American Tegumentary Leishmaniasis
American tegumentary leishmaniasis is an endemic anthropozoonosis undergoing expansion on the American continent. The disease is caused by several Leishmania species, and, thus, there are intraspecific parasitological dissimilarities that may generate dif
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Introduction Leishmaniasis is an infectious disease caused by flagellate protozoa of the genus Leishmania (L.). The disease is transmitted to humans through the bite of an insect vector, the sand fly. Depending on the vertebrate reservoir found in a specific geographic zone, the disease is classified as zoonotic or anthroponotic. Leishmaniasis is characterized by a spectrum of clinical, histopathological, and immunological features linked to the pathogenicity of the infecting parasite as well as to the immunological response of the host. As stated in various chapters of the present volume, clinical manifestations of leishmaniasis include lesions in the skin and/or the mucous membranes, or invasion of visceral organs (Goto and Lindoso 2010). Leishmania infections range in severity from asymptomatic lesions to disfiguring tegumentary leishmaniasis and fatal visceral leishmaniasis. Dermotropic strains cause American tegumentary leishmaniasis (ATL) characterized by a spectrum of clinical manifestations including localized cutaneous (LCL), diffuse cutaneous (DCL), disseminated (DL), and mucocutaneous (MCL) leishmaniasis (Goto and Lindoso 2010; Souza et al. 2010). The main species (in 86–98% of cases) causing the limited clinical manifestations (characteristic ulcerative lesion) of leishmaniasis in the Old World are L. (L.) major, L. (L.) tropica, L. (L.) aethiopica, and some zymodemes of L. (L.) infantum. The lesions usually heal spontaneously in periods from 3 months to
O. Zerpa Ca´tedra de Dermatologia, Instituto de Biomedicina, Universidad Central de Venezuela, Caracas, Venezuela e-mail: [email protected] A. Ponte-Sucre (*) Laboratorio de Fisiologı´a Molecular, Instituto de Medicina Experimental, Escuela Luis Razetti, Universidad Central de Venezuela, Ciudad Universitaria, Los Chaguaramos, Caracas, Venezuela e-mail: [email protected] A. Ponte-Sucre et al. (eds.), Drug Resistance in Leishmania Parasites, DOI 10.1007/978-3-7091-1125-3_10, # Springer-Verlag Wien 2013
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2 years or may evolve to a relapsing lesion known as leishmaniasis recidiva cutis (L. (L.) tropica) or to DCL (L. (L.) aethiopica) (Akilov et al. 2007). L. (L.) donovani visceral infections may develop into post-Kala-azar dermic leishmaniasis (PKDL) (Zijlstra et al. 2003). A detailed description of the clinical manifestations of Old World cutaneous leishmaniasis is found in a recently published comprehensive review (Akilov et al. 2007). Most of the species that cause tegumentary leishmaniasis occur in the New World. They are numerous and belong to both the Leishmania (L.) and Viannia (V.) subgeni, L. (V.) braziliensis being the most prevalent species, followed by L. (L.) amazonensis and L. (L.) mexicana, L. (V.) guyanensis, and L. (V.) panamensis. Other types of Leishmania that may also produce the disease in America are L. (L.) pifanoi, L. (L.) shawi, L. (L.) venezuelensis, L. (V.) lainsoni, and L.(V.) peruviana (Souza et al. 2010). This variety in the species responsible for New World ATL determines the diverse cl
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