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→cutaneous leishmania
*basically self-limited
*rarely diffuce or disseminated
*600700,000-1 .2 mil. new cases per year*90% of cases are from 7 countries**Afghanistan, Pakistan, Iran, Syria, Saudi Arabia, Algeria, Brazil, Colombia, Iran, Syria***completely different from VL countries but Brazil
**imported in Texas, US in 2015
**cutaneous leishmaniasis by ''L. donovani'' is reported in Sri Lanka
**tends to increase in conflict area, mass displacement, military deployment
***especially in Syria since its civil war
*''L. tropica'', ''L. mexicana'', ''L. amazonensis'' and other species >20
*"old world" Africa and South Asia
*"new world" Latin America
*''Rhombomys opimus'' (great gerbil) is primary reservoir
===transmission===*cutaneous leishmaniasis by anthroponotic (''L. donovanitropica'' is reported ) or zoonotic (other species)*skin contact with active lesion innocuous*risk factors **poor quality housing**male**younger age <15 y/o**proximity to forest**domestic dog ownership**sleeping in Sri Lankatemporary shelters ===clinical features===*no life threatening*significant cosmetic morbidity**stigmatization*old world**dryer, warty, scaly*new world**wet, ulcerative**lymphadenopathy
===diagnosis of cutaneous leishmaniasis===
*smear of fine needle aspirate or biopsy of skin lesion
*serological test is of no use; low sensitivity and variable specificity
*DDx
**staphylococcal infection
**streptococcal infection
**mycobacterial ulcer
**fungal ulcer
**cancer
**sarcoidosis
**tropical ulcer -
==mucocutaneous leishmania==
