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

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

  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]

  […] 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]

  The patient develops fever, discomfort from an enlarged spleen, abdominal swelling, weight loss, cough, or diarrhoea. Classically, the fever spikes twice daily, usually without rigors, but daily, irregular, or undulant fevers are common. [enetmd.com]

• Pain

  The lesions are usually without pain or pruritus, although secondary bacterial infection may complicate the wound (see the following image). Healing may occur spontaneously over 2-12 months and is followed by scarring and changes in pigmentation. [emedicine.medscape.com]

  However, administration of intra-lesional injections is painful and requires well-trained and well-equipped health workers. [thementorinitiative.org]

  Abstract Background: Pethidine, an opioid analgesic is used for pain management. Clomipramine a tricyclic antidepressant primarily used for mood management is also used to treat pain. [profiles.uonbi.ac.ke]

  They are usually painless, but can become painful if infected with bacteria. The lesions can take a long time to heal and usually leave scarring. [iamat.org]

• 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]

  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]

  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]

  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]

• 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]

  U.S. military personnel have become infected in various countries, such as Iraq and Afghanistan. Is leishmaniasis found in the United States? Not usually. [cdc.gov]

  Cases in US service personnel have reflected military activities (such as in Afghanistan and Iraq). CL is usually more common in rural than urban areas, but it is found in some periurban and urban areas (such as in Kabul, Afghanistan). [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]

• Swelling

  Samples taken from leading edge of lesion - Visceral Leishmaniasis : Abdominal swelling without definite illness, anemia, dermal nodules or lesions resembling leprosy. Diagnosis is made by visualizing the parasite. [web.stanford.edu]

  People who develop clinical evidence of infection usually have fever, weight loss, enlargement (swelling) of the spleen and liver, and abnormal blood tests. [cdc.gov]

  The patient develops fever, discomfort from an enlarged spleen, abdominal swelling, weight loss, cough, or diarrhoea. Classically, the fever spikes twice daily, usually without rigors, but daily, irregular, or undulant fevers are common. [enetmd.com]

  Visceral (kala-azar) is characterised by high fever, substantial weight loss, swelling of the spleen and liver, and anemia. If left untreated, the disease can have a fatality rate as high as 100% within two years. [thenewsminute.com]

  Invasion occurs slowly, sometimes causing no initial disturbance, thus allowing the mucosal injury to go unnoticed; on some occasions, it causes only mild local pruritus and swelling 4, 9, 17, 42, 46. [f1000research.com]

• Nausea

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

  Usually the drug is well tolerated but towards the end of treatment there may be malaise, anorexia, nausea, vomiting, and muscle pains. Should toxic effects develop, rest for 1 day and reduce each dose by 2 mg Sb/kg. [enetmd.com]

  The most frequently described adverse effects of antimonials are local irritation, anorexia, nausea, vomiting, myalgia, arthralgia, increases in hepatic enzymes, urea, and creatinine, and electrocardiographic alterations, such as inversion of the T wave [f1000research.com]

• Thrombosis

  The issue concludes with three very interesting case reports: one on mesenteric venous thrombosis; one primary a plastic anaemia and the other on Herpes zoster IRIS in pregnancy. [ncbi.nlm.nih.gov]

  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]

  Journal of the American Animal Hospital Association 20(3): 487-490 Akar, N. 2006: Idiopathic portal vein thrombosis and FVIII levels. [eurekamag.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]

• Ulcer

  085.1 urban 085.1 Old World 085.1 Oriental sore 085.1 Sore Delhi 085.1 Lahore 085.1 oriental 085.1 Ulcer, ulcerated, ulcerating, ulceration, ulcerative 707.9 Cochin-China 085.1 Crosswalk Information The code 085.1 converts into the following ICD-10 code [healthprovidersdata.com]

  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]

  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]

  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]

  Ulcer progression is slow and steady. [emedicine.medscape.com]

• 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]

  Symptoms of Cutaneous Leishmaniasis: Initial symptoms include skin lesions, which develop after several weeks or months after being infected, and swollen glands. The lesions – closed or open sores – can change overtime in size and appearance. [iamat.org]

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

  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]

  Also multiple sores may form The skin lesions then become nodules, and the nodules develop and ulcerate The skin turns black in color Persistent rashes can be found in the body The skin symptoms may be accompanied by fever, fatigue, and general malaise [dovemed.com]

• 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]

  The initial sore heals, but papules recrudesce in the edge of the scar and the lesion spreads slowly over many years. [enetmd.com]

• 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]

  The treatment measures include: Oral medicines and topical ointments/applications for skin lesions The skin ulcers may heal without treatment; the administration of appropriate medications can prevent scar formation If the ulcers heal and cause cosmetic [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 sores may start out as papules (bumps) or nodules (lumps) and may end up as ulcers (like a volcano, with a raised edge and central crater); skin ulcers may be covered by scab or crust. The sores usually are painless but can be painful. [cdc.gov]

  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]

• Skin Disease

  Tehran, Iran 4 Skin Diseases and Leishmaniasis Research center, Department of Biostatistics and Epidemiology, Isfahan University of Medical Sciences, Isfahan, Iran 5 Isfahan Provincial Health Center, Department of Disease Control, Isfahan University [journalssc.com]

  Old World cutaneous leishmaniasis is a mostly self-limiting skin disease in adults, but depending on the species, infected infants and children can develop the visceral form of the disease. [iamat.org]

