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Leishmaniasis

Definition

Leishmaniasis is a parasitic disease spread by the bite of the sandfly.

Alternative Names

Causes

There are different forms of leishmaniasis.

• Cutaneous leishmaniasis affects the skin and mucous membranes. Skin sores can resemble those due to other diseases including tuberculosis, syphilis, leprosy, skin cancer, and fungal infections. Ulcers may develop on mucous membranes.
• Systemic, or visceral, leishmaniasis affects the entire body. This form can be 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. In the Americas, leishmaniasis can be found in Mexico and south into the South American continent. Leishmaniasis has been reported among some military personnel returning from the Persian Gulf.

Symptoms

Systemic visceral infection in children usually begins suddenly with vomiting, diarrhea, fever, and cough. Adults usually have a fever for 2 weeks to 2 months, along with nonspecific symptoms such as fatigue, weakness, and loss of appetite. Weakness increases as the disease gets worse.

Other symptoms of systemic visceral leishmaniasis may include:

• Cough (children)
• Diarrhea (children)
• Fever that persists for weeks; may come and go in cycles
• Night sweats
• Scaly, gray, dark, ashen skin
• Thinning hair
• Vague belly area (abdominal) discomfort
• Vomiting (children)
• Weight loss

Cutaneous leishmaniasis affects the skin and mucuous membranes. Symptoms may include:

• Breathing difficulty
• Skin sores (macule or papule)
• Skin ulcer (forms at site of original sore); ulcer heals very slowly
• Smaller lesions may form around the ulcer (satellite lesions)
• Stuffy nose, runny nose, and nosebleeds
• Swallowing difficulty
• Ulcers and wearing away (erosion) of tissues on the mouth, tongue, gums, lips, nose, and inner nose

Exams and Tests

A physical exam may show signs of an enlarged spleen, liver, and lymph nodes. The patient may have a history of being bit by sandflies or being in an area known for leishmaniasis.

Tests that may be done to diagnose the condition include:

• Biopsy of the spleen and culture to see if microorganisms grow
• Bone marrow biopsy and culture to see if microorganisms grow
• Direct agglutination assay
• Indirect immunofluorescent antibody test
• Lymph node biopsy and culture to see if microorganisms grow
• Montenegro skin test
• Skin biopsy

Other tests that may be done include:

• Complete blood count
• Hemoglobin
• Immunoglobulins
• Serum protein
• Serum albumin

Treatment

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

• Meglumine antimonate
• Sodium stibogluconate

Other drugs that may be used include:

• Amphotericin B
• Pentamidine

Plastic surgery may be needed to correct disfigurement by destructive facial lesions (cutaneous leishmaniasis). Removal of the spleen (splenectomy) may be required in drug-resistant cases of visceral leishmaniasis.

Outlook (Prognosis)

Cure rates are high with the proper medicine. Treatment should be received before damage to the immune system occurs. Cutaneous leishmaniasis may lead to disfiguration.

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

Possible Complications

• Deadly infections due to immune system damage
• Disfiguration of the face
• Hemorrhage (bleeding)

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. Insect repellent, appropriate clothing, screening of windows, and fine mesh netting around the bed (in endemic areas) will reduce exposure.

Public health measures to reduce the sandfly population and animal reservoirs are important. There are no preventive vaccines or drugs for leishmaniasis.

References

Reithinger R. Cutaneous leishmaniasis. Lancet Infect Dis. Sep 2007; 7(9): 581-96.

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