Disseminated Cutaneous Leishmaniasis Due to Leishmania Guyanensis: Case of a Patient With 425 Lesions

Abstract

Disseminated cutaneous leishmaniasis is characterized by the presence of a large (> or =10) number of lesions at several anatomic sites (head, limbs, and trunk). Most of the lesions are small, papular, and appear simultaneously with or secondarily to one or several ulcerated lesions of localized cutaneous leishmaniasis. We report the first case of disseminated cutaneous leishmaniasis in French Guiana. It concerns a 24-year-old woman who tested negative for human immunodeficiency virus (HIV). The disease began with three lesions that became ulcerated. One week later, multiple papulo-nodular lesions appeared. We counted a total of 425 lesions. Leishmania were observed in the lesions. The species involved was L. guyanensis, which has never been described in a case of disseminated cutaneous leishmaniasis. The patient was rapidly cured by a single course of pentamidine. Disseminated cutaneous leishmaniasis should be distinguished from other types of leishmaniasis with multiple lesions. These include anergic diffuse cutaneous leishmaniasis, post-kala-azar leishmaniasis, and leishmaniasis associated with HIV infection.

Unusual manifestations of tegumentary leishmaniasis in AIDS patients from the New World

“…The lesions described so far range from isolated papules, plaques or ulcers on exposed areas similar to those found in nonimmunosuppressed patients or in nonHIVinfected patients 7,14,15 to disseminated ulcers or plaques. 16,17 Frequently, cutaneous lesions in HIV-infected patients are associated with visceral leishmaniasis resembling postkala-azar dermal leishmaniasis. 18,19 As the clinical manifestations of tegumentary leishmaniasis in HIV-infected patients are likely to be dependent on immunological status, and as the presence of severe immunosuppression may modify the clinical characteristics of the disease, hindering the diagnosis of tegumentary leishmaniasis by physicians, we investigated tegumentary leishmaniasis in HIV-infected patients, focusing on clinical manifestations, diagnosis, immunological status and outcome.…”

What determines the success or failure of intracellular cutaneous parasites? Lessons learned from leishmaniasis

“…However, some Leishmania species mainly in the New World can cause a more disseminated disease in the host producing very large numbers of lesions, i.e. up to 425 in a single individual [6]. In general, the pathological changes characterizing the various clinical forms of leishmaniasis reXect the balance between parasite multiplication, the immune response of the patient and the resulting degenerative changes.…”

Phlebotomine sand flies (Diptera: Psychodidae) associated with changing patterns in the transmission of the human cutaneous leishmaniasis in French Guiana

“…With about 300 cases of human cutaneous leishmaniasis (HCL) reported annually (Carme 2001, Lightburn et al 2001) and some extreme situations (Couppié et al 2004), this disease still represents a major public health problem in French Guiana. The first HCL cases were confirmed in French Guiana in 1943 (Floch 1943) and past studies showed that Leishmania (Viannia) guyanensis is the predominant species of Leishmania (Floch 1957, Dedet et al 1989, Raccurt 1996 and L. (V.) naiffi have also been diagnosed (Dedet et al 1985, Raccurt et al 1995, Basset et al 2001, Pratlong et al 2002.…”