Chronic cutaneous leishmaniasis, a great mimicker with various clinical presentations: 12 years experience from Aleppo.
Protozoan parasites : 1) Leishmania major; 2) L. tropica; 3) L. infantum (very rare) WHO case definition Suspected case A person showing clinical signs (skin lesions). A papule appears, which may enlarge to become an indolent ulcerated nodule or plaque. The sore remains in this stage for a variable time before self healing and typically leaves a depressed scar. Other atypical forms may occur. A person showing clinical signs (skin lesions) with parasitological confirmation of the diagnosis (positive smear or culture from the skin lesion). Mainly, as a vector-borne disease through bite of infective female phlebotomines (sandflies). L. major is transmitted by Phlebotomus papatasi from the animal reservoir to humans. L. tropica is transmitted by P. sergenti from person to person. Incubation period-L. major: At least one week. Usually less than 4 months.-L. tropica: At least one week. Usually 2–8 months. Communicability period-Not directly transmitted from reservoir to person, but infectious to sandflies as long as parasites remain in lesions in untreated cases, usually a few months to 2 years.