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*Bolivia, Brazil, Peru
→sand flly
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==taxonomy==
*phylum ''Sarcomastigophorea'', class ''Zoomastigophorea'', genus ''Leishmania''
*amastigote - 2-4 μm
**transform from promastigote and propagate inside macrophage
**propagetes inside macrophage
**parasitized macrophage finally ruptures and let amasitgote out which eventually by sandfly
**transform to promastigote inside sandfly midgut
*simpler than ''Trypanosoma''
*host: human, dog, rodent
===sand fllysandfly===
*''Phlebotomus'' spp.
**Eurasian
**Latin America
*Feed during night
*Bitten site by sandfly produces asymptomatic papule, eventually enlarges to an ulcerated nodule and will be spontaneously healed
==visceral 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===*anthroponotic (''L. tropica'') 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 temporary shelters ===clinical features===*no life threatening*significant cosmetic morbidity**stigmatization*old world**dryer, warty, scaly*new world**wet, ulcerative**lymphadenopathy ====diffuse cutaneous leishmaniasis ====*rare form of CL*nodular, papular ====disseminated CL====*rare form of CL*>10 mixed type skin lesions*in immunocompromised host ====leishmania recidivans====*by ''L. donovanitropica'' is reported in Sri Lanka*new lesions encircling years-old scar
===diagnosis of cutaneous leishmaniasis===
*smear of fine needle aspirate or biopsy of skin lesion
**specimen from ulcer margin is the highest yield
**fine needle aspiration cytology is generally better
*serological test is of no use; low sensitivity and variable specificity
*NAAT is available
====DDx of CL====
**staphylococcal infection
**streptococcal infection
**mycobacterial ulcer
**fungal ulcer
**cancer
**sarcoidosis
**tropical ulcer -
==mucocutaneous leishmania==
*only in new world CL
**Bolivia, Brazil, Peru
*same as Espundia, white leprosy
*lyphatic or hematogenous dissemination to mucosa in mouth and/or upper respiratory tract, resulted in destruction and deformity of nose, palate, pharynx
*''L. braziliensis'', ''L. panamensis''
*progressive ever without treatment
*secondary bacterial infection
*worsening nasal congestion, epistaxis or discharge common
*permanent disfigurement of face
**cleft palate, nasal septum destruction, "Tapir" nose
===diagnosis of mucocutaneous leishmaniasis===
==treatment==
*majority spontaneously healed in 2-15months
*distinguish simple or complex
**complex -
*new world needs more to identify species to anticipate of progression to mucocutaneous CL
*pentavalent antimonial
**meglumine antimoniate
**liquid nitrogen
*thermotherapy
**40-42℃ for 3min.***50℃ for 30min30 sec.**make second degree burn *topical application
==vaccine==
*vector control for sandfly-borne leishmaniasis
*destruction of burrows of great gerbil
==GHIT Fund==
Global Health Innovative Technology Fund
*supported by Japanese Government
