Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes References 1. [f1000research.com]

MATERIALS AND METHODS: A retrospective study was performed among patients who presented at The Sheba Medical Center between 2005 and 2014 with atypical clinical presentations of CL due to L. major. [ncbi.nlm.nih.gov]

Atypical presentation of cutaneous leishmaniasis in native population of Baluchistan. J Pak Assoc Dermatol. 2006;16:196-200. 18. Sindhu PS, Ramesh V. Unusual presentation of cutaneous leishmaniasis. [revistabiomedica.org]

• Pain

  Positive detection of germs in the ulcer border and "pain" and "pruritus" revealed no influence on wound closure. [ncbi.nlm.nih.gov]

• Asymptomatic

  Abstract Cutaneous leishmaniasis is a parasitic infection caused by protozoa of the Leishmania genus that presents as asymptomatic pink papules that may ulcerate. [ncbi.nlm.nih.gov]

  Therefore, the spectrum of the disease varies from asymptomatic cutaneous infection to visceral involvement, which is potentially mortal (14). [revistabiomedica.org]

  Their bite is asymptomatic and classically on exposed sites. Leishmaniasis has several recognized clinical forms and their manifestation depends upon the species inoculated and the host ’s immune response. [dermnetnz.org]

• Weight Loss

  It was their presentation with history of weight loss and fever that prompted Enzyme-linked Immunosorbent Assay (ELISA) tests for HIV, which turned out to be positive. [ncbi.nlm.nih.gov]

  The disease affects the vital organs of the body and is characterized by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia. [who.int]

  People may have mild or no symptoms or have skin sores that result in scars or sores in the nose, mouth, or throat that can lead to severe disfigurement or have fever, weight loss, and fatigue, depending on which part of the body is affected. [msdmanuals.com]

  Symptoms of Visceral Leishmaniasis: Usually symptoms appear weeks or months after being infected and include fever, weight loss, and enlarged liver. [iamat.org]

  Visceral — affects organs of the abdominal cavity Severe weight loss Loss of appetite ( anorexia ) Diarrhea Tarry feces (less common) Vomiting Nose bleed Exercise intolerance Cutaneous — affects the skin Hyperkeratosis — most prominent finding; excessive [petmd.com]

• Military Personnel

  INTRODUCTION: In the Netherlands, cutaneous leishmaniasis is most commonly seen in military personnel deployed on a mission or training abroad. [ncbi.nlm.nih.gov]

  It poses a risk to the local population, travelers, military personnel, and aid workers. The chronic and sometimes disfiguring lesions eventually heal leaving a scar. [skintherapyletter.com]

  The condition is diagnosed every year in travelers, immigrants, and military personnel. Physicians in the United States must be alert to the diagnosis of leishmaniasis in travelers returning from endemic areas. [aafp.org]

• Localized Edema

  These effects included local itch 42.1% (16/38), sensation of burning 28.9% (11/38), local pain 21% (8/38) and local edema 2.6% (1/38). All adverse effects disappeared within one week after finishing the treatment. [doi.org]

• Hoarseness

  Complications include nasal septum perforation, vocal cord involvement with hoarseness, and deformity of the nasal pyramid. Upper respiratory tract obstruction leading to death has been reported [ 3 ]. [doi.org]

  […] perforation; nose cartilage may be involved, giving rise to external changes known as parrot's beak or camel's nose Possible presence of granulation, erosion, and ulceration of the palate, uvula, lips, pharynx, and larynx, with sparing of the bony structures; hoarseness [emedicine.medscape.com]

  Lesions of the oral mucosa usually produce symptoms that range from simple discomfort and mild pain or odynophagia to cachexia in extreme cases; the latter is observed only in cases in which the lesion involves the totality of the pharynx, larynx (with hoarseness [f1000research.com]

• Nausea

  Adverse effects include nausea, vomiting, transient elevations in aminotransferases, and dizziness. Miltefosine is contraindicated during pregnancy; women of childbearing age who are taking this drug must use effective birth control measures. [merckmanuals.com]

  More side effects of mild abdominal pain and nausea (RR 2.36, 95% CI 0.74 to 7.47; 3 studies; 204 participants) and mild abnormal liver function (RR 3.08, 95% CI 0.53 to 17.98; 3 studies; 84 participants) occurred in the itraconazole group (as well as [ncbi.nlm.nih.gov]

  This is associated with light parasitic burden and mild symptoms including fever, malaise, and nausea. [emedicine.medscape.com]

  Myalgias, arthralgias, anorexia, nausea, and headache were common adverse effects. [doi.org]

• Vomiting

  Visceral — affects organs of the abdominal cavity Severe weight loss Loss of appetite ( anorexia ) Diarrhea Tarry feces (less common) Vomiting Nose bleed Exercise intolerance Cutaneous — affects the skin Hyperkeratosis — most prominent finding; excessive [petmd.com]

