Leishmaniasis of the Penis: A Review and Update
of the Literature
Volume 2 - Issue 4
Anthony Kodzo-Grey Venyo*
-
Author Information
Open or Close
- Department of Urology, North Manchester General Hospital, M8 5RB Lancashire, United Kingdom
*Corresponding author:
Anthony Kodzo-Grey Venyo, Department of Urology, North Manchester General Hospital, M8 5RB
Lancashire, United Kingdom
Received: October 17, 2019; Published: October 29, 2019
DOI: 10.32474/OAJRSD.2019.02.000145
Full Text
PDF
To view the Full Article Peer-reviewed Article PDF
Abstract
Leishmaniasis is caused by Leishmania parasites that are transmitted through bites of over 90 infected species of the female
phlebotomine sand-fly. Three main forms of leishmaniasis including cutaneous, mucocutaneous, and visceral leishmaniasis exist.
The disease tends to affect some of the world’s poorest people. An estimated 700,000 to 1 million new cases and 20,000 to 30,000
deaths occur globally due to the disease. 24,200 deaths were attributed to leishmaniasis in 2015 and 4 million to 12 million cases
of leishmaniasis have been documented to exist globally. Leishmaniasis of the penis (LOP) is extremely rare. LOP does present
with subcutaneous nodules of the penis, ulceration of penis, crust on penis, erythematous scaling plaque, crusty scar on penis.
Clinical examination may reveal on the penis/glans penis: papules, crusts, serous or sero-haemorrhagic fluid secretion, usually
painless ulcer(s), hyperkeratotic plates with induration of the penis or haemorrhagic crust lesion on the penis of a child or adult.
Smears from the ulcer could typically demonstrate amastigotes, leishmania may be grown in culture of smears or specimens of
the penile lesion. Histopathology features of LOP would show a granulomatous infiltrate containing some leishmania parasites.
Histopathology examination of biopsies of the penile lesion may show ulceration of epidermis and a diffuse inflammatory infiltrate
in the dermis composed of lymphocytes, histiocytes, plasma cells, giant cells with granuloma formation and presence of leishmania
amastigotes histiocytes that contain small oval organisms with bar shaped paranuclear kinetoplast.
Haematoxylin and Eosin as well as Giemsa staining may be sufficient but with regard to positive staining for LOP, weigert ion
haematoxylin could stain better than H&E or Giemsa stain and immunostaining with G2D10 antibody tends to be more sensitive
in diagnosing LOP. The diagnostic methods available for the detection of LOP include: Intradermal delayed hypersensitivity test
(Montenegro); Culture on NNN agar using smears from the ulcer; ELIA; DNA probes; PCR. The Identification of parasites on H & E
or smears, by culture on specialized media, fluorescent antibody tests using patient’s serum, or by PCR using specific primers. But
polymerase chain reaction (PCR) results can be false positive, leishmanin intradermal skin test (Montenegro), positive culture for
leishmania from specimen or smear, zymodeme analysis and monoclonal antibody to detect leishmaniasis. A high index of suspicion
is required to undertake the most appropriate investigation to diagnose LOP. Resistance to various anti-leishmaniasis medicaments
exist in various parts of the world therefore treatment of LOP should include utilization of recommended medicament appropriate
to the geographical area of the world and could either be
a) antimoniate oral medication (doxycycline and others),
b) topical ointment (paromomycin and methylbenzethonium chloride,
c) intramuscular injection (meglumine).
With early diagnosis, appropriate treatment, and follow-up assessment, cases of LOP should resolve and this should be followed
up by appropriate steps to prevent leishmaniasis including use of nets impregnated with sand fly repellent and environmental
spraying methods to ensure control of vectors of the disease.
Keywords: Leishmaniasis; penis; Sand fly; Haematoxylin and Eosin; Giemsa stain; Novy-McNeal-Nicolle medium; meglumine
antimoniate; Montenegro test; polymerase chain reaction
Abstract|
Introduction|
Aim|
Method|
Results / Literature Review|
Investigations|
Prevention|
Outcome|
Conclusion|
References|