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Leishmaniasis

Kala-azar; Cutaneous leishmaniasis; Visceral leishmaniasis; Old world leishmaniasis; New world leishmaniasis

 

Leishmaniasis is an infectious disease spread by the bite of the female sandfly.

Causes

 

Leishmaniasis is caused by a tiny parasite called leishmania protozoa. Protozoa are one-celled organisms.

There are different forms of leishmaniasis.

  • Cutaneous leishmaniasis affects the skin and mucous membranes. Skin sores usually start at the site of the sandfly bite. In a few people, sores may develop on mucous membranes.
  • Systemic, or visceral, leishmaniasis affects the entire body. This form occurs 2 to 8 months after a person is bitten by the sandfly. Most people do not remember having a skin sore. This form can lead to deadly complications. The parasites damage the immune system by decreasing the numbers of disease-fighting cells.

Cases of leishmaniasis have been reported on all continents except Australia and Antarctica. In the Americas, leishmaniasis can be found in Mexico and South America. Leishmaniasis has been reported in military personnel returning from the Persian Gulf.

 

Symptoms

 

Symptoms of cutaneous leishmaniasis depend on where the lesions are located and may include:

  • Breathing difficulty
  • Skin sores, which may become a skin ulcer that heals very slowly
  • Stuffy nose, runny nose, and nosebleeds
  • Swallowing difficulty
  • Ulcers and wearing away (erosion) in the mouth, tongue, gums, lips, nose, and inner nose

Systemic visceral infection in children usually begins suddenly with:

  • Cough
  • Diarrhea
  • Fever
  • Vomiting

Adults usually have a fever for 2 weeks to 2 months, along with symptoms such as fatigue, weakness, and appetite loss. Weakness increases as the disease gets worse.

Other symptoms of systemic visceral leishmaniasis may include:

  • Abdominal discomfort
  • Fever that lasts for weeks; may come and go in cycles
  • Night sweats
  • Scaly, gray, dark, ashen skin
  • Thinning hair
  • Weight loss

 

Exams and Tests

 

Your health care provider will examine you and may find that your spleen, liver, and lymph nodes are enlarged. You will be asked if you recall being bitten by sandflies or if you've been in an area where leishmaniasis is common.

Tests that may be done to diagnose the condition include:

  • Biopsy of the spleen and culture
  • Bone marrow biopsy and culture
  • Direct agglutination assay
  • Indirect immunofluorescent antibody test
  • Leishmania-specific PCR test
  • Liver biopsy and culture
  • Lymph node biopsy and culture
  • Montenegro skin test (not approved in the United States)
  • Skin biopsy and culture

Other tests that may be done include:

  • Complete blood count
  • Serologic testing
  • Serum albumin
  • Serum immunoglobulin levels
  • Serum protein

 

Treatment

 

Medicines called antimony-containing compounds are the main drugs used to treat leishmaniasis. These include:

  • Meglumine antimoniate
  • Sodium stibogluconate

Other drugs that may be used include:

  • Amphotericin B
  • Ketoconazole
  • Miltefosine
  • Paromomycin
  • Pentamidine

Plastic surgery may be needed to correct the disfigurement caused by sores on the face (cutaneous leishmaniasis).

 

Outlook (Prognosis)

 

Cure rates are high with the proper medicine, especially when treatment is started before the immune system is damaged. Cutaneous leishmaniasis may lead to disfigurement.

Death is usually caused by complications (such as other infections), rather than from the disease itself. Death often occurs within 2 years.

 

Possible Complications

 

Leishmaniasis may lead to the following:

  • Bleeding (hemorrhage)
  • Deadly infections due to immune system damage
  • Disfigurement of the face

 

When to Contact a Medical Professional

 

Contact your provider if you have symptoms of leishmaniasis after visiting an area where the disease is known to occur.

 

Prevention

 

Taking measures to avoid sandfly bites can help prevent leishmaniasis:

  • Putting fine mesh netting around the bed (in areas where the disease occurs)
  • Screening windows
  • Wearing insect repellent
  • Wearing protective clothing

Public health measures to reduce sandflies are important. There are no vaccines or drugs that prevent leishmaniasis.

 

 

References

Boelaert M, Sundar S. Leishmaniasis. In: Farrar J, Hotez PJ, Junghanss T, Kang G, Lalloo D, White NJ, eds. Manson's Tropical Diseases. 23rd ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 47.

Magill AJ. Leishmania species. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 277.

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  • Leishmaniasis

    Leishmaniasis

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  • Leishmaniasis, mexicana - lesion on the cheek

    Leishmaniasis, mexicana ...

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  • Leishmaniasis on the finger

    Leishmaniasis on the fin...

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  • Leishmania panamensis on the foot

    Leishmania panamensis on...

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  • Leishmania panamensis - close-up

    Leishmania panamensis - ...

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    • Leishmaniasis

      Leishmaniasis

      illustration

    • Leishmaniasis, mexicana - lesion on the cheek

      Leishmaniasis, mexicana ...

      illustration

    • Leishmaniasis on the finger

      Leishmaniasis on the fin...

      illustration

    • Leishmania panamensis on the foot

      Leishmania panamensis on...

      illustration

    • Leishmania panamensis - close-up

      Leishmania panamensis - ...

      illustration

     

    Review Date: 9/10/2015

    Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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