Leishmaniasis, affecting more than two million individuals every year in various parts of the world, is an infection caused by the protozoan parasite Leishmania [1]. Sand flies are the principal vectors involved in the transmission of this parasite from infected animal hosts to humans, indicating the zoonotic nature of the disease in many parts of the world, including Latin America, countries around the Mediterranean sea, the Middle East, and North Africa [1] [2] [3]. However, a growing number of reports have confirmed a transmission of Leishmaniasis between humans through sand fly vectors in endemic and highly populated areas [4]. More than 20 species have been implicated in the pathogenesis of human infections, while L. tropica is described as one of the main culprits in the development of urban cutaneous leishmaniasis [2]. Regarded as the most common type of Leishmaniasis, the cutaneous presentation is characterized by the appearance of an erythematous papule at the site of the sand fly bite after a period that may last for weeks, months, or even years [2] [3] [4] [5]. The face and the extremities (forearms and lower legs) are the main locations of the initial lesion [3]. The papule progressively increases in size over time and transforms into a nodule that subsequently breaks and forms a raised and well-demarcated ulcer [3] [4] [5]. In most cases, skin lesions resolve spontaneously over time, but their recurrence and dissemination (causing severe cutaneous or mucocutaneous leishmaniasis) can be severely debilitating, particularly when larger lesions affect the face and cause extensive disfiguring [2] [4] [5]. Immunosuppressed patients are at an increased risk for dissemination of the disease [5].

• Fever

  The side-effects of the drug were tenderness (83 per cent), induration (27 per cent) fever (6 per cent) and abscess (2 per cent). No changes in complete blood count were observed. [acta.tums.ac.ir]

  ESSAYS ON THE PUERPERAL FEVER, AND OTHER DISEASES PECULIAR TO "WOMEN. Selected from the writings of British Authors previous to the close of the Eighteenth Century. In one neat octavo volume, extra cloth, of about 450 pages. ‏ [books.google.com]

  Other terms used to describe visceral disease include Dumdum fever, Assam fever, and infantile splenomegaly in various parts of the world. [emedicine.medscape.com]

  […] skin sores (develop w/in weeks or months) -sores can turn into ulcers -change in size/appearance over time Visceral Leishmaniasis symptoms -affects internal organs (spleen, liver, bone marrow) -can be life threatening -develops w/in months or years -fever [quizlet.com]

  It is a slow but progressive illness, with bouts of irregularly recurring fever, and is invariably fatal, unless treated. [parasite.org.au]

• Physician

  In the case of urban cutaneous leishmaniasis, physicians must identify the potential source of this parasite in the urban setting, thus patients may be asked whether they have observed similar lesions in other individuals in their environment. [symptoma.com]

  Physicians in the United States must be alert to the diagnosis of leishmaniasis in travelers returning from endemic areas. [aafp.org]

  J Coll Physicians Surg Pak. 2014; 24 Suppl 2 -5[ PubMed ] 6. Mendes DS, Dantas ML, Gomes JM, Santos WL, Silva AQ, Guimaraes LH, et al. [intjinfection.com]

  The pentavalent antimonial compound sodium stibogluconate (Pentostam) is available to US-licensed physicians through the CDC Drug Service (404-639-3670) for intravenous or intramuscular administration under an investigational new drug protocol (see www.cdc.gov [wwwnc.cdc.gov]

  As of 2007, at least 1300 soldiers have been diagnosed with leishmaniasis (mostly CL but a few isolated cases of VL) since deployment to both countries; many speculate that the number may be as high as 2,500, due to underreporting or misdiagnoses by physicians [blogs.discovermagazine.com]

• Military Personnel

  Click for source Soldiers have also had to contend with other tropical delights such as malaria, Q fever, brucellosis but prevention and control measures have largely kept other infections in check among deployed military personnel (12). [blogs.discovermagazine.com]

  Military Personnel - Southwest/Central Asia, 2002-2003 米軍隊員における皮膚リーシュマニア症－南西/中央アジア,2002 2003年 熱帯、亜熱帯、ヨーロッパ南部へ渡航または居住した軍関係者は、風土病である皮膚リーシュマニア症(CL)感染のリスクを有する。2002－2003年に南西/中央アジアの3ヶ国(アフガニスタン、イラク、クウェート)でCLを発症した米軍隊員22例について予備データを報告する。 [imic.or.jp]

  Examples of types of travelers who might have an increased risk for CL include ecotourists, adventure travelers, bird watchers, Peace Corps volunteers, missionaries, military personnel, construction workers, and people who do research outdoors at night [wwwnc.cdc.gov]

  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]

  As an imported disease, cutaneous leishmaniasis is common in travellers, military personnel, and immigrants coming from endemic areas, while the diagnosis of the less common visceral leishmaniasis is frequently overlooked. [enetmd.com]