  Research Article Hadi Ghasemloo, Sima Rasti, Mahdi Delavari and Abbas Doroodgar ABSTRACT Cutaneous leishmaniasis is a common skin disease caused by leishmania parasite. [scialert.net]

  diseases & Skin Care Open Access Journal Surgery: Current Research Official Journal of European Society of Aesthetic Surgery Translational Medicine Open Access Journal Trauma & Acute Care Open Access Journal Tropical Medicine & Surgery Open Access Journal [omicsonline.org]

  Lyme disease (LD) accounts for over 70% of tick-borne disease reported in the United States. The disease in humans is characterized by skin rash, arthritis, cardiac and neurological signs. [pubag.nal.usda.gov]

• Epistaxis

  Early signs of mucosal disease are nasal stuffiness, which may progress to epistaxis. [dermatologyadvisor.com]

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

  tropica and Leishmania major in urban and rural areas, respectively. [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]

  Presence, in dogs, of Leishmania infantum Nicolle and Leishmania tropica (Wright) (Kinetoplastida-Trypanonomatidae) [in French], Ann Parasitol Hum Comp, 1991, vol. 66 (pg. 252 - 5 ) 22 Short report: Leishmania tropica : etiologic agent of a case of canine [jid.oxfordjournals.org]

  Distribution of the three old Leishmania parasites [COUGH]. Leishmania major, Leishmania tropica, and Leishmania aethiopica. [COUGH] Excuse me. [coursera.org]

  Leishmania tropica is the most common species in the Bam and Mashhad, respectively (Aflatoonian et al ng1041 ., 2013; Mahmoodi et al ., 2010 ). Sequences alignment showed no differences between isolates and all samples were L. tropica and L. major. [scialert.net]

TREATMENT OF URBAN CUTANEOUS LEISHMANIASIS IN IRAN WITH CYCLOGUANIL PAMOATE. Acta Med Iran. :125-130. [acta.tums.ac.ir]

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]

Treatment Options Treatment options for CL re summarized in Table II. Table II. [dermatologyadvisor.com]

The vast majority of patients with acute cutaneous leishmaniasis eventually heal without treatment. Recalcitrant or multiple lesions, however may require treatment. Sodium stibogluconate (Pentostam) has been the treatment of choice. [annsaudimed.net]

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 authors contend that addressing this might, in the long run, improve prognosis of childhood cancer. Amputation is loathed by the patient, surgeon and community. [ncbi.nlm.nih.gov]

Species identification is critical as it determines the clinical course, prognosis and treatment choice, and until the recent development of molecular methods it was only possible through isoenzyme analysis of Leishmania culture. [dermatologyadvisor.com]

Public Health, Tehran University of Medical Sciences (TUMS), Tehran, Iran. [email protected] Abstract Shiraz district in south of Iran is a classical focus of Cutaneous leishmaniasis (CL) and previous research has consistently documented the etiologic [ncbi.nlm.nih.gov]

(Etiology) Cutaneous Leishmaniasis is an infectious disease caused by the bite of sandflies; small flying insects that are smaller than mosquitoes and less noisy. [dovemed.com]

Etiology Disease expression depends upon a number of factors: Leishmania species, size of Leishmania inoculum, sandfly saliva (has vasodilatory properties) and other vector virulence factors, and host cellular immune responses. [dermatologyadvisor.com]

Compendium on Continuing Education for the Practicing Veterinarian 24(4): 342-344 Merritt, A.M. 2002: Idiopathic eosinophilic enteritis: etiology and pathophysiology. [eurekamag.com]

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]

[Epidemiologic study of a new foci of anthroponotic cutaneous Leishmaniasis in Isfahan province/Iran]. The 3rd National Epidemiology Congress, Kerman, Iran. 8. [Epidemiologic study of cutaneous Leishmaniasis in Noogh/Rafsanjan in 2005]. [journalssc.com]

Epidemiological Aspects of Cutaneous Leishmaniasis in Iran Salman Khazaei 1, Abdollah Mohammadian Hafshejani 2, Mohammad Saatchi 3, Hamid Salehiniya 3, 4, * and Shahrzad Nematollahi 3 1 Department of Epidemiology and Biostatistics, School of Public Health [archcid.com]

Access the full text: NOT AVAILABLE Lookup the document at: Other subjects epidemiology Leishmania Sex of host Age of host leishmaniasis protozoal infections Vectors, Insecta From the journal Bulletin de la Societe Pathologie Exotique et de ses filiales [agris.fao.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]

Pathophysiology [ edit ] Promastigotes of Leishmania are transmitted to human skin by the bite of a sandfly. Leishmania then invades human macrophages and replicates intracellularly. [en.wikipedia.org]

[…] 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 [dermatologyadvisor.com]

Compendium on Continuing Education for the Practicing Veterinarian 24(4): 342-344 Merritt, A.M. 2002: Idiopathic eosinophilic enteritis: etiology and pathophysiology. [eurekamag.com]

Knowledge of Men and Women about Warning Signs of Cancer and Adoption of Preventive Behaviors. Der Pharmacia Lettre. 2016; 8 (5): 134-40 27. Ghahremani L, Faryabi R, Kaveh M. [emedicalj.com]

What can I do to prevent infection? No vaccines or drugs to prevent infection are available. The best way for travelers to prevent infection is to protect themselves from sand fly bites. [cdc.gov]

How can Cutaneous Leishmaniasis be Prevented? Currently, no vaccination has been discovered to prevent Leishmaniasis. Research is being undertaken to develop a vaccine at the earliest. [dovemed.com]

They prevent affected adults and children from going to school, working, or fully participating in community life, contributing to stigma and the cycle of poverty. [iamat.org]

Individual parasite descriptions include concise information on life cycles, epidemiology, clinical symptomatology, laboratory diagnosis, treatment, prevention and control, notes of interest, and new trends. [books.google.com]

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.