  Oral ketoconazole Alters permeability of cell wall inhibiting fungal enzymes Oral, topical Oral: 200-400 mg/day single daily dose, 4-8 wks Topical: rub on affected area 1-2x daily Headache, vomiting, abdominal pain Itraconazole Inhibits cell membrane [web.stanford.edu]

  Adverse effects include nausea, vomiting, transient elevations in aminotransferases, and dizziness. Miltefosine is contraindicated during pregnancy; women of childbearing age who are taking this drug must use effective birth control measures. [merckmanuals.com]

  The most frequent AE were nausea, vomiting, abdominal pain, and mildly increased creatinine levels ( Table 4 ). AEs were more frequently reported during weeks 1 and 2 of treatment (median, day 9; IQR, 1 to 19 days). [aac.asm.org]

  Likewise, many of the respondents also reported that such treatments can spoil or otherwise damage breast milk and/or harm nursing infants by causing fevers, diarrhea, vomiting, delayed development, or dental damage. [scielosp.org]

• Ulcer

  METHODS: Twenty-five patients with a confirmed diagnosis of CL and ulcerated lesions underwent biopsy of ulcer borders. [ncbi.nlm.nih.gov]

  Two patients with eyelid involvement (see Figure 1 and Figure 2) had superficial ulcerative lesions (25%), three had nodulo-ulcerative lesions (37.5%), two had nodular lesions (25%) and one (Figure 3) had a plaque-like lesion (12.5%). [cehjournal.org]

  Her right ear was edematous and erythematous with a large, painless ulcerative lesion covering a third of the pinna and satellite papular lesions on the posterior. She was diagnosed with chiclero's ulcer. [doi.org]

• Skin Lesion

  Sometimes lymphadenopathy is noticed, before skin lesions develop. Back To Top Ulcerative skin lesion, with a raised outer border, on a Guatemalan patient who has cutaneous leishmaniasis. (Credit: MERTU, Guatemala; courtesy of B. [cdc.gov]

  A 25-year-old man presented to our clinic with a 1-year history of skin lesions on his nose and arm. [nejm.org]

  Seventeen (17) wild rodents were captured, six of them had skin lesions with characteristics of Leishmania infection. [ncbi.nlm.nih.gov]

• Papule

  Cutaneous leishmaniasis typically begins as a painless papule that enlarges to a nodule with a central crust. The papules and nodules enlarge, may develop central ulceration, and take approximately 1 year to heal without treatment. [nejm.org]

  Physical examination revealed a violet erythematous plaque on the right lumbar region over de rmatomes L2, L3 and L4 that was composed of pseudo-vesicles and yellowish erythematous papules. [revistabiomedica.org]

  Lesions usually start with erythematous papules, gradually enlarges and afterwards it ulcerates. We present a 12-year-old boy with diffuse persistent lip swelling mimicking granulomatous cheilitis. Systemic glucantime was started. [ncbi.nlm.nih.gov]

• Skin Disease

  disease, rare skin disease, lesioni elementari della cute, leishmaniosi Controllo di autorità Q2590966 Reasonator Scholia Statistica Sottocategorie Questa categoria contiene un'unica sottocategoria, indicata di seguito. [commons.wikimedia.org]

  Atypical cutaneous leishmaniasis should not be ruled out in the differential diagnosis of unresponsive skin diseases, with slit/smear and a skin biopsy is required. [ncbi.nlm.nih.gov]

• Osteoporosis

  Journal of Alexandria Oral Implantology Association, London School of Facial Orthotropics Journal of Orthodontics & Endodontics Open Access Journal Journal of Orthopedic Oncology Open Access Journal Journal of Osteoarthritis Open Access Journal Journal of Osteoporosis [omicsonline.org]

• Confusion

  The appearance and distribution of lesions can cause the disease to be confused with herpes zoster, thus complicating initial diagnosis. [revistabiomedica.org]

  Symptoms are usually vague, resembling those of incipient pulmonary tuberculosis; the disease is often confused with malaria. There may be fever, chills, malaise, cough, anorexia, anemia, and wasting. [medical-dictionary.thefreedictionary.com]

  Very early lesions may be confused with insect bites or pyoderma, the latter especially when there is secondary bacterial infection of CL lesions. [clinicaladvisor.com]

  The symptoms of leishmaniasis can vary and may be confused with skin diseases caused by other etiological agents; therefore diagnostic confirmation of the parasite is mandatory for starting the specific treatment. [journals.plos.org]