• Malnutrition

  Leishmaniasis in Syria Cutaneous leishmaniasis is often associated with malnutrition, population displacement, poor housing and weakened immune systems, all widespread across Syria. [thementorinitiative.org]

  These include: Poverty Malnutrition Famine Illiteracy Lack of sanitation and proper hygiene Large-scale migration and settlements Leishmaniasis is more common in the villages and small towns (especially in the outskirts) than in the cities Individuals [dovemed.com]

  The research found that: -leishmaniasis is highly correlated with poverty, malnutrition and other diseases which affect immunity, as well as factors such as crowded living conditions and poor sanitation. [thenewsminute.com]

  With prolonged infection, death occurs from respiratory compromise and malnutrition. Mucocutaneous leishmaniasis may arise after inadequate treatment of certain Leishmania species. Children are rarely affected. [emedicine.medscape.com]

  Malnutrition is a risk factors for mucosal leishmaniasis. Infection with L. peruviana occurs in high Andean valleys, where it may be locally common. [enetmd.com]

• Falling

  During the study period, there were 4672 recorded clinical cases of CL, the incidence of which was found to fall into three types of areas, such as high, intermediate and low-level endemic areas. [geospatialhealth.net]

  The risk of an average American falling ill with it is very low. [medicaldaily.com]

  The best time to find infected sandflies is, therefore, when the population is falling towards the end of the season. [jpma.org.pk]

  Hepatic and pancreatic enzyme levels may rise and haemoglobin levels fall, but they return to normal when treatment is stopped. The electrocardiogram develops unimportant T-wave changes. [enetmd.com]

• Hepatomegaly

  Abdominal ultrasound did not reveal the presence of hepatomegaly or splenomegaly. [ncbi.nlm.nih.gov]

  It is manifested by lymphadenopathy, hepatomegaly, splenomegaly, pallor, anemia, leukopenia, thrombocytopenia, fever, night sweats, weakness, anorexia, asthenia, cutaneous pigmentation, and weight loss, which can progress rapidly in weeks or months. [f1000research.com]

• Thrombosis

  The drug is administered by intramuscular injection, which may be painful, or by intravenous injection through a fine-gauge needle, slowly or by infusion in 50 to 100 ml of 5% dextrose over 20 min to reduce the risk of venous thrombosis. [enetmd.com]

  […] of Sports Medicine & Doping Studies Open Access Journal Journal of Steroids & Hormonal Science Open Access Journal Journal of Surgery and Emergency Medicine Open Access Journal Journal of Surgery Jurnalul de Chirurgie Open Access Journal Journal of Thrombosis [omicsonline.org]

• Skin Lesion

  The typical skin lesion is an erythematous papule progressing to a painless ulcer that appears on the face or the extremities. Microbiological examination of skin lesion scrapings or biopsy samples is vital for confirming the diagnosis. [symptoma.com]

  (L) infantum chagasi in the culture of fragments of skin lesions or unimpaired skin 20. Cases related to L. [ncbi.nlm.nih.gov]

  Infections with some strains of New World cutaneous leishmaniasis may develop into Mucocutaneous Leishmaniasis years after the initial skin lesions seem to have healed completely. [iamat.org]

  Cutaneous leishmaniasis (CL) which is the most common, causing skin lesions that can be self-resolving but if untreated can lead to mucocutaneous lesions. 3. [thementorinitiative.org]

• Papule

  The papule progressively increases in size over time and transforms into a nodule that subsequently breaks and forms a raised and well-demarcated ulcer. [symptoma.com]

  The papules characteristically are present at the edge of the scarred area. [mdedge.com]

  The rural or "moist" form is characterized by a tender papule at the site of the sandfly bite that rapidly becomes a fulminating inflammatory nodule. Lesions may be single or multiple. [annsaudimed.net]

  Incubation occurs over weeks to months, followed by the appearance of an erythematous papule, which can evolve into a plaque or ulcer. These lesions are usually painless. No systemic symptoms are evident. [emedicine.medscape.com]

  In these cases, cutaneous lesions (macules, papules, nodules, or plaques), without a tendency to ulcerate, arise on the skin after the end of the treatment for VL 19. In Brazil, this presentation is rare and is usually related to HIV-coinfection 4. [ncbi.nlm.nih.gov]

• Skin Ulcer

  Known locally as uta L. guyanensis The Guyana, Brazil Single skin ulcers, but lymphatic spread may result in widespread ulceration. Known locally as pian bois. [web.stanford.edu]

  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 frequency of old-world cutaneous leishmaniasis in skin ulcers in Peshawar. J Ayub Med Coll Abbottabad 2009;21(3):72-5. 2. Alrajhi AA. Cutaneous Leishmaniasis of the Old World. Skin Therapy Lett 2003;8(2):1-4. 3. [cehjournal.org]

  The cutaneous form of the disease can lead to distressing and disfiguring skin ulcers and scarring, while visceral leishmaniasis, which affects organs such as the liver and spleen, is invariably fatal if not treated. [thenewsminute.com]

