Clinical features and diagnosis of 42 travellers with cutaneous leishmaniasis.
BACKGROUND
Leishmania species that occur within different geographical areas may cause different clinical manifestations, virulence and drug sensitivity. Patients/Methods. All patients with a clinical diagnosis of cutaneous leishmaniasis seen at the Hospital for Tropical Diseases from 1997 to 2000 were identified and clinical details recorded onto a database, with emphasis on clinical presentation, risk factors, travel history and laboratory diagnosis.


RESULTS
Forty-two patients were identified, 23 of whom had travelled to New World and 19 to Old World countries. Clinical presentation typically consisted of a single nodule with ulceration. In 50% infection was caused by L. (Viannia) braziliensis. PCR was performed in specimens from 34 patients and species identification was possible in 32 cases (sensitivity 94%), the two PCR negative patients had amastigotes demonstrated by histology and culture. Patients were treated with established therapies. Seventy one percent were cured by treatment, 12% had a spontaneous cure, 7% were lost to follow-up and the remaining 10% required a second-line therapy. No relapses were reported during a mean follow-up period of 27 months.


CONCLUSIONS
Our study highlights the need for comprehensive investigations and the advantages of PCR in the diagnosis of patients with suspected leishmaniasis in non-endemic regions of the world.
Scarisbrick
J J
JJ
Department of Dermatology, Middlesex Hospital, Mortimer Street, London W1N 8AA, UK. juliascarisbrick@doctors.net.uk
Chiodini
P L
PL
Watson
J
J
Moody
A
A
Armstrong
M
M
Lockwood
D
D
Bryceson
A
A
Vega-López
F
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D000818:Animals; D000935:Antifungal Agents / Q000008:administration & dosage; D000967:Antimony Sodium Gluconate; D000981:Antiprotozoal Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004739:England; D005260:Female; D014943:Global Health; D006801:Humans; D007654:Ketoconazole / Q000008:administration & dosage; D007891:Leishmania / Q000302:isolation & purification* / Q000469:parasitology; D016773:Leishmaniasis, Cutaneous / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012307:Risk Factors; D012867:Skin / Q000473:pathology; D014195:Travel; D016896:Treatment Outcome
D000935:Antifungal Agents; D000981:Antiprotozoal Agents; D007654:Ketoconazole; D000967:Antimony Sodium Gluconate