Cutaneous leishmaniasis: diagnosis

Attempts should be made to detect the parasite microscopically in a biopsy or smear from the edge of the wound. The biopsy will, if possible, be divided up for pathology (seldom available, not very sensitive, is principally used more for exclusion of another cause) and cultures (bacteria, mycobacteria, fungi, Leishmania) and an impression preparation should also be made. Lesions on the face can be injected with 0.1 ml physiological saline and aspirated again while moving the small, thin needle back and forth in the skin. Serology is usually negative. Differential diagnosis includes ulcers due to mycobacteria, cutaneous diphtheria, tertiary syphilis, yaws, cutaneous carcinoma and deep or subcutaneous mycosis. Acid fast bacilli can be made visible using the method of Ziehl-Neelsen. Field sore (cutaneous diphtheria) and tropical ulcers (fusobacteria + Borrelia) are painful, particularly in the early phase.

Category: Medicine Notes