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Cutaneous leishmaniasis — DTM&H MCQ

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EasyProtozoal infectionsCutaneous leishmaniasisDTM&H

A 27-year-old traveller returns from Bolivia with a painless ulcer on the forearm with a raised indurated edge. It began as a papule after sandfly bites near forest camps. What is the most appropriate investigation?

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Correct answer: C — Skin scraping or biopsy for microscopy and PCR

Skin scraping or biopsy for microscopy and PCR is the single best answer because cutaneous leishmaniasis is confirmed from lesion material using microscopy, culture or molecular testing. Blood culture is plausible in a related presentation, but it is less appropriate because it does not fit the key discriminator in this vignette. The teaching point is that species identification is useful because New World disease can have mucosal risk.

Reference: Manson's Tropical Diseases; WHO neglected tropical diseases guidance; CDC DPDx