Table 1 A bibliographic summary of the differences between diffuse-CL and disseminated-CL cutaneous leishmaniasis in the New and Old Worlds
Characteristics | DCL | DSL |
|---|---|---|
Main agents | ||
In the New World | L. (L.) amazonensis | L. (V.) braziliensis group |
L. (L.) mexicana | L. (L.) mexicana group | |
In the Old World | L. (L.) aethiopica | No specific case reports other than HIV co-infection |
L. (L.) major | ||
No. of parasites in lesions/smears | Massive/abundant in smear (uncontrolled parasite growth) | Scanty/rare in smear |
Leishmanin skin test | Negative/poor (specifically anergic to Leishmania antigen; lack of cell-mediated immunity) | Strongly positive |
Reaction to TB, PPD, and other antigens | Yes | Yes |
Antibody response | Elevated, rK39+a | Elevated, rK39+a |
Ulceration of lesions | Never (non-necrotizing) | Frequent (necrotizing) |
Coalescence to form plaques | Frequent | Rare |
Type of lesions | Nodules, papules, plaques, macules, erythema | Papules, nodules, ulcers (mixture of small lesions) |
Typical lesion | Lepromatous | Acneiform |
Response to drug/therapy | Resistant/poor, relapse frequently | Good/poor |
Infection/clinical course | Chronic, persist 20 years or more, for a life long | Not chronic |
Analogous to lepromatous leprosy | Yes | No |
Affected ages and sex | All ages and sexes | Young adults, maleb |
No. of lesions | Often innumerable, plaques on body surface | 0–300b, 308c, 425d, 745e |
Mucosal involvement | No | Frequentb |
Disease entity | Rare, less than 0.1 % of total CL in Venezuelaf | Less than 2 % of CLb |