  There are two types of cutaneous leishmaniasis in Iran, dry skin ulcer (urban type) caused by Leishmania tropica and moist skin (rural type) caused by L. major ( Collier et al ., 2005 ). [scialert.net]

• Cutaneous Manifestation

  While in Central America cutaneous manifestations of L. (L) infantum chagasi are quite common, in Brazil they are extremely rare. We report the first case of leishmaniasis with exclusively cutaneous manifestations caused by L. [ncbi.nlm.nih.gov]

• Alopecia

  D Alopecia and lesions on a rock hyrax (Procavia capensis). [jid.oxfordjournals.org]

A comprehensive clinical and microbiological workup is needed in order to recognize leishmaniasis as the underlying cause of skin lesions. A thorough patient history should cover the patient's country of residence and travel to endemic areas, as well as a history of sand fly bites [5]. In the case of urban cutaneous leishmaniasis, physicians must identify the potential source of this parasite in the urban setting, thus patients may be asked whether they have observed similar lesions in other individuals in their environment. A detailed physical examination should follow, during which assessment of skin lesions may point to the diagnosis. To confirm Leishmania as the causative agent, microbiological studies must be employed. Skin lesions can be scraped for microscopic examination (using Giemsa and other staining techniques) or cultivation (up to 10 days are necessary for Leishmania species to grow on specific media), both carrying good diagnostic rates [1] [4] [6]. A skin biopsy and subsequent histological examination have also been recommended [4] [5] [6]. Serological testing should be performed whenever possible, such as the Montenegro's reaction (inoculation of Leishmania antigen) which yields a conclusive result within 72 hours and is particularly useful for establishing an infection in travelers. Polymerase chain reaction (PCR) testing is considered as the most specific and most sensitive [4] [5] [6] [7].

• Anergy

  Diffuse cutaneous leishmaniasis This form is characterized by anergy (that is, lack of cellular immune response to parasite antigens). [f1000research.com]

• Leishmania Tropica

  Gov't MeSH terms Animals DNA, Kinetoplast/chemistry DNA, Protozoan/chemistry DNA, Ribosomal Spacer/chemistry Female Humans Insect Vectors/classification Insect Vectors/parasitology* Iran/epidemiology Leishmania tropica/classification Leishmania tropica [ncbi.nlm.nih.gov]

  Convert to ICD-10-CM : 085.1 converts approximately to: 2015/16 ICD-10-CM B55.1 Cutaneous leishmaniasis Applies To Aleppo boil Baghdad boil Delhi boil Infection by Leishmania tropica (minor) Leishmaniasis, cutaneous: dry form late recurrent ulcerating [icd9data.com]

  […] pg. 416 11 A new rural focus of cutaneous leishmaniasis caused by Leishmania tropica in Kenya, Trans R Soc Trop Med Hyg, 1992, vol. 86 (pg. 381 - 7 ) 12 A zoonotic focus of cutaneous leishmaniasis due to Leishmania tropica at Utut, Rift Valley Province [jid.oxfordjournals.org]

  Leishmania tropica occurs in Middle East, Mediterranean littoral, India, and Pakistan. Leishmania aethiopica occurs in Kenya, Tanzania, Uganda, and Ethiopia. [coursera.org]

  There are two types of cutaneous leishmaniasis in Iran, dry skin ulcer (urban type) caused by Leishmania tropica and moist skin (rural type) caused by L. major ( Collier et al ., 2005 ). [scialert.net]

• Visceromegaly

  An eighty-one-year-old woman presented three pleomorphic skin lesions that were not associated with systemic symptoms or visceromegalies. Multilocus enzyme electrophoresis identified L. [ncbi.nlm.nih.gov]

1. De Vries HJC, Reedijk SH, Schallig HDFH. Cutaneous Leishmaniasis: Recent Developments in Diagnosis and Management. Am J Clin Dermatol. 2015;16(2):99-109.
2. Palumbo E. Treatment strategies for mucocutaneous leishmaniasis. J Glob Infect Dis. 2010;2(2):147-150.
3. McGwire BS, Satoskar AR. Leishmaniasis: clinical syndromes and treatment. QJM. 2014;107(1):7-14.
4. Masmoudi A, Hariz W, Marrekchi S, Amouri M, Turki H. Old World cutaneous leishmaniasis: diagnosis and treatment. J Dermatol Case Rep. 2013;7(2):31-41.
5. Markle WH, Makhoul K. Cutaneous leishmaniasis: recognition and treatment. Am Fam Physician. 2004;69(6):1455-1460.
6. Davies CR, Kaye P, Croft SL, Sundar S. Leishmaniasis: new approaches to disease control. BMJ. 2003;326(7385):377-382.
7. Lemrani M, Hamdi S, Laamrani A, Hassar M. PCR detection of Leishmania in skin biopsies. J Infect Dev Ctries. 2009;3(2):115-122.