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Leishmaniasis

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Leishmaniasis is a parasitic disease, and is contracted and spread when a person is bitten by an infected sand fly. There are different forms of this disease, including the most common forms, cutaneous leishmaniasis and visceral leishmaniasis. It is estimated that there are about 1.5 million new cases of cutaneous leishmaniasis and about 500,000 new cases of visceral leishmaniasis every year.

LEISHMANIASIS SYMPTOMS

Cutaneous leishmaniasis occurs on the skin and appears as skin sores, which is how this illness is diagnosed. These sores can change in their size or their appearance over time, but often end up raised, looking something like a volcano in that they have a raised edge and a central crater. They may cover over with scabs, and they may be painful, but they might not be. In some cases, the glands may swell, especially if they are near one of your sores. The sores usually develop within a few weeks of the bite, but sometimes there is a lapse of months before the sores appear.

Visceral leishmaniasis, on the other hand, occurs within the body and affects one or more of the internal organs, such as the spleen, liver, or bone marrow. It usually results in fever, unexplained weight loss, and an enlarged spleen and liver—so enlarged that the spleen becomes even bigger than the liver. As with cutaneous leishmaniasis, these patients can also have swollen glands. You might have low red or white blood cell count or low platelet count. The symptoms of visceral leishmaniasis don’t develop for months after someone is bitten, but can sometimes take as long as years.

LEISHMANIASIS CAUSES

Leishmaniasis is found in many countries throughout the world, but not at all in some others. It is not found in Australia or Oceania, which includes islands in the Pacific. It is, however, very common in Mexico, Central and South America, southern Europe, Asia except for Southeast Asia, the Middle East, and Africa, especially East and North Africa. It is very rare for leishmaniasis to occur in the United States, although it has been known for people in Texas to develop cutaneous leishmaniasis. There have been no reported cases of visceral leishmaniasis in the United States.
Leishmaniasis
Image: Leishmaniasis


Leishmaniasis is spread when people are bitten by some types of blood-sucking sand flies. These sand flies themselves become infected when they themselves bite an infected animal or person. Sand flies do not make noise when they fly, and they are very small, so sometimes people don’t realize they are around, but they are usually most active at night. In very rare cases, this disease can be spread from a pregnant woman to her baby. It can also be spread by blood transfusions and by sharing needles.

LEISHMANIASIS RISK FACTOR

The most significant risk factor is geographical; if you live in a place where leishmaniasis is found, or if you even only travel to those places, you are at risk. It is more common in rural areas than in cities, but it can be found in cities as well. In the high-risk areas, it is more often those people who have to be out of doors at night who have a greater chance of being bitten by an infected sand fly.

LEISHMANIASIS TREATMENT

Leishmaniasis can be very serious if it is not treated promptly. Skin sores will heal without treatment, but it takes a very long time, perhaps months or even years, and even then they will leave unsightly scars. It can also spread to the nose or mouth and cause sores in those tissues—this is called mucosal leishmaniasis. This kind of infection is often not even noticed until long after the original infection has cleared up, and by that time it may have resulted in complications. Visceral leishmaniasis, because it affects the internal organs, can be fatal if it is not treated in a timely manner.

LEISHMANIASIS DIAGNOSIS

If you suspect you may have contracted leishmaniasis, see your doctor right away. Your doctor will want to know when the sores or other symptoms first appeared, and whether you have traveled to any of the areas where leishmaniasis is common. In most cases, your doctor will want to consult with the CDC (Center for Disease Control) about your illness and any course of treatment that is determined. First, however, some tests may be required to make sure that leishmaniasis is correctly diagnosed. If you have skin sores, your doctor will want to take some samples of material directly from the sores; this will help detect the presence of the parasite. You may also be asked to give a blood sample, to check whether the antibody for the leishmaniasis parasite is present in your blood. This can be especially helpful with the visceral form, since symptoms are sometimes vague with this type.


Since the CDC is usually involved in the treatment of leishmaniasis, most treatment is done in consultation with specialists on tropical and parasitical diseases. In many cases, the CDC provides the drug sodium stibogluconate for treatment. This is the preferred drug for both the cutaneous and visceral forms. Other drugs that are offered include meglumine antimonite, pentamidine, or paromomycin.

LEISHMANIASIS PREVENTION

The best thing, however, is to prevent an infection in the first place, and the only way to do this is to avoid being bitten by an infected sand fly. There are no drugs or inoculations that can prevent you from getting this disease if you are bitten. However, there are some practical steps you can take to keep that from happening.
 Avoid outdoor activities from dusk to dawn, when sand flies are most active.
 Wear protective clothing, such as long sleeves and long pants, socks, and hats.
 Use insect repellent with DEET on all exposed skin and under the edges of your clothing.
 Use mosquito netting on your bed. You can buy this netting in the United States already treated with DEET.
 Make sure there are screens on the windows and doors of the place where you are sleeping.
 Spray the room or home where you are sleeping with insect repellent.
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