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Facial Disfiguration 

Facial Disfiguration
Facial Disfiguration
Acute Care Casebook

Douglas Hofstetter

, Andrea Austin

, and Ryan Maves


Leishmaniasis is a vector-borne protozoan disease that affects human populations across over 90 countries including areas in Latin America, Africa, and Asia bearing the brunt of the disease burden. Disease transmission occurs through the bite of infected female sandflies within the genera Phlebotomus (Old World) and Lutzomyia (New World). Depending on the host’s immune response and the infecting Leishmania species, clinical leishmaniasis can manifest as a cutaneous, mucocutaneous, or visceral disease. Overlap between the categories is common, as are asymptomatic infections. In cutaneous leishmaniasis, patients present with an array of skin findings at the site of inoculation that range from painless papules and nodules to deep, mutilating ulcerations. In mucocutaneous leishmaniasis, protozoa spread hematogenously or lymphatically from a cutaneous lesion to mucosal tissue. DNA polymerase chain reaction is therefore the best diagnostic test when available. Liposomal amphotericin B is the preferred treatment for visceral leishmaniasis in the United States.

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