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Cutaneous and mucocutaneous leishmaniasis


Key sources

The following summarized guidelines for the evaluation and management of cutaneous and mucocutaneous leishmaniasis are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA/ASTMH 2017). ...
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Diagnostic investigations

Clinical examination: as per ASTMH/IDSA 2017 guidelines, assess for mucosal symptoms snd signs, even during initial evaluation, in all patients with cutaneous leishmaniasis at risk for mucocutaneous leishmaniasis on the basis of the etiologic agent of Leishmania infection, if known, and the region in the New World in which infection was acquired.
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  • Laboratory testing (general principles)

  • Laboratory testing (DNA-based assays)

  • Laboratory testing (serology)

  • Skin testing

Diagnostic procedures

Biopsy: as per ASTMH/IDSA 2017 guidelines, collect tissue specimens from lesions when cutaneous leishmaniasis is clinically suspected. Recognize that full-thickness skin biopsy specimens allow for simultaneous testing for other diagnoses, such as by histopathology and cultures.
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Medical management

General principles: as per ASTMH/IDSA 2017 guidelines, consider offering empiric treatment based on individualized risk-benefit assessment after a careful diagnostic evaluation in which neither leishmaniasis nor another diagnosis is confirmed.
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  • Systemic therapy (indications)

  • Systemic therapy (choice of agent, dose and duration)

  • Local therapy

  • Corticosteroids

Specific circumstances

Patients with HIV/AIDS: as per ASTMH/IDSA 2017 guidelines, offer systemic anti-leishmanial therapy in patients with HIV/AIDS-associated cutaneous/mucocutaneous leishmaniasis, particularly in moderately to severely immunosuppressed patients (such as having CD4+ T-lymphocyte counts < 200-350 cells/mm³), possibly being at increased risk for suboptimal therapeutic responses, for post-treatment relapses, and for cutaneous, mucosal, or visceral dissemination.
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  • Patients with other causes of immunosuppression

Patient education

Patient education
As per ASTMH/IDSA 2017 guidelines:
Educate and provide patients with cutaneous leishmaniasis at risk for mucocutaneous leishmaniasis with personalized documentation about the importance of seeking medical attention for possible mucocutaneous leishmaniasis if they ever develop persistent, atypical (unusual for the patient) naso-oropharyngeal/laryngeal manifestations not having a clear etiology.
Educate patients with cutaneous leishmaniasis about the signs and symptoms of relapse and mucocutaneous leishmaniasis and instruct them to seek medical attention anytime these appear.

Follow-up and surveillance

Observation: as per ASTMH/IDSA 2017 guidelines, offer clinical observation alone for spontaneously healing skin lesions in immunocompetent patients with cutaneous leishmaniasis caused by infection with Leishmania species not associated with increased risk for mucocutaneous leishmaniasis, if the patient concurs with this management.
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  • Indications for referral

  • Monitoring of treatment response

  • Monitoring for progression

  • Management of treatment failure