Cutaneous leishmaniasis (CL) is caused by the protozoan parasite Leishmania and is transmitted through the bite of an infected female sandfly. CL is commonly diagnosed in travelers and immigrants who are susceptible to exposure. The lesions of CL usually begin as small erythematous papules that increases in size and eventually ulcerate and crust over. Lesions generally have distinct borders that are raised and erythematous. The diagnosis can be made based on travel history, lesion appearance, skin biopsy, and serology. Without treatment, the ulcers heal slowly but can leave disfiguring scars. Treatment modalities include pentamidine, amphotericin B, antimoniate, paromomycin, imiquimod, thermotherapy and cryotherapy. Visceral leishmaniasis (VL) is the most serious form of infection and is almost always fatal if untreated. With VL, the parasites directly infect organs including the spleen, liver, bone marrow, and other viscera. Common signs and symptoms of VL include fever, weight loss, fatigue, weakness, night sweats, hepatosplenomegaly, and pancytopenia.

Take-Home Points

• Cutaneous Leishmaniasis should be suspected in travelers who have been to endemic areas and present with non-healing skin ulcerations. Visceral Leishmaniasis is the most severe form of disease and carries an extremely high mortality rate if untreated.
• The vector for this disease is the sandfly; diagnosis is made through skin biopsy and direct microscopy of the parasite.