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We report an immunocompromised patient with a complex cutaneous leishmaniasis (CL) who suffered from singular bone involvement of the little left toe due to Leishmania (L.) infantum infection. The diagnosis was confirmed by positive polymerase chain reaction (PCR) testing in skin and bone tissue. The patient was successfully treated with miltefosine. In immunocompromised patients with CL, extracutaneous manifestations should always be ruled out. This is the first case report describing osseous involvement in CL due to Leishmania infantum., (© 2024. The Author(s).)

Cutaneous leishmaniasis is one of the most common travel dermatoses in Germany, which can be acquired not only in Africa, Asia or the American continent, but also in southern European countries. In addition to the currently available topical and systemic therapy options, there have been increasing reports of successful treatment of cutaneous leishmaniasis with photodynamic therapy (PDT) using numerous therapy regimens and different photosensitizers in recent years. We report on successful photodynamic therapy of Old World cutaneous leishmaniasis with red and green light PDT with 10% 5‑aminolevulinic acid., (© 2022. The Author(s), under exclusive licence to Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

A 5-year-old Syrian boy , presented with a complex cutaneous leishmaniasis (CL) of the right ankle caused by Leishmania (L.) tropica. The patient received photodynamic therapy (PDT; 6 cycles with application of 5‑aminolevulinic acid and foil occlusion for 3 h). Due to pain during exposure to red light, exposure was continued with simulated daylight (sDL-PDT). The lesion healed with an atrophic scar. Due to fewer side effects and less pain, sDL-PDT seems to be a good therapeutic strategy for CL caused by L. tropica., (© 2021. Springer Medizin Verlag GmbH, ein Teil von Springer Nature.)

The delayed appearance of a papule after returning from travelling hints towards the diagnosis cutaneous leishmaniasis. Histologically, a granulomatous inflammatory response is seen, and using Giemsa staining, intracellular parasites can be visualized within histiocytes. Polymer chain reaction (PCR) from the tissue or subsequent cultures not only aids in excluding other differential diagnoses, but also in the identification of the causing Leishmania subspecies. The latter is important for the choice of the optimal therapeutic regimen.

Leishmaniasis is a disease with worldwide increasing incidence, which in Germany is almost exclusively observed in patients who have travelled to classical endemic regions such as the Mediterranean basin. Cause of the disease is an infection with protozoan parasites of the genus Leishmania, which are transmitted by sand flies and replicate intracellularly within mammalian hosts. Depending on the inoculated parasite (sub-) species and the immune status of the host, a local cutaneous, diffuse cutaneous, mucocutaneous or visceral form of leishmaniasis will develop. Cutaneous leishmaniasis, which frequently appears only weeks after the bite of a sand fly, starts with the formation of a papule, which subsequently can turn into a skin ulcer. The latter may heal spontaneously after months leaving behind a scar or persist as chronic, non-healing cutaneous leishmaniasis. If cutaneous leishmaniasis is suspected, a sterile skin biopsy followed by appropriate diagnostic measures in a specialized laboratory to identify the pathogen should be performed. For the decision on the type of therapy, several clinical parameters (e.g. number and localization of lesions, immune status) and, most importantly, the underlying parasite (sub-) species need to be considered. Therapy can consist of a variety of topical measures or systemic drug treatment. A modern and safe vaccine does not yet exist.

Cutaneous leishmaniasis is an infectious disease with increasing prevalence in Germany. Diagnosis and therapy may be difficult due to the variability of the clinical and histomorphological picture and resistance to therapy. In this case study we report on a female patient with a persistent cutaneous leishmaniasis successfully treated with topical administration of paromomycin.

While efficacy of topical photodynamic therapy (PDT) for the treatment of superficial non-melanoma skin cancer is already well-proven by several controlled clinical trials, there are only a few controlled studies showing efficacy of PDT for non-oncologic skin disorders. This report provides information on the use of PDT for inflammatory skin disorders, disorders of the pilosebaceous unit, infections of the skin, sclerotic skin diseases and cosmetic indications.

We report about a 19-year-old Turkish patient who presented with cutaneous leishmaniasis after a holiday in Turkey. Cutaneous leishmaniasis often heals spontaneously leading to life-long immunity, but it can persist and lead to extensive scarring. In the literature, many therapeutic modalities have been reported; however, they can be accompanied by severe side effects. In our patient, photodynamic therapy resulted in healing of the lesion with only slight hypopigmentation.

