Summary
Leishmaniasis is a vector-born disease caused by obligate
intracellular parasites of macrophages, Leishmania, which are
transmitted by infected female sandflies. The incidence of
cutaneous leishmaniasis approaches 2 million new cases a year with
a large majority of cases reported in nine countries of the "Old
World", and Latin America. Infection may be restricted to the skin
with development of characteristic ulcers, or may affect the
mucosal membranes in its mucocutaneous form. The various clinical
forms of the disease reflect the fascinating immune-pathogenesis of
leishmaniasis. Clinical diagnosis is verified by the presence of
amastigotes in slit-skin smears, by parasite culture, and newer
polymerase chain reaction (PCR) techniques that permit Leishmania
species identification. Therapeutic modalities include both
systemic treatments (pentavalent antimony compounds, sodium
stibogluconate, lipid formulations of amphotericin B, oral
ketoconazole or itraconazole) and topical treatments (paromomycin
sulfate, local heat, freezing with liquid nitrogen, or photodynamic
therapy). Effective vaccines are still not available and the focus
of extensive research.