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Cutaneous leishmaniasis
Cutaneous leishmaniasis is a parasitic infection transmitted by the bite of a sandfly; in Israel there are two main species — L. major in the Negev and Arava, with a rodent reservoir and usually healing within months, and L. tropica in the north and centre, with a rock hyrax reservoir, slower and more resistant — and diagnosis and treatment depend on the species, site and number of lesions.
Why it matters in the exam
The exam shows a soldier back from training in the Negev or a hiker in the Jordan Valley with a painless papule that grew over weeks into an ulcer with raised edges and crust, sometimes several lesions on exposed parts of the body. The question tests diagnosis (smear or biopsy from the edge showing amastigotes, and PCR to identify the species), the choice between watchful waiting, local treatment (cryotherapy, intralesional antimony, paromomycin ointment, heat therapy) and systemic treatment (high-dose fluconazole for L. major, miltefosine or liposomal amphotericin), and when systemic treatment is essential: many lesions, facial lesions, lesions near joints, lymphatic spread or immunosuppression. Remember the recurrent form (leishmaniasis recidivans) of L. tropica, with new papules around an old scar, and the distinction from visceral leishmaniasis (L. infantum and L. donovani), which presents with fever, splenomegaly and pancytopenia. Prevention includes fine-mesh nets, insect repellents and long clothing in the evening.
Key points
- Cutaneous leishmaniasis is transmitted by sandfly bites and presents as a papule that becomes a painless ulcer with raised edges.
- In Israel L. major is common in the Negev and Arava and heals fast, and L. tropica in the north and centre is slower and may recur.
- Diagnosis is by smear or biopsy from the ulcer edge, and PCR identifies the species, which sets the treatment.
- Few small lesions are managed by waiting or local treatment such as cryotherapy, paromomycin and intralesional antimony.
- Many lesions, facial lesions, lesions near joints or immunosuppression require systemic treatment.
Summary table
| Aspect | L. major | L. tropica | Note |
|---|---|---|---|
| Area in Israel and reservoir | Negev, Arava and Jordan Valley; rodents (Psammomys) | North, Galilee and desert margins in the centre; rock hyraxes | The sandfly is active in the evening and at night |
| Course | "Wet" ulcer, usually heals within 3–6 months | Slow "dry" lesion, over a year; recurrent form | Both leave a scar |
| Diagnosis | Smear or biopsy from the edge; PCR to identify the species | As L. major | Species identification guides treatment |
| Local treatment | Waiting, cryotherapy, paromomycin ointment, heat therapy | Intralesional antimony with cryotherapy | Suits few, small lesions away from the face and joints |
| Systemic treatment | Fluconazole 400–600 mg daily for 6 weeks | Miltefosine or liposomal amphotericin | Many lesions, face, joints, lymphangitis, immunosuppression |
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Sources
- IDSA/ASTMH clinical practice guidelines for the diagnosis and treatment of leishmaniasis, 2016 — Cutaneous leishmaniasis
- WHO guideline for the treatment of cutaneous leishmaniasis in the Eastern Mediterranean region, 2023 — Local and systemic treatment
- Israeli Ministry of Health — leishmaniasis epidemiology and reporting, 2024 — Cutaneous leishmaniasis in Israel
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.