaria, enteric fevers, bacterial endocarditis, sarcoidosis, hemophagocytic syndromes, typhus, acute Chagas, acute schistosomiasis, miliary tuberculosis, and ~~amebic~~ liver abscess		*'''Acute form:''' [[malaria]], [[Enteric fever\|enteric fevers]], [[Infective endocarditis\|bacterial endocarditis]], [[sarcoidosis]], hemophagocytic syndromes, [[typhus]], acute [[Chagas disease\|Chagas]], acute [[schistosomiasis]], miliary [[tuberculosis]], and [[amoebic liver abscess]]
	*'''Subacute or chronic:''' brucellosis, prolonged ''Salmonella'' bacteremia, histoplasmosis, infectious mononucleosis, lymphoma, leukemia, myeloproliferative disorders, hepatosplenic schistosomiasis, and chronic malaria		*'''Subacute or chronic:''' [[brucellosis]], prolonged ''[[Salmonella]]'' bacteremia, [[histoplasmosis]], [[infectious mononucleosis]], [[lymphoma]], [[leukemia]], [[myeloproliferative disorders]], hepatosplenic [[schistosomiasis]], and chronic [[malaria]]
	*'''Late leishmaniasis:''' hematologic malignancies (hard spleen), disseminated histoplasmosis, tropical splenomegaly syndrome		*'''Late leishmaniasis:''' hematologic malignancies (hard spleen), disseminated [[histoplasmosis]], [[tropical splenomegaly syndrome]]
	*'''PKDL:''' leprosy, yaws, and syphilis		*'''PKDL:''' [[leprosy]], [[yaws]], and [[syphilis]]

	====Diagnosis====		====Diagnosis====
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	*Molecular: PCR (best test in Canada, based on skin scraping or aspirate, or filter paper test)		*Molecular: PCR (best test in Canada, based on skin scraping or aspirate, or filter paper test)
	*Immunology		*Immunology
	**~~Leshmenin~~ skin test		**Leishmanin skin test
	**RDT rapid antigen test		**RDT rapid antigen test

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	*Despite clinical cure, viable parasites remain in scar tissue		*Despite clinical cure, viable parasites remain in scar tissue

	===Visceral ~~leishmaniasis~~===		===Visceral Leishmaniasis===

	*Predominantly intramuscular [[Is treated by::pentavalent antimony]] (SbV) (in resource-poor countries) or [[Is treated by::amphotericin B]] (in resource-rich countries)		*Predominantly intramuscular [[Is treated by::pentavalent antimony]] (SbV) (in resource-poor countries) or [[Is treated by::amphotericin B]] (in resource-rich countries)
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	**If immunocompetent, liposomal AmB 3 mg/kg/day on days 1 to 5, 14, and 21		**If immunocompetent, liposomal AmB 3 mg/kg/day on days 1 to 5, 14, and 21
	**If immunocompromised, liposomal AmB 4 mg/kg/day on days 1 to 5, 10, 17, 24, 31, and 38		**If immunocompromised, liposomal AmB 4 mg/kg/day on days 1 to 5, 10, 17, 24, 31, and 38
	*'''[[Pentavalent antimony]]'''		*'''[[Pentavalent antimony]] (SbV)'''
	**No longer recommended in India due to resistance		**No longer recommended in India due to resistance
	**Typically prepared as sodium stibogluconate or meglumine antimoniate		**Typically prepared as sodium stibogluconate or meglumine antimoniate
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	**Non-inferior to [[amphotericin B]] in India, but more side effects		**Non-inferior to [[amphotericin B]] in India, but more side effects

	===Post-kala-azar ~~dermal~~ ~~leishmaniasis~~===		===Post-kala-azar Dermal Leishmaniasis===

	*Difficult to treat		*Difficult to treat
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	*Prefer ''not'' to use local treatment if there's a risk of ''Viannia'' subgenus, given risk of later mucocutaneous leishmaniasis		*Prefer ''not'' to use local treatment if there's a risk of ''Viannia'' subgenus, given risk of later mucocutaneous leishmaniasis

	===Diffuse ~~cutaneous~~ ~~leishmaniasis~~===		===Diffuse Cutaneous Leishmaniasis===

	*Nothing works		*Nothing works

	===Mucocutaneous ~~leishmaniasis~~===		===Mucocutaneous Leishmaniasis===

	*SbV, with variable response and frequent relapses		*SbV, with variable response and frequent relapses

