LEISHMANIASIS

Leishmaniasis is caused by an infection with the leishmania parasite,
after the bite of an infected sandfly. After an incubation period of two
weeks to four months an erythematous or skin coloured nodule appears.
This ulcerates and then becomes crusted or even verrucous, in most
cases eventually leaving an ugly scar. The sandfly likes to bite on moist
areas, preferably around the eyes, ears, nose and mouth. Lesions may be
found on the skin, the mucous membranes or both. The latter,
mucocutaneous leismaniasis, may completely destroy the nose and does
not heal spontaneously.
Leishmaniasis may cause lymphadenitis or become visceral, Kala Azar.
After Kala Azar it may cause PKDL, Post Kala Azar Dermal Leishmaniasis.
In a few cases leishmaniasis becomes generalised, showing infiltration
and nodules over the whole body. This persists for life.
Management of leishmaniasis
The sore type of leishmaniasis:
- Cryosurgery.
- Excision.
- In some cases itraconazole or ketaconazole may be tried.
Leishmaniasis with lymphadenitis:
- Pentavalent antimonium prepararions
(stibogluconate) Glucantine or Pentostam
20 mg/kg/day for 20-30 days i.v. or i.m.
- Pentamidine isothionate 4 mg/kg/week for 4 weeks to
8 months.
- Amphotericine B 1 mg/kg on alternate days for
2 months
PKDL: stibogluconate.
Diffuse generalised leishmaniasis: repeated
courses of pentamidine isothionate