Cutaneous leishmaniasis

An infectious disease caused by a protozoan called Leishmania. When it manifests symptoms on the skin, it is called cutaneous Leishmaniasis. 

 

It occurs most frequently in southern Europe, Asia, Africa, Mexico and Central and South America.

 

It is transmitted by the bite of a mosquito called a sand fly, which bites dogs and/or rodents and then bites humans.  

 

The first symptom is usually a lump on the skin which appears at the site of the bite weeks or even months later. Parasites and white blood cells accumulate there and fight to contain the infection. Over time, the bump enlarges and becomes an open wound in the form of an ulcer, which oozes and eventually crusts over. At the same time new lumps appear in the area surrounding the initial lump. Ulcers are generally painless and are not accompanied by other symptoms, unless they are superinfected by bacteria, with pain, reddening of the skin and fever.   

 

The diagnosis of suspicion is clinical, when the lump in the skin is evidenced and in the interrogation detect a possible mosquito bite in the area of the lesion. To confirm the diagnosis, a sample of the ulcer should be collected where Leishmania will be isolated in culture and/or where its genetic material will be detected. 

 

Treatment depends on the size of the ulcer. If it is a small ulcer it can be treated with cryotherapy, paromomycin ointment and/or injecting stibogluconatosodium stibide into the sore. In larger ulcers and/or if there are multiple ulcers, an antileishmanial drug such as liposomal amphotericin B or miltefosine is indicated. 

In case of bacterial superinfection, an antibiotic of the usual ones for skin infections should be added. 

 

It is advisable to prevent leishmaniasis by avoiding mosquito bites with repellents, appropriate clothing and mosquito nets; in addition, if possible, outdoor activities should be avoided from dusk onwards when mosquitoes are most active.