BOF: 7
A soldier returns from
training in Belize. He has developed an ulcer on his right leg that has failed
to heal despite treatment with antibiotics and daily dressings.
Skin biopsy from the edge of the lesion has been examined histological and
amastigotes bodies have been detected.
Your next course of action would
be.
a) Leave
the lesion alone and await spontaneous healing.
b) Freeze
the lesion with liquid nitrogen
c) Treat
the patient with a twenty-day course of sodium stibogluconate
d) Surgical
excision
e) Intralesional injection of sodium stibogluconate
Answer
c)
Amastigotes (LD) bodies seen
on biopsy suggest the diagnosis of Leshmaniasis. Cutaneous leishmaniasis may
be divided into that of the Old World (Africa, Mediterranean, Afghanistan) and
cutaneous leishmaniasis of the New World (Central and South America).
Cutaneous leishmaniasis of the Old World heals in 4-18 months leaving a scar.
No serious sequelae occur. It may be left alone.
It could be frozen with liquid nitrogen.
A pentavalent antimonial such as sodium stibogluconate may be administered
intralesionally.
Cutaneous leishmaniasis of the New World runs a more protracted course.
Without treatment the ulcers may persist for years.
Some of the patients may develop the mucocutaneous form where the infection
spreads from the skin the nasopharyngeal mucosa and this leads to progressive
destruction of the nose and pharynx.
New World cutaneous leishmaniasis should be treated and the drug used is
sodium stibogluconate.
Revision Tip
Revise Leishmaniasis
KEYS to SUCCESS in Medicine page 563-567
