American Tegumentary Leishmaniasis

  • Olga Zerpa
  • Alicia Ponte-Sucre


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 different pathologies. Furthermore, in America, Leishmania spp. has diverse reservoirs (that may change continuously) and can use various vectors to infect humans and mammals. Antimonials are the drugs of choice for the treatment of American tegumentary leishmaniasis; however, their efficacy is not predictable, and this may be linked to parasite drug resistance. This is further complicated by the fact that the etiological parasitic species in America belong to both the Leishmania and the Viannia subgeni. For all these reasons, the identification of the etiological infectious agent – up to the species level – is fundamental for precise clinical diagnosis, for treatment and prognosis, and for control of the disease. The present chapter offers a description of American tegumentary leishmaniasis, a fundamental piece of knowledge for the comprehension of the challenges we face for leishmaniasis in times of drug resistance. As a way to better understand the unique scenario that America offers for leishmaniasis, some data related to the figures present in the Old World will be presented.


Visceral Leishmaniasis Cutaneous Leishmaniasis Leishmania Species Lepromatous Leprosy Erythematous Papule 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



The authors are grateful for the financial support received from the Coordination for Research, Faculty of Medicine, Universidad Central de Venezuela (UCV), and the Council for Scientific and Humanistic Research (CDCH), UCV. Likewise, they are grateful for the support conferred by the Alexander von Humboldt Foundation, Germany, to Alicia Ponte-Sucre.