Aidan at 17:03, 27 September 2024

2024-09-27T17:03:53Z

← Older revision		Revision as of 17:03, 27 September 2024
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	*Lesions don't always need treatment, as many will self-resolve		*Lesions don't always need treatment, as many will self-resolve
	*The decision to treat or not depends on a number of factors: age and clinical course of lesion (resolving?), number of lesions, complexity, size of lesion, immune status of the patient, mucosal involvement, location ''L braziliensis'' (higher risk for late complications), and how bothersome the lesions are to the patient		*The decision to treat or not depends on a number of factors: age and clinical course of lesion (resolving?), number of lesions, complexity, size of lesion, immune status of the patient, mucosal involvement, location ''L braziliensis'' (higher risk for late complications), and how bothersome the lesions are to the patient
			*See also [[CiteRef::chivinski2023in]]
	*See also <ref>Jeffrey Chivinski, M.D and others, Intravenous Liposomal Amphotericin B Efficacy and Safety for Cutaneous and Mucosal Leishmaniasis: ''A Systematic Review and Meta-analysis'', ''Open Forum Infectious Diseases'', 2023;, ofad348, https://doi.org/10.1093/ofid/ofad348</ref>

	====Old World CL====		====Old World CL====

Aidan at 13:17, 23 July 2023

2023-07-23T13:17:46Z

← Older revision		Revision as of 13:17, 23 July 2023
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	*Possibly treatable with amphotericin B		*Possibly treatable with amphotericin B

	===HIV ~~coinfection~~===		===HIV Coinfection===

	*Should start HAART within ~2 weeks, but beware IRIS		*Should start HAART within ~2 weeks, but beware IRIS

	===Cutaneous ~~leishmaniasis~~===		===Cutaneous Leishmaniasis===

	*Lesions don't always need treatment, as many will self-resolve		*Lesions don't always need treatment, as many will self-resolve
	*The decision to treat or not depends on a number of factors: age and clinical course of lesion (resolving?), number of lesions, complexity, size of lesion, immune status of the patient, mucosal involvement, location ''L braziliensis'' (higher risk for late complications), and how bothersome the lesions are to the patient		*The decision to treat or not depends on a number of factors: age and clinical course of lesion (resolving?), number of lesions, complexity, size of lesion, immune status of the patient, mucosal involvement, location ''L braziliensis'' (higher risk for late complications), and how bothersome the lesions are to the patient
			*See also <ref>Jeffrey Chivinski, M.D and others, Intravenous Liposomal Amphotericin B Efficacy and Safety for Cutaneous and Mucosal Leishmaniasis: ''A Systematic Review and Meta-analysis'', ''Open Forum Infectious Diseases'', 2023;, ofad348, https://doi.org/10.1093/ofid/ofad348</ref>

	====Old World CL====		====Old World CL====
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	*Good wound care		*Good wound care
	*Systemic treatment, possibly		*Systemic treatment, possibly
	**If treatment is indicated, SbV 20 mg/kg/day IM for 20 days		**If treatment is indicated, [[SbV]] 20 mg/kg/day IM for 20 days
	**Alternatively		**Alternatively
	***Fluconazole 200 mg po daily for 6 weeks (''L. major'')		***[[Fluconazole]] 200 mg po daily for 6 weeks (''L. major'')
	***Itraconazole 200 mg/day po for 6 to 8 weeks (''L. major'' > ''L. tropica'')		***[[Itraconazole]] 200 mg/day po for 6 to 8 weeks (''L. major'' > ''L. tropica'')
	***Miltefosine 2.5 mg/kg/day for 28 days (''L. major'')		***[[Miltefosine]] 2.5 mg/kg/day for 28 days (''L. major'')
	*Local treatment, possibly		*Local treatment, possibly
	**Intralesional SbV		**Intralesional [[SbV]]
	**Paromomycin/methylbenzethonium cloride 15%/12% cream topically twice daily for 28 days (''L. major'')		**[[Paromomycin]]/methylbenzethonium cloride 15%/12% cream topically twice daily for 28 days (''L. major'')
	**Hyperthermic treatments and cryotherapy		**Hyperthermic treatments and cryotherapy

