cutaneous leishmaniaois
TRANSCRIPT
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CUTANEOUS LEISHMANIASIS
Caused by a protozoa calledleishmania
Pathogenesis:
The vector host is a sandfly
PHLEBOTOMUS.
The disease is transmitted to the humanbeings by the bite of the infected sandfly.
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Primary reservoir can be humans orcertain animals
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Life cycle
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CLINICAL FEATURES
The disease can present to thedoctor in our part of the worldin a variety ofways
INCUBUTION PERIOD 3WEEKS TO 3 MONTHS
STARTS AS INSECT BITE LIKERASH
1. A nodule or nodules onExposed parts of the body.
2. An ulcer or ulcers on theexposed parts of the body.
3. Dry psoriasiform plaque orplaques.
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Always examine the ulcer to checkfor induration
4.SubcutaneusNodules and ulcers inlinear chains.
relapse of the disease
in a previously healedscar known asleishmaniasisrecidivans
Dessiminatedleishmaniasis
Postkalazar dermalleishmaniasis
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DESSIMINATED LEISHMANIASIS
Clinically thedisease presents as
multiple papulesand plaques onvarious parts of thebody
IT is very resistantto treatment
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DIAGNOSIS
Clinical Smear Examination: Skin Biopsy. Culture
DIFERENTIAL DIAGNOSIS Syphilis ,deep mycosis, cutaneous tuberculosis, Leprosy, Psoriasis ,skin tumors, dermatitis artifacta, pyoderma gangrenosum.
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TREATMENT
PHYSICAL THERAPY
CRYOTHERAPY. Local heat therapy.
DRUG THERAPY SODIUM STIBOGLUCONATE MEGLUMINE ANTIMONATE. Ketoconazole Itraconazole Dapsone Rifampicin Allopurinal. Amphoterin B.
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LYMPHATIC SPREAD INLEISHMANIASIS
Such pathology can also be seen inSPOROTRICOSIS,MYCOBACTERIALINFECTIONS
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This can be misdiagnosed ifpalpation to feel dermal
pathology is not done
PSORIASIFORM SKIN LESION
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PSORIASIFORM SKINPATHOLOGY ON COVERED
AREAAlways take skin biopsy from such
atypical skin lesions
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Intralesional glucantime does notwork as the disease has spread
through lymphatics
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Leishmaniasis simulating cellulitis
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Leishmaniasis simulating sacoidosis
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Leishmaniasis simulating basal cellcarcinoma
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Awarenes about this disease islacking
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ANNULAR SKIN LESION INLEISHMANIASIS
SIMILAR PATHOLOGY CAN BE SEEN INGRANULOMA
ANNULARAE,LEPROSY,FUNGAL
INFECTIONS,LICHENPLANUS,TUBERCULOSIS.
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Staph aureus and streptococalskin infections may have
similar pictureAlways take history and do clinical
examination
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LEISHMANIASIS SIMULATING DLE
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Steroid modified leishmaniasis
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HIV +,has developed nodules on theskin and oral mucosa,
5 hi t h i
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5 years history,chronicgranulomatous inflamation,pas stain
+
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Many diseases can have such likepresentation
LICHEN PLANUS
PSORIASIS
EPIDERMAL NEVUS LICHEN STRIATICUS
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Chronic swelling of the legs
Gets recurrent fever with increase inswelling,pain and erythema.
Good response to penicillins
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PRURITUS,FAMILYHISTORY +
PRURITIC NODULES ON
GENITALIA ARE DIAGNOSTIC
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Family history +parents first cousins
Similar rash in perioral region,oralthrush,decrease hair growth
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Short history,fresh ulcers,unfreindlyfamily envirnoment
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Small skin lesion usedclobavate
Steroids are not the answer for
every skin rash
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ACNAE VULGARIS
Teen age
Polymorphic skin rash
Papules,pustules,nodules,comedones/
Face,chest,back can beinvolved
There is follicularplugging,increased sebumproduction and increasein the no ofpropianibacterium acnae
Treatment includes
Tetracyclines
macrolides
Clindamycin Synthetic vitamin a
derivatives
Benzyle peroxide
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ACNE ROSACIA
Midle age,usuallyfemales,fair color
There are papules andpustules
with,telangiactasia,erythema,
Central part of face isinvolved
Complain of burning andeye irritation
Tetracyclines andmetronidazole are given