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Old World cutaneous leishmaniasis in Child
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Old World cutaneous leishmaniasis in Child

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Contributors: Edith Lederman MD, Belinda Tan MD, PhD, Noah Craft MD, PhD
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Old World cutaneous leishmaniasis (OWCL), also known as Oriental sore, bouton d'Orient, bouton de Crete, bouton d'Alep, bouton de Biskra, Aleppo boil, Baghdad boil, and Dehli boil, is endemic in most countries in southern Europe, Africa (particularly in North and East Africa, with sporadic cases elsewhere), and the Middle East, as well as in parts of the Indian subcontinent, China, and the republics of the former USSR.

Cutaneous leishmaniasis results from infection of the skin with obligate intracellular parasites of the Leishmania genus. The parasites are transmitted by the bite of infected female phlebotomine sandflies (species in the Lutzomyia genus in the New World and in the Phlebotomus genus in the Old World). The World Health Organization estimates that 1.5 million new cases of cutaneous leishmaniasis occur each year. More than 90% of the cases occur in the following countries:

Old World
Afghanistan, Algeria, Iran, Iraq, Saudi Arabia, and Syria

New World
Brazil and Peru

However, the geographic areas of acquisition of infection for cases evaluated in the developed world reflect travel and immigration patterns. OWCL is most commonly caused by infection with Leishmania major and Leishmania tropica; Leishmania aethiopica, Leishmania infantum, and Leishmania donovani also cause OWCL. The reservoir hosts for the zoonotic Leishmania species include dogs, other canines, desert rodents, hyraxes, and gerbils. Infected humans are the reservoir hosts for L. tropica, which is anthroponotic and often endemic in urban areas. Recent periods of civil unrest and armed conflicts, with resultant poor sanitation and vector control, are some of the factors associated with ongoing epidemics of OWCL in Afghanistan and Iraq.

The appearance and evolution over time of the skin lesions of OWCL can vary widely. Typically, the primary lesions are noted several weeks to months after the sandfly exposure and evolve thereafter, over weeks to months, from papular, to nodular, to ulcerative. Some lesions persist as nodules or plaques. Lymphangitis that ascends the lymphatic chain and lymphadenopathy are sometimes seen; the latter may precede the presence of skin lesions. Pruritus, pain, and bacterial superinfection are also present at times. Systemic symptoms are rarely seen. Ultimately, over months to years, lesions may heal without therapy, leaving hypopigmented, atrophic scars. Reactivation of infection, typically first noted at the margins of scars, can occur months, sometimes years, after clinical resolution of lesions.

Diffuse cutaneous leishmaniasis (DCL) is a rare variant caused by L. aethiopica. It occurs in the context of leishmanial-specific anergy and is manifested by disseminated, nonulcerated lesions.


B55.1 – Cutaneous leishmaniasis

186807008 – Asian desert cutaneous leishmaniasis

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Last Updated: 09/29/2017
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Old World cutaneous leishmaniasis in Child
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Old World cutaneous leishmaniasis : Asia, Erythema, Eschar, Lymphadenopathy, Middle East, North Africa, Plaque with ulcer, Sandfly exposure
Clinical image of Old World cutaneous leishmaniasis
A close-up of a pink plaque with a central round erosion.
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