  1. Akilov OE, Khachemoune A, Hasan T (2007) Clinical manifestations and classification of Old World cutaneous leishmaniasis. Int J Dermatol 46:132–142PubMedCrossRefGoogle Scholar
  2. Barral A et al (1995) Polar and subpolar diffuse cutaneous leishmaniasis in Brazil: clinical and immunopathologic aspects. Int J Dermatol 34:474–479PubMedCrossRefGoogle Scholar
  3. Bittencourt AL et al (1993) Leishmaniasis recidiva cutis in American cutaneous leishmaniasis. Int J Dermatol 32:802–805PubMedCrossRefGoogle Scholar
  4. Bray RS, Lainson R (1965) The immunology and serology of leishmaniasis the fluorescent antibody staining technique. Trans Roy Soc Trop Med Hyg 59:535–544PubMedCrossRefGoogle Scholar
  5. Calvopina M et al (2006) Leishmaniasis recidiva cutis due to Leishmania (Viannia) panamensis in subtropical Ecuador: isoenzymatic characterization. Int J Dermatol 45:116–120PubMedCrossRefGoogle Scholar
  6. Castés M, Tapia FJ (1998) Inmunopatologia de la leishmaniasis tegumentaria americana. Acta Cient Venezolana 49:42–56Google Scholar
  7. Convit J (1996) Leishmaniasis immunological and clinical aspects and vaccines in Venezuela. Clin Dermatol 14:479–487PubMedCrossRefGoogle Scholar
  8. Convit J et al (1989) Inmunotherapy of localized, intermediate, and diffuse forms of American cutaneous leishmaniasis. J Infect Dis 160:104–115PubMedCrossRefGoogle Scholar
  9. Convit J et al (1993) The clinical and inmunological spectrum of American cutaneous leishmaniasis. Trans Roy Soc Trop Med Hyg 87:444–448PubMedCrossRefGoogle Scholar
  10. Cuba CA et al (2000) Diagnóstico parasitológico e inmunológico de leishmaniasis tegumentaria Americana. Rev Med Exper 17:1–4Google Scholar
  11. Davies CR et al (2000) The epidemiology and control of leishmaniasis in Andean countries. Cader Saude Publ 16:925–950CrossRefGoogle Scholar
  12. de Castro EA et al (2005) Eco-epidemiological survey of Leishmania (Viannia) braziliensis American cutaneous and mucocutaneous leishmaniasis in Ribeira Valley River, Parana State, Brazil. Acta Trop 93:141–149PubMedCrossRefGoogle Scholar
  13. De Lima H et al (2002) Cotton rats and black rats as possible reservoirs of cutaneous leishmaniasis in an endemic area in Lara State, Venezuela. Memór Instit Oswaldo Cruz 97:169–174CrossRefGoogle Scholar
  14. El-Hassan AM et al (1995) Sudanese mucocutaneous leishmaniasis: epidemiology, clinical features, diagnosis, immune responses and treatment. Trans Roy Soc Trop Med Hyg 89:647–652PubMedCrossRefGoogle Scholar
  15. Feliciangeli MD (1991) Vectors of leishmaniasis in Venezuela. Parassitologia 33:229–236PubMedGoogle Scholar
  16. Feliciangeli MD, Rabinovich J (1998) Abundance of Lutzomyia ovallensi but not Lu. Gomezi (Diptera:Psychodidae) correlated with cutaneous leishmaniasis incidence in north-central Venezuela. Med Vet Entomol 12:121–131PubMedCrossRefGoogle Scholar
  17. Feliciangeli MD et al (1994) Vectors of cutaneous leishmaniasis in north-central Venezuela. Med Vet Entomol 8:317–324PubMedCrossRefGoogle Scholar
  18. Garcia AL et al (2009) Leishmaniases in Bolivia: comprehensive review and current status. Am J Trop Med Hyg 80:704–711PubMedGoogle Scholar
  19. Gautret P et al (2009) Multicenter EuroTravNet/GeoSentinel study of travel-related infectious diseases in Europe and for the GeoSentinel Surveillance Network. Emerg Infect Dis 15:1783–1790PubMedCrossRefGoogle Scholar
  20. Goto H, Lindoso JA (2010) Current diagnosis and treatment of cutaneous and mucocutaneous Leishmaniasis. Exp Rev Anti-infect Ther 8:419–433CrossRefGoogle Scholar
  21. Gramiccia M, Gradoni L (2005) The current status of zoonotic leishmaniases and approaches to disease control. Int J Parasitol 35(11–12):1169–1180Google Scholar
  22. Grimaldi G Jr, Tesh RB, McMahon-Pratt D (1989) A review of the geographic distribution and epidemiology of leishmaniasis in the New World. Am J Trop Med Hyg 41:687–725PubMedGoogle Scholar
  23. Jones TC et al (1987) Epidemiology of American cutaneous leishmaniasis due to Leishmania braziliensis braziliensis. J Infect Dis 156:73–83PubMedCrossRefGoogle Scholar
  24. López M et al (1993) Diagnosis of Leishmanina using the polymerase chain reaction: a simplified procedure for field work. Am J Trop Med Hyg 49:34–42Google Scholar
  25. Machado P et al (2002) Failure of early treatment of cutaneous leishmaniasis in preventing the development of an ulcer. Clin Infect Dis 34:E69–E73PubMedCrossRefGoogle Scholar
  26. Marsden PD (1986) Mucocutaneous leishmaniasis (“Espundia” Escomel, 1911). Trans Roy Soc Trop Med Hyg 80:859–876PubMedCrossRefGoogle Scholar
