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Cutaneous and mucocutaneous leishmaniasis
Guidelines
Key sources
The following summarized guidelines for the evaluation and management of cutaneous and mucocutaneous leishmaniasis are prepared by our editorial team based on guidelines from the Infectious Diseases Society of America (IDSA/CDC/NIH/HIVMA 2024) and the Infectious Diseases Society of America (IDSA/ASTMH 2017).
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Diagnostic investigations
Clinical examination: as per ASTMH/IDSA 2017 guidelines, assess for mucosal symptoms snd signs, even during initial evaluation, in all patients with cutaneous leishmaniasis at risk for mucocutaneous leishmaniasis on the basis of the etiologic agent of Leishmania infection, if known, and the region in the New World in which infection was acquired.
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Laboratory testing (general principles)
Laboratory testing (DNA-based assays)
Laboratory testing (serology)
Skin testing
Diagnostic procedures
Medical management
General principles: as per ASTMH/IDSA 2017 guidelines, consider offering empiric treatment based on individualized risk-benefit assessment after a careful diagnostic evaluation in which neither leishmaniasis nor another diagnosis is confirmed.
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Systemic therapy (indications)
Systemic therapy (choice of agent, dose and duration)
Local therapy
Corticosteroids
Specific circumstances
Patients with HIV, antiretroviral therapy: as per CDC/HIVMA/IDSA/NIH 2024 guidelines, initiate antiretroviral therapy as soon as possible.
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initiate or optimize antiretroviral therapy to prevent reactivation of cutaneous leishmaniasis. ⁄
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Patients with HIV (antileishmanial therapy)
Patients with HIV (secondary prophylaxis)
Patients with HIV (pregnancy)
Patients with HIV (treatment monitoring)
Patients with other causes of immunosuppression
Patient education
Patient education
As per ASTMH/IDSA 2017 guidelines:
Educate and provide patients with cutaneous leishmaniasis at risk for mucocutaneous leishmaniasis with personalized documentation about the importance of seeking medical attention for possible mucocutaneous leishmaniasis if they ever develop persistent, atypical (unusual for the patient) naso-oropharyngeal/laryngeal manifestations not having a clear etiology.
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Educate patients with cutaneous leishmaniasis about the signs and symptoms of relapse and mucocutaneous leishmaniasis and instruct them to seek medical attention anytime these appear.
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Follow-up and surveillance
Observation: as per ASTMH/IDSA 2017 guidelines, offer clinical observation alone for spontaneously healing skin lesions in immunocompetent patients with cutaneous leishmaniasis caused by infection with Leishmania species not associated with increased risk for mucocutaneous leishmaniasis, if the patient concurs with this management.
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Indications for referral
Monitoring of treatment response
Monitoring for progression
Management of treatment failure