	====New World CL====		====New World CL====

	*SbV 20 mg/kg/day IM for 20 days		*[[SbV]] 20 mg/kg/day IM for 20 days
	*Amphotericin B		*[[Amphotericin B]]
	*Pentamidine 4 mg/kg IM twice for ''L. guyanensis'' in French Guyana and Surinam (but not for other species)		*[[Pentamidine]] 4 mg/kg IM twice for ''L. guyanensis'' in French Guyana and Surinam (but not for other species)
	*Ketoconazole 600 mg daily for 28 days (''L. mexicana'' and ''L. panamensis'', but not ''L. braziliensis'')		*[[Ketoconazole]] 600 mg daily for 28 days (''L. mexicana'' and ''L. panamensis'', but not ''L. braziliensis'')
	*Miltefosine up to 50 mg po bid to tid for 28 days (possibly less useful against ''L. braziliensis'' but maybe not)		*[[Miltefosine]] up to 50 mg po bid to tid for 28 days (possibly less useful against ''L. braziliensis'' but maybe not)
	*Prefer ''not'' to use local treatment if there's a risk of ''Viannia'' subgenus, given risk of later mucocutaneous leishmaniasis		*Prefer ''not'' to use local treatment if there's a risk of ''Viannia'' subgenus, given risk of later mucocutaneous leishmaniasis

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	*SbV, with variable response and frequent relapses		*SbV, with variable response and frequent relapses
	*Amphotericin for salvage		*[[Amphotericin]] for salvage
	*Miltefosine 2.5 mg/kg/day for 28 days		*[[Miltefosine]] 2.5 mg/kg/day for 28 days

	{{DISPLAYTITLE:''Leishmania''}}		{{DISPLAYTITLE:''Leishmania''}}

Aidan: Aidan moved page Leishmania species to Leishmania without leaving a redirect

2022-01-25T16:48:17Z

Aidan moved page Leishmania species to Leishmania without leaving a redirect

← Older revision		Revision as of 16:48, 25 January 2022
(No difference)

Aidan at 16:48, 25 January 2022

2022-01-25T16:48:10Z

← Older revision		Revision as of 16:48, 25 January 2022
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	*Miltefosine 2.5 mg/kg/day for 28 days		*Miltefosine 2.5 mg/kg/day for 28 days

	{{DISPLAYTITLE:''Leishmania'' ~~species~~}}		{{DISPLAYTITLE:''Leishmania''}}
	[[Category:Protozoa]]		[[Category:Protozoa]]

Aidan: Text replacement - "([Ss])olid-organ" to "$1olid organ"

2020-08-07T14:20:51Z

Text replacement - "([Ss])olid-organ" to "$1olid organ"

← Older revision		Revision as of 14:20, 7 August 2020
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	*Infantile splenomegaly is a Mediterranean VL caused by ''L. infantum''		*Infantile splenomegaly is a Mediterranean VL caused by ''L. infantum''
	*Incubation period 2 to 8 months (range 10 days to more than 1 year)		*Incubation period 2 to 8 months (range 10 days to more than 1 year)
	*Risk factors include HIV, chronic steroids, methotrexate, anti-TNF-α inhibitors, and solid-organ transplant		*Risk factors include HIV, chronic steroids, methotrexate, anti-TNF-α inhibitors, and solid organ transplant
	**Can also have late reactivation after starting immunosuppressive medication		**Can also have late reactivation after starting immunosuppressive medication
	*There is a range of severity, from asymptomatic or self-limited illness to classic VL and death		*There is a range of severity, from asymptomatic or self-limited illness to classic VL and death

Aidan: /* Microbiology */ completed table

2020-08-07T14:16:32Z

Microbiology: completed table

@@ Line 16: / Line 16: @@
 !Disease
 |-
-| rowspan="4" |''Leishmania''
+| rowspan="8" |''Leishmania''
 | rowspan="3" |''L. donovani''
 |''L. donovani''
@@ Line 38: / Line 38: @@
 |East Mediterranean, Middle East, Central Asia
 |CL
 |}

Aidan: /* Microbiology */ partially filled table

2020-08-07T14:12:21Z

Microbiology: partially filled table

@@ Line 7: / Line 7: @@
 **''Viannia'' species develop in the hindgut before migradting to the midgut and foregut
 **''Leishmania'' species develop in the midgut and foregut
 ===Life Cycle===

Aidan at 14:00, 5 August 2020

2020-08-05T14:00:58Z

Show changes

Aidan: Text replacement - "Clinical Presentation" to "Clinical Manifestations"

2020-07-17T13:20:54Z

Text replacement - "Clinical Presentation" to "Clinical Manifestations"

← Older revision		Revision as of 13:20, 17 July 2020
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	* Diseminates to skin and reticuloendothelial system		* Diseminates to skin and reticuloendothelial system

	== Clinical ~~Presentation~~ ==		== Clinical Manifestations ==

	=== Cutaneous leishmaniasis (CL) ===		=== Cutaneous leishmaniasis (CL) ===