0521779407-10 CUNY1086/Karliner 0 521 77940 7 June 6, 2007 17:44
890 Leishmaniasis, Cutaneouslymphatic channels. L braziliensis complex can metastasize to nasal
septum and adjacent tissues (known as mucocutaneous leishmania-
sis, or espundia), producing erosion of the septum, palate, and other
nasopharyngeal tissues.tests
■Basic tests: blood: usually normal
■Basic tests: urine: normal
■Specific tests: Biopsy specimen should include a portion sent for
culture (on NNN or similar medium), a portion sent for touch prep,
and a portion sent for routine pathology. Kinetoplasts should be
noted on path to diagnose leishmaniasis.
■Other tests: PCR available as research tool, also helpful in speciat-
ing leishmania. The CDC speciates using monoclonal antibodies.
Serology variably positive, not diagnostic.differential diagnosis
■Most common similar lesion is pyogenic ulcer, usually with less
raised border. Other causes of skin ulcer are tuberculosis, cutaneous
diphtheria, paracoccidioidomycosis, other fungus diseases, atypical
mycobacterial disease, syphilis. Mucocutaneous disease resembles
midline granuloma, syphilis, tuberculosis, tumors.management
What to Do First
■Treat any secondary infection with antibiotics. In mucocutaneous
disease, assess extent of damage, include CT scanning.General Measures
■Obtain baseline studies, including CBC, renal function (creatinine),
liver function tests, pancreatic enzymes, and EKG, in preparation for
treatment.specific therapy
Indications
■All patients with L braziliensis complex infections, to avoid metas-
tasis
■All patients with mucocutaneous disease should be treated.
■All patients with New World disease that cannot be speciated
■With other species, treat large or multiple lesions, or lesions in func-
tionally important or cosmetically sensitive areas. Treatment for
other lesions is optional.