Internal Medicine

0521779407-13 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:15

Leishmaniasis, Cutaneous Leishmaniasis, Visceral 891

Treatment Options

■Sodium stibogluconate for 20 days for cutaneous disease, 30 days in

mucocutaneous disease

■Liposomal amphotericin B over 5 or more days

■Topical paromomycin (15% in soft white paraffin) effective in some

Old World disease

Side Effects & Complications

■Sodium stibogluconate: see Leishmaniasis, Visceral

■Liposomal amphotericin B: see Leishmaniasis, Visceral

■Topical paromomycin: local irritation and sometimes pain

■Contraindications to treatment: absolute: allergies to the medica-

tion, first trimester of pregnancy

■Contraindications to treatment: relative. Pregnancy, small or single

lesions of Old World disease or known mexicana complex (which do

not metastasize)

follow-up

During Treatment

■See Leishmaniasis, Visceral

Routine

■Relapse can occur, may need retreatment. Mucocutaneous disease

not considered cured until 2-year follow-up.

complications and prognosis

■Cutaneous disease leaves a scar. Mucocutaneous disease is destruc-

tive and may require plastic surgery after cure. Immunosuppressed

patients may develop visceral disease and require prolonged or

maintenance therapy. Otherwise prognosis is good.

LEISHMANIASIS, VISCERAL

J. GORDON FRIERSON, MD

history & physical

History

■Exposure: bite of phlebotomine fly. Disease due to Leishmania infan-

tum (found in Mediterranean littoral, middle East, southern Russia,

northern China), L. donovani (found in Indian subcontinent, Pak-

istan, Nepal, China), and L. chagasi (found in Central and South

America).