Brian J. Hall, MD

Francisco G. Bravo, MD

Cutaneous leishmaniasis manifests as a typical round to oval painless ulcer on an exposed area of skin with a well-delineated elevated border. This patient spent 3 months in Peru and did not recall a bite. (Courtesy T. Sofarelli, PA-C.)

This lesion of cutaneous leishmaniasis demonstrates numerous amastigotes image within the cytoplasm of numerous histiocytes that filled the dermis.



  • Cutaneous leishmaniasis

    • Oriental sore (Asia), Uta (Andes), Chiclero ulcer (Mexico, typically involves ear), tropical sore, Bagdad boil, Baure ulcer, Delhi boil, Aleppo boil, Aleppo button

  • Mucocutaneous leishmaniasis

    • American leishmaniasis, Espundia (Amazon basin), Pian bois (northern Brazil), forest yaws

  • Visceral leishmaniasis

    • Kala-azar, black fever, dumdum fever


  • Protozoal infection caused by intracellular parasites of Leishmania genera of Trypanosomatidae family

  • Old World leishmaniasis is caused by species located in India, Mediterranean, Middle East, Africa, and Asia (mainly causes cutaneous and visceral disease)

  • New World leishmaniasis is caused by species in Central and South America (causes cutaneous, mucocutaneous, and visceral disease)


Environmental Exposure

  • Disease transmitted by animal reservoirs (dogs or rodents) to humans by bite of female sandfly (genera Phlebotomus and Lutzomyia)

  • Parasite has 2 different forms: Promastigote and amastigote

  • Amastigote or nonflagellated form is seen in human tissue

    • Ovoid in shape

    • Measures 3-5 µm in diameter

    • Contains a nucleus and kinetoplast

      • Kinetoplast is a unique form of mitochondrial DNA

      • Identification of kinetoplast allows for distinction from other commonly confused microorganisms

Infectious Agents

  • Caused by several species of Leishmania and divided into 4 main groups or complexes

    • L. tropica complex

      • Includes L. tropica, L. major, and L. aethiopica

    • L. mexicana complex

      • Includes L. mexicana, L. amazonensis, and L. pifanoi

    • L. braziliensis complex

      • Includes L. braziliensis, L. peruviana, L. panamensis, and L. guyanensis

    • L. donovani complex

      • Includes L. donovani, L. infantum, and L. chagasi

    • Complexes 1-3 cause cutaneous leishmaniasis

    • Complex 3 causes mucocutaneous leishmaniasis

    • Complex 4 causes visceral leishmaniasis



  • Incidence

    • Worldwide

      • ˜ 1,500,000 new cases of cutaneous leishmaniasis/ year

      • Occurs in Mexico, Central and South America (except Uruguay and Chile), Southern Europe, Asia, Middle East, and Africa

    • In USA

      • Rare cutaneous case reports in southern Texas

Jul 8, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Leishmaniasis

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