• Agitation

  Animals are observed daily to monitor: a) physical appearance (hair, coordination, temperature, eyes, position of the ears, grooming, defecation, presence of ascitic fluid, agitation and dehydration) and b) behavior (awake, alert, curious, attentive, [jove.com]

BACKGROUND: Several case reports describe diseases presenting with skin ulcerations, which resemble pyoderma gangrenosum especially in immune-compromised patients, often proven on further workup, to have an infective or malignant etiology. [ncbi.nlm.nih.gov]

[…] considered include the following: CBC count, coagulation studies, liver function tests, peripheral blood smear Measurements of lipase, amylase, gamma globulin, and albumin Leishmanin (Montenegro) skin testing (LST) (not FDA approved in the United States) See Workup [emedicine.medscape.com]

Treatment Treatment with antimonials will heal lesions faster and prevent relapse, local dissemination, mucosal disease (usually), and transmission. Not all lesions require treatment. [aafp.org]

Liposomal amphotericin B is FDA-approved for treatment of visceral leishmaniasis and generally is the treatment of choice for U.S. patients. [cdc.gov]

B, Day 10 of treatment, with signs of reepithelialization. C, Day 20 of treatment, with complete reepithelialization. Figure 1 Photograph of skin lesions on a 17-year-old patient with cutaneous leishmaniasis. A, Before treatment. [doi.org]

There is no current protocol for efficient and accurate treatment of lupoid CL. First-line treatment involves administration of pentavalent antimony compounds 10. [f1000research.com]

Abstract The clinical manifestations and prognosis of cutaneous leishmaniasis (CL) can be influenced by the immune response of the patient and the species of the parasite. [ncbi.nlm.nih.gov]

However, a spontaneous resolution of the skin ulcers is also observed in some cases The prognosis depends upon the promptness in providing treatment. [dovemed.com]

The presentation and prognosis will vary depending on the species involved. [dermnetnz.org]

CONCLUSIONS: Leishmania major is confirmed to be the etiological agent of cutaneous leishmaniasis in northwestern Saudi Arabia. [ncbi.nlm.nih.gov]

Distribution and etiology of leishmaniasis in Colombia. Am J Trop Med Hyg. 1990;42:206-14. 16. Ovalle CE, Porras L, Rey M, Ríos M, Camargo YC. [revistabiomedica.org]

However, the epidemiology of the disease in this area is not well understood. Thus, an epidemiological survey was conducted in 2015-2016 to identify the circulating parasite and the sand fly fauna in the region of Hail. [ncbi.nlm.nih.gov]

American cutaneous leishmaniasis is a dynamic disease with unclear pathophysiology because of continually changing environments, demographics, and human behaviors. [ncbi.nlm.nih.gov]

Pathophysiology of Leishmania infection during pregnancy. Trends Parasitol. 2017;33:935-46. https://doi.org/10.1016/j.pt.2017.08.012 Ávila-García M, Mancilla-Ramírez J, Segura-Cervantes E, Farfán-Labone B, Ramírez-Ramírez A, Sevilla-Galindo N. [revistabiomedica.org]

University Tropical Parasitology: Protozoans, Worms, Vectors and Human Diseases This course provides students an understanding of important human parasitic diseases, including their life cycles, vectors of transmission, distribution and epidemiology, pathophysiology [coursera.org]

References 1 Recent advances in the pathophysiology and treatment of human cutaneous leishmaniasis, Curr Opin Dermatol, 1997, vol. 4 (pg. 51 - 8 ) 2 Polar and sub-polar diffuse cutaneous leishmaniasis in Brazil: clinical and immunopathological aspects [academic.oup.com]

[…] venezuelensis CL/MCL OWNW L aethiopicaL braziliensis complexL (Viannia) braziliensisL (Viannia) colombiensisL (Viannia) guyanensisL (Viannia) panamensisL (Viannia) peruviana VL/CL OWNW L donovani complexL donovaniL infantumL donovani complexL chagasi Pathophysiology [clinicaladvisor.com]

Centers for Disease Control and Prevention. Parasites- Leishmaniasis (Internet). Centers for Disease Control and Prevention. 2015. http://www.cdc.gov/parasites/leishmaniasis/ 67. World Health Assembly. Control of Leishmaniasis. [doi.org]

As is the case for any infectious disease, treatment and prevention go hand in hand. [dsghreview.com]

The best incidence estimates are based on the number of physician requests for sodium stibogluconate and travel surveillance data collected by the Centers for Disease Control and Prevention. [mdedge.com]

Prevention is currently limited to bite prevention measures. [ncbi.nlm.nih.gov]

There is currently no vaccine approved for the prevention of leishmaniasis. Some informal vaccination efforts for the prevention of cutaneous leishmaniasis have been conducted in endemic areas through a process known as " leishmanisation ." [conferenceseries.com]