Leishmaniasis

Leishmaniasis is a parasitic disease caused by different species of protozoa that can manifest as lesions on the skin or on mucous membranes like nose and throat. The disease involving the skin and mucous membranes of the nose and throat can be disfiguring or progress over time to involve multiple organs like spleen, liver and bone marrow .

The involved parasites are leishmania donovani, L tropica, L major and L aethiopica in the eastern hemisphere ( primarily Middle east and South Asia) and L braziliensis and L infantum/chagasi in the western hemisphere ( primarily South America).

The disease is spread by the bite of sandflies.

Where does it occur?

The disease is primarily seen in tropical and subtropical countries and has been reported in nearly 90 countries of the world from Africa, Asia, Southern Europe, Mediterranean, Central and South America.

However the highest risk regions accounting for nearly 90% of the cases are as follows:

Skin & Mucous disease – Afghanistan, Algeria, Iran, Iraq, Saudi Arabia, Syria. (L tropica) Brazil, Peru (L braziliensis)

Organ Disease – Bangladesh, India, Nepal, Sudan. (L donovani) Brazil (L infantum/chagasi) Map

How is it transmitted?

The disease is most commonly transmitted through the bite of sandflies. Rarely, one can contract the infection through infected blood transfusions or contaminated syringes and needles.

Is it contagious from person to person?

It is not contagious from person to person.

What is the risk for travelers?

In general the risk for most travelers is quite low. Sandflies that transmit the parasite is mostly seen in rural areas