Cutaneous leishmaniasis: recognition and treatment.

Cutaneous leishmaniasis is a parasitic disease occurring throughout the Americas from Texas to Argentina, and in the Old World, particularly the Middle East and North Africa. It is spread by the female sandfly. The condition is diagnosed every year in travelers, immigrants, and military personnel. Physicians in the United States must be alert to the diagnosis of leishmaniasis in travelers returning from endemic areas. Physicians working for short periods in endemic areas often must make the diagnosis and should be aware of local disease patterns. When faced with a possible leishmanial skin lesion, a skin scraping with microscopic analysis is the best test. Punch biopsies with tissue-impression smears also can be diagnostic. Needle aspiration of tissue fluid from the margin of a lesion can yield fluid for culture to isolate the organism and identify the species. Immunologic tests are being developed, including a highly sensitive polymerase chain reaction test. The treatment mainstay is pentavalent antimony (e.g., sodium stibogluconate). Not all patients require treatment; many lesions heal spontaneously. Antimonials have a high incidence of reversible adverse effects. Other medications used for treatment include amphotericin B, pentamidine isethionate, paromomycin, and antifungals. This disease must be considered in at-risk patients, and family physicians should know the basics of diagnosis and where to go for more help.