Cutaneous Leishmaniasis: An Emerging Infectious Disease in Travelers
Leishmaniasis describes any of 3 diseases caused by protozoan parasites of the genus Leishmania, the most common of which is cutaneous leishmaniasis. The majority of cutaneous cases occur in Central and South America, the Mediterranean basin, the Middle East, and Central Asia. Most cases diagnosed among nonmilitary personnel in the United States are acquired in Mexico and Central America. Here, we present the case of an American tourist who developed localized cutaneous leishmaniasis 2 weeks after returning from Costa Rica. After undergoing several unsuccessful rounds of empiric antibiotic treatment for a presumed Staphylococcus aureus skin infection, the patient was referred to our dermatology clinic where cutaneous leishmaniasis was diagnosed by tissue biopsy. This case highlights the importance of cutaneous leishmaniasis as an emerging infectious disease that may be misdiagnosed due to its rarity and varied clinical presentation as well as the limited use of tissue biopsy in general practice. We also provide relevant background information on cutaneous leishmaniasis, a rhyming poem, and an illustration in order to promote greater awareness of this disease and assist clinicians with its diagnosis.
Practice Points
- Cutaneous leishmaniasis is an emerging infectious disease that may be misdiagnosed due to its rarity and varied clinical presentation as well as the limited use of tissue biopsy in general practice.
- United States health care practitioners who evaluate patients with new isolated skin lesions and a history of recent travel to Mexico or South or Central Americas should consider cutaneous leishmaniasis in the differential diagnosis.
- Whenever possible, travelers to rural areas of Mexico and South and Central Americas should be educated about strategies to avoid arthropod bites, such as wearing protective clothing and using insect repellents.
Conclusion
Cutaneous leishmaniasis should be included in the differential diagnosis for travelers returning from endemic areas who present with new skin lesions. Since no specific lesion types are pathognomonic for cutaneous leishmaniasis, tissue biopsy for histopathology and PCR are essential for diagnosis. Prevention of cutaneous leishmaniasis hinges on appropriate counseling of travelers to endemic regions.