Hexadecylphosphocholine (HDPC, Miltefosine, Impavido) was synthesized at the Max-Planck-Institut für Biophysikalische Chemie in Göttingen, Germany and successfully used for the therapy of cancer metastases. At the Institute of General and Tropical Hygiene of Göttingen University the antiparasitic efficacy--earlier mentioned by Croft et al. (1987)--could be established for the first time in animals after oral administration. In India Impavido has been recently registered for the treatment of visceral leishmaniasis as the first oral medication in this indication. Clinical studies in India--actually a phase IV study is running--and Columbia (cutaneous leishmaniosis) demonstrated the excellent efficacy of this oral treatment also in patients with Antimon resistance. The cure rates are above 90% with low side effects (Impavido twice 50 mg capsules daily over 28 days).

History and Clinical Findings: Three weeks after returning from a trip to Guatemala, a 33-year-old man developed two ulcers with indurated edges on his right leg and painful lymph nodes in the right groin. His general condition was not impaired., Examinations: Histological examination revealed cellular infiltrates of the corium by lymphocytes and plasma cells, always accompanied by epithelial cells and multinuclear giant cells. Special stainings were unable to detect pathogens but Leishmania brasiliensis was identified using PCR. The Leishmania culture remained negative., Therapy and Course: After 7-day intravenous therapy with 20 mg/kg/d pentostam (pentavalent antimonial compound), the patient developed gastrointestinal complaints, coupled with a marked elevation of transaminases. Therapy was discontinued until the transaminase values normalized, then continued in reduced dosage (12 mg/kg body weight) for 23 days. The ulcers and lymphadenitis healed under this therapy., Conclusion: The diagnosis of American cutaneous Leishmaniasis may be complicated by the relative lack of pathogens in the lesions. PCR diagnosis are very helpful here. The therapy must be systemic owing to the danger of progression to mucocutaneous Leishmaniasis. The standard therapeutic pentostam has, however, a high rate of side effects and administration is exclusively intravenous.

Leishmaniasis is a vector-borne disease caused by an obligate intracellular protozoa, Leishmania, which resides in macrophages. The parasite is transmitted by an infected female sandfly. The incidence of cutaneous leishmaniasis approaches 2 million new cases per year with 90% of the cases occurring in the "Old World", while the "New World" accounts for the rest. Infection may be restricted to the skin with development of characteristic ulcers, or may affect the mucous membranes in its mucocutaneous form. The clinical diagnosis is verified by the presence of amastigotes in slit-skin smears. Therapeutic modalities include systemic treatments such as the pentavalent antimony compound sodium stibogluconate, liposomal formulations of amphotericin B, oral ketoconazole or itraconazole, as well as topical paromomycin sulphate, local heat, freezing with liquid nitrogen, or photodynamic therapy. An effective vaccine is not available.

A 19-year-old male patient with chronic cutaneous leishmania is was treated topically with paromomycin sulphate (15%) and methylbenzethonium chloride (12%) in petrolatum album. After application twice daily for two periods of 32 and 44 days the lesions were completely healed. Previous treatment for 9 months with ketoconazole (400 mg/day) together with the topical application of thiabendazole (2.5%) in base had been unsuccessful. No major side effects were observed after paromomycin sulphate application.

Cutaneous leishmaniasis is an uncommon finding among patients seen in Central Europe. We report on three patients with cutaneous leishmaniasis who were initially misdiagnosed. Case 1, a woman who had returned from South America, was first thought to have an ulcer due to immunosuppression. Spread of the lesions to the nasal mucosa and a cosmetically disturbing scar were partly caused by delayed diagnosis and treatment. Case 2 shows a patient who has developed red papules on both legs after a trip to Spain. The lesions were misinterpreted as a residual reaction to insect bites. In case 3, a patient who had travelled in Nicaragua, the diagnosis of leishmaniasis was delayed because of coexisting acne vulgaris. In all three patients the final diagnosis of cutaneous leishmaniasis was confirmed by culture of the parasite. The only case with positive serology was the patient with mucocutaneous involvement. Two patients were radically cured, and one patient showed a substantial improvement of the lesions. The importance of a broad history including previous travel is emphasized to avoid the fallacies of missing a rare, but important disease among people travelling to countries with endemic leishmaniasis.

Six weeks after a holiday trip to Yugoslavia, a previously well 48-year-old man developed a reddish-livid, firm nodule, 0.5 cm in diameter, on the proximal joint of the right thumb. A similar nodule appeared nearby, as well as over the left patella. Eleven additional nodules occurred over the next 4 months. His general health remained good and physical examination merely noted the liver edge palpable 3 cm below the costal margin. The histology of one of the nodules showed a tuberculoid, plasma-rich inflammatory reaction reminiscent of leishmaniasis or brucellosis. No organisms were seen. Immunohistochemistry of a frozen section demonstrated Leishmania-associated antigens, and the Western-blot test was characteristic for leishmaniasis. No systemic treatment was undertaken because of likely alcoholic toxic liver damage. On local treatment with paromomycin-containing ointment the cutaneous nodules healed without scar within 3 months.