Thread by @guerreroespejo

A 24-YO ♂️ 2 years prior bitten by an insect on his left mid-arm in Nicaraguan: within a week, developed a lesion at the site of the bite; over time increased in number and spread in multiple hyperkeratotic, wart-like papules.
1/8

doi.org/10.1093/cid/ci…
#IDtwitter #dermatology

Wet mount slide from cultures of biopsy using rabbit blood agar slant: aggregates of Leishmania promastigotes (arrow), which can be identified based on their elongated shape and flagella.

CUTANEOUS LEISHMANIASIS
2/8

doi.org/10.1093/cid/ci…
#parasitology #MedTwitter

Biopsy cultures in “triple N” media, PCR and DNA sequencing: Leishmania panamensis.

He received a 10-day course of intravenous liposomal amphotericin B. His lesions slowly regressed over 3 months.
3/8

doi.org/10.1093/cid/ci…
#Doctor #microbiology

Leishmaniasis, caused by different species of Leishmania, is transmitted by female sandflies.

Infection can lead to visceral, cutaneous, or mucocutaneous forms of leishmaniasis depending on the species.
4/8
#MedStudentTwitter #resident

The patient was infected by Leihsmania panamensis, which is endemic to Central and South America and associated with both cutaneous, and or mucocutaneous
5/8

#epidemiology #medicine

Cutaneous leishmaniasis begins with a small area of erythema near the sandfly bite.
The erythema develops into a papule & then a nodule, which generally ulcerates over 2 weeks to 6 months.
Lesions may spontaneously heal within 6 to 15 months of disease onset

6/8
#MedicalStudents

The differential diagnosis includes:
✔️atypical mycobacterial infection,
✔️leprosy,
✔️nocardiosis,
✔️paracoccidioidomycosis,
✔️chromoblastomycosis, and
✔️skin cancer.
7/8

#MedEd

Parasitological diagnosis: Giemsa-stained biopsy smears or aspirates, histopathological examination of biopsies, or culture

PCR has a sensitivity of 87% & allows species identification but is only available at limited centers
8/8

#parasitology #parasites