Cutaneous leishmaniasis

Cutaneous leishmaniasis (also known as oriental sore, tropical sore, chiclero ulcer, or chiclero's ulcer) is the most common form of leishmaniasis affecting humans. It is a skin infection caused by a single-celled parasite that is transmitted by the bite of a phlebotomine sandfly. There are about twenty species of Leishmania that may cause cutaneous leishmaniasis.

Signs and symptoms

Post-kala-azar dermal leishmaniasis (PKDL) is a recurrence of kala azar that may appear on the skin of affected individuals up to 20 years after being partially treated, untreated or even in those considered adequately treated. In Sudan, they can be demonstrated in up to 60% of treated cases.

They manifest as hypopigmented skin lesions (such as macules, papules, nodules), or facial redness. Though any organism causing kala azar can lead to PKDL, it is commonly associated with Leishmania donovani which gives different disease patterns in India and Sudan. In the Indian variant, nodules enlarge with time and form plaques but rarely ulcerate, but nodules from the African variety often ulcerate as they progress. Nerve involvement is common in African variety but rare in Indian subcontinent.

Mucocutaneous leishmaniasis produces destructive and disfiguring lesions of the face and is very difficult to treat. Treatment involves the use of pentavalent antimonial compounds, which are highly toxic (common side effects include thrombophlebitis, pancreatitis, cardiotoxicity and hepatotoxicity) and not very effective.

Patient story
'I recognized her eyes': An MSF nurse describes a life-changing diagnosis for a patient in Pakistan.