Leishmaniasis

Leishmaniasis is endemic in 88 countries on five continents. From 1 to 1.5 million cases of cutaneous leishmaniasis are reported yearly worldwide. It is therefore not surprising that cutaneous leishmaniasis is increasingly seen among returning travellers and is considered one of the top 10 dermatological diagnoses. Based on geographical distribution, cutaneous leishmaniasis is divided into Old World and New World leishmaniasis. The clinical picture of the Old World species is largely as a benign and self-limiting cutaneous disease, whereas the American species can cause mucosal involvement, which is usually a complication of Leishmania braziliensis. Until recently, diagnosis of CL was based on direct visualization of the parasite through a microscope. PCR is a rapid tool with high sensitivity, giving a species-specific diagnosis and allowing species-specific treatment. PCR should be regarded as the method of choice for diagnosis in travellers. For Old World leishmaniasis, local treatment can be sufficient, but for New World leishmaniasis, systemic treatment is required. Liposomal amphotericin B seems to be the best option.