Jacobs Journal of Nephrology and Urology

Leishmaniasis of the Penis: A Review and Update

Published on: 2019-02-08

Abstract

Leishmaniasis is caused by Leishmania parasites that are transmitted through bites of over 90 species of the infected female phlebotomine sand-fly. . Three main forms of leishmaniasis including cutaneous, mucocutaneous, and visceral leishmaniasis exist. The disease tends to affect some of the worlds 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 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, Wiegert 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 (Novy-McNeal-Nicolle) agar using smears from 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) oral medication (doxycycline and others), (b) topical ointment (paromomycin and methylbenzethonium chloride, (c) intramuscular injection (meglumine antimoniate). 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