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38 5 Hemoflagellates
from animals by bite of sandfly vectors of genus Lutzomyia. Sylvatic rodents and domes-
tic animals are the common sources and reservoir of infection. Direct transmission also
occurs from human to human.
Pathogenesis and Clinical Features
Leishmania mexicana complex causes cutaneous leishmaniasis which closely
resembles the old world cutaneous leishmaniasis. However, a specific lesion caused
by L. mexicana is chiclero ulcer which is characterized by ulcerations in pinna. L.
braziliensis complex causes both cutaneous and mucocutaneous leishmaniasis.
Diagnosis
1. Microscopic examination
Stained smears from skin lesions and mucous membrane to demonstrate
amastigotes.
2. Biopsy
Skin biopsy to demonstrate amastigotes.
3. Culture
Culture of specimens obtained from ulcers in NNN medium.
4. Skin test
Leishmanin test.
5. Molecular diagnosis
PCR on clinical specimens.
Treatment
Pentavalent antimonials compound is moderately effective for mild mucocutaneous
leishmaniasis. Amphotericin B (i.v. 0.25–1.0 mg/kg daily or every other day for up
to 8 weeks) is the best alternative drug.
Prevention and Control
1. Insect repellants, insecticide spraying
2. Use protective clothing
Due to sylvatic and rural nature of the disease, control is often difficult.
