- Etiology: many species of obligate intracellular protozoa Leishmania; predominant species are:
- Old World: L. tropica,L. major,L. aethiopica
- New World: L. Mexican complex, Viannia subgenus
- Vector: sandflies
- Old World: Plebotomus
- New World: Luzomyia
- Infection of macrophages in skin (dermis), nasooropharyngeal mucosa, and the reticuloendothelial system (viscera)
- Diversity of clinical syndromes due to particular parasite, vector, and host species.
- Clinical syndromes: cutaneous, mucosal, visceral
- Cutaneous leishmaniasis (CL) characterized by development of single or multiple cutaneous papules at the site of a sandfly bite, often evolving into nodules and ulcers, which heal spontaneously with a depressed scar
- Old World cutaneous leishmaniasis (OWCL)
- New World cutaneous leishmaniasis (NWCL)
- Diffuse (anergic) cutaneous leishmaniasis (DCL)
- Mucosal leishmaniasis (ML)
- Visceral leishmaniasis (VL); kala-azar; post–kala-azar dermal leishmaniasis (PKDL)
- Management: parenteral antimonials for significant disease
- OWCL: Baghdad/Delhi boil or button, oriental/Aleppo sore/evil, bouton d'Orient.
- NWCL: chiclero ulcer, pian bois (bush yaws), uta.
- ML: Espundia.
- VL: Kala-azar (Hindu for black fever)
Infection in humans is caused by ∼20 Leishmania species (Leishmania and Viannia subgenera). See Table 29-1.
Table 29-1 Leishmania Species that Cause Disease in Humans |Favorite Table|Download (.pdf)
Table 29-1 Leishmania Species that Cause Disease in Humans
L. donovani complex
L. donovani sensu strictiori
VL (PKDL, OWCL)
China, Indian subcontinent, southwestern Asia, Ethiopia,c Kenya, Sudan, Uganda; possibly sporadic in sub-Saharan Africa
L. infantum sensu strictiorid
China, central and southwestern Asia, Middle East, southern Europe, North Africa, Ethiopia,c Sudan; sporadic in sub-Saharan Africa
Central and South America
L. mexicana complex
Texas, Mexico, Central and South America
NWCL (ML, DCL, VL)
Panama and South America
Central Asia, India, Pakistan, southwestern Asia, Middle East, Turkey, Greece, North Africa, Ethiopia,c Kenya, Namibia
Central Asia, India, Pakistan, southwestern Asia, Middle East, Turkey, North Africa, Sahel region of north-central Africa, Ethiopia,c Sudan, Kenya
OWCL (DCL, ML)
Ethiopia,c Kenya Uganda
L. (V.) braziliensis
Central and South America
L. (V.) guyanensis
L. (V.) panamensis
Central America, Venezuela, Colombia, Ecuador, Peru
L. (V.) peruviana
Peru (western slopes of Andes)
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