Causes
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 - 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 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:
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
A physical exam may show signs of an enlarged spleen, liver, and lymph nodes. The patient may have been bitten by sandflies, or was in an area known for leishmaniasis.
Tests that may be done to diagnose the condition include:
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). Patients with drug-resistant viral leishmaniasis may need to have their spleen removed (splenectomy).
Outlook (Prognosis)
Cure rates are high with the proper medicine. Patients should get treated before damage to the immune system occurs. 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.
When to Contact a Medical Professional
Contact your health care provider if you have symptoms of leishmaniasis after visiting an area where the disease is known to occur.
Prevention
Preventing sandfly bites is the most immediate form of protection. You can prevent a bite by:
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 the sandfly population and animal reservoirs are important. There are no vaccines or drugs that prevent leishmaniasis.
Magill AJ. Leishmania
species. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases
. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 256.
Update Date: 8/24/2011
David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and 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. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
