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Published on: April 21, 2012

[Cutaneous leishmaniasis--an import from Belize].

Jakob Schnedl¹, Herbert Auer, Marcellus Fischer

¹Heeresspital Wien, Dermatologische Abteilung, Wien, Osterreich. jakob.schnedl@meduniwien.ac.at

Wiener Klinische Wochenschrift

|December 6, 2007

Summary

New World cutaneous leishmaniasis, potentially caused by Leishmania (Viannia) braziliensis, requires systemic treatment due to dissemination risk. Intravenous pentamidine effectively treated three soldiers with ulcers acquired in Belize.

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Published on: November 2, 2016

Area of Science:

Tropical medicine
Parasitology
Dermatology

Background:

Cutaneous leishmaniasis (CL) in the New World, especially from Leishmania (L.) braziliensis, poses a risk of dissemination.
Disseminated CL can lead to mucocutaneous leishmaniasis, causing severe orofacial destruction, even years after initial skin lesion resolution.
Old World CL is typically localized, allowing for conservative management.

Observation:

Three Austrian soldiers presented with multiple upper limb ulcers weeks after a jungle patrol course in Belize.
Diagnosis was confirmed via histological evaluation of biopsies and detection of amastigote Leishmania in ulcer smears.
Species identification was not performed, necessitating consideration of L. brasiliensis and potential mucocutaneous progression.

Findings:

Initial treatments including cryotherapy, topical paromomycin, and oral fluconazole were ineffective.
Systemic therapy with intravenous pentamidine (3-4 mg/kg, three doses) resulted in complete regression of lesions within four weeks.

Implications:

Systemic treatment is crucial for New World CL when L. (Viannia) braziliensis infection is suspected.
Intravenous pentamidine demonstrates efficacy in treating severe or treatment-refractory cutaneous leishmaniasis.
Prompt and appropriate systemic therapy can prevent severe disease progression and complications.