What are the approach considerations in the workup of cutaneous leishmaniasis?

Updated: Feb 18, 2020
  • Author: Craig G Stark, MD, FACP, FFTM, RCPS(Glasg), FISTM; Chief Editor: Pranatharthi Haran Chandrasekar, MBBS, MD  more...
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Answer

In more than 70% of cutaneous leishmaniasis cases, microscopy of the parasite in Giemsa stains or histologic section can reveal the parasite and should be attempted first. Culture of the organisms is an option but is unreliable (approximately 40% sensitivity), because the organisms are difficult to isolate from the lesion, especially as the lesion becomes older. Consequently, the diagnosis often is epidemiologic (travel to endemic area, clinical picture, coupled with laboratory data).

The organism grows on liquid media with fetal calf serum (eg, Schneider Drosophila medium) (positive results in 1 wk) and Novy-MacNeal-Nicolle (NNN) medium (media available from the CDC), or a biphasic medium. Cultures can produce positive results in 1-3 weeks.


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