Itraconazole Can be Effective in the Treatment of Sporotrichoid Leishmaniasis

Abstract

J Travel Med 2004; 11:328–330. Leishmaniasis represents a diverse group of diseases caused by protozoan parasites that are transmitted to humans by the bite of phlebotomine sandflies. Three major clinical forms can be recognized,visceral,cutaneous and mucocutaneous, which are widespread in tropical, subtropical and temperate areas.1 Data on the incidence of cutaneous leishmaniasis in travelers are scarce. In fact, constant parameters (time of exposure,kind of travel,burden of outdoor activities, rural or urban setting) are necessary to determine this incidence. Studies performed in defined groups such as military personnel in the Middle East showed an incidence of about 8/1,000 persons.2 Cutaneous leishmaniasis is sometimes associated with sporotrichoid spread. Sporotrichoid leishmaniasis is characterized by the development of subcutaneous, nontender, slightly erythematous nodules, often associated with lymphangitis, that progress, starting from the mother lesion, along dermal and subcutaneous lymphatics. In sporotrichoid cutaneous leishmaniasis, amastigotes may be found in both primary lesions and subcutaneous nodules.3,4 Sporotrichoid spread is more frequently associated with New World cutaneous leishmaniasis,particularly Leishmania braziliensis, although it can be observed also in association with Old World cutaneous leishmaniasis (L. major).5,6 The factors that trigger lymphatic dissemination are unclear.Some data suggest that both antileishmanial treatment and the host immune status could influence the dissemination.7,8 The diagnosis of cutaneous leishmaniasis is often made clinically on the basis of a typical lesion together with a history of exposure.Confirmation can be obtained by the direct detection of amastigotes during histologic examination of the biopsy of the lesion. The identification of Leishmania spp. is done traditionally through isoenzyme analysis and requires parasite culture. PCR is a suitable and quick tool for the diagnosis and identification of the different species.9 In the differential diagnosis of sporotrichoid infections, we have to consider, apart from Leishmania spp., infections caused by Sporotrix schenkii,Mycobacterium spp., Nocardia spp. and Francisella tularensis.