  27. Moll H (1997) The role of chemokines and accessory cells in the immunoregulation of cutaneous leishmaniasis. Behring Inst Mitt 99:73–78PubMedGoogle Scholar
  28. Moll H (2000) The role of dendritic cells at the early stages of Leishmania infection. Adv Exp Med Biol 479:163–173PubMedCrossRefGoogle Scholar
  29. Natera S et al (2007) Leishmania s.p.: proficiency of drug resistant parasites. Int J Antimicrob Agents 29:637–642PubMedCrossRefGoogle Scholar
  30. Oliveira-Neto MP et al (1998) Leishmaniasis recidiva cutis in New World cutaneous leishmaniasis. Int J Dermatol 37:846–849PubMedCrossRefGoogle Scholar
  31. Padrón Nieves M et al (2008) Valor pronóstico de los cambios fisiológicos asociados a la quimio-resistencia en Leishmania. Vitae 33:
  32. Ponte-Sucre A (2003) Physiological consequences of drug resistance in Leishmania and their relevance for chemotherapy. Kinetoplastid Biol Dis 2:14 Google Scholar
  33. Puig L, Pradinaud R (2003) Leishmania and HIV co-infection: dermatological manifestations. Ann Trop Med Parasitol 97:107–114PubMedCrossRefGoogle Scholar
  34. Reed SG (1996) Diagnosis of leishmaniasis. Clin Dermatol 14:471–478PubMedCrossRefGoogle Scholar
  35. Reithinger R et al (2007) Cutaneous leishmaniasis. Lancet Infect Dis 7:581–596PubMedCrossRefGoogle Scholar
  36. Restrepo IM (1980) La reacción de Montenegro en la epidemiología de la leishmaniasis sudamericana. Bol Oficina Sanit Panam 89:130Google Scholar
  37. Ridley DS et al (1980) A histological classification of mucocutaneous leishmaniasis in Brazil and its clinical evaluation. Trans Roy Soc Trop Med Hyg 74:508PubMedCrossRefGoogle Scholar
  38. Rodríguez N et al (1994) Diagnosis of cutaneous leishmaniasis and species discrimination of parasites by PCR and hybridization. J Clin Microbiol 32:2246–2252PubMedGoogle Scholar
  39. Rondón A (1993) Leishmaniasis tegumentaria americana. Clin Dermatol Venezolana 31:12–17Google Scholar
  40. Sanchez MA et al (1993) Epidermal Langerhans cells and dendritic epidermal T cells in murine cutaneos leishmaniasis. Immunocytochemical Study. Acta Microscop 2:180–187Google Scholar
  41. Sassi A et al (1999) Leishmanin skin test lymphoproliferative responses and cytokine production after symptomatic or asymptomatic Leishmania major infection in Tunisia. Clin Exp Immunol 116:127–132PubMedCrossRefGoogle Scholar
  42. Scarisbrick JJ et al (2006) Clinical features and diagnosis of 42 travellers with cutaneous leishmaniasis. Trav Med Infect Dis 4:14–21CrossRefGoogle Scholar
  43. Shaw JJ, Lainson R (1975) Leishmaniasis in Brazil: X. Some observations of intradermal reactions to different trypanosomatid antigens of patients suffering from cutaneous and mucocutaneous leishmaniasis. Trans Roy Soc Trop Med Hyg 69:323–335PubMedCrossRefGoogle Scholar
  44. Souza AS et al (2010) Resistance of Leishmania (Viannia) braziliensis to nitric oxide: correlation with antimony therapy and TNF-alpha production. BMC Infect Dis 10:209
  45. Stuart K et al (2008) Kinetoplastids: related protozoan pathogens, different diseases. J Clin Invest 118:1301–1310PubMedCrossRefGoogle Scholar
  46. Tapia FJ et al (1994) Adhesion molecules in lesions of American cutaneous leishmaniasis. Exp Dermatol 3:17–22PubMedCrossRefGoogle Scholar
  47. Turetz ML et al (2002) Disseminated leishmaniasis: a new and emerging form of leishmaniasis observed in northeastern Brazil. J Infect Dis 186:1829–1834PubMedCrossRefGoogle Scholar
  48. Ulrich M et al (1995) Differing antibody IgG isotypes in the polar forms of leprosy and cutaneous leishmaniasis characterized by antigen specific T cell anergy. Clin Exp Immunol 100:54–58PubMedCrossRefGoogle Scholar
  49. Weigle KA et al (1987) Diagnosis of cutaneous and mucocutaneous leishmaniasis in Colombia: a comparison of seven methods. Am J Trop Med Hyg 36:489–496PubMedGoogle Scholar
  50. World Health Organization (2010) Control of the leishmaniasis. Technical report series, vol 949, Geneva, 2010Google Scholar
  51. Yardley V et al (2006) American tegumentary leishmaniasis: is antimonial treatment outcome related to parasite drug susceptibility? J Infect Dis 194:1168–1175PubMedCrossRefGoogle Scholar
  52. Zijlstra EE et al (2003) Post-kala-azar dermal leishmaniasis. Lancet Infect Dis 3:87–98PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Wien 2013

Authors and Affiliations

  1. 1.Cátedra de Dermatologia, Instituto de BiomedicinaUniversidad Central de VenezuelaCaracasVenezuela
  2. 2.Laboratorio de Fisiología Molecular, Instituto de Medicina Experimental, Escuela Luis RazettiUniversidad Central de Venezuela, Ciudad UniversitariaCaracasVenezuela

Personalised recommendations