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Leishmania (cutaneous (Cutaneous leishmaniasis (Localized cutaneous…

- - - - Regional adenopathy can also occur and bubonic in nature.
      - The site of infection becomes a nodule and subsequently form an ulcer with central depression and raised indurated border (volcanic appearance). It can persist and grow a few centimetres before eventually healing and leaving a scar.
      - Lesions pruiritus , and secondary bacterial infection may also occur.
      - Koebner phenomenon can also occur.
      - Nodular lymphangitis
    - - Closely resemble lepromatous leprosy.
      - A single lesion gives rise to multiple diffuse nodules or plagues that contain multiple Amastigotes.
      - It is unlikely to resolve spontaneously and is difficult to treat.
      - There maybe extensive depigmentation in the area of the affected skin.
    - - Resemble Lupus Vulgaris, usually affecting the face and sometimes invading the mucous membrane.
      - Lesions wax and wane. The combination of scarring and active inflammation is characteristic of this condition.
      - Rare, but most commonly found in Iraq and Iran.
    - - Patients may initially complain of chronic nasal congestion.
      - The first perceptible lesion is a often a nodule adjacent to the nose.
      - The onset usually a few years after resolution of cutaneous lesions, but may occur while the primary lesion is still present.
      - Granulomatous destructive lesion with chronic ulceration follow and secondary bacterial infection.
      - After many years the nasal septum, other nasal cartilaginous structures, and palate may be destroyed. Leaving a grotesque cavity in the centre of the face.
    - - Response to treatment maybe problematic with recurrence of the disease. Condition may deteriorate or improve upon the commencement of cART.
  - - - meglumine antimoniate IV or IM -20mg/kg/day im/iv for 20-28 days
      - Sodium stibogluconate IV, IM, Intralesional. (brand name Pentostam)
    - - ketoconazole
      - fluconazole -if localised disease not likely to become systemic.
      - itraconazole
- - - - Splenic aspirate, bone marrow, lymph nodes for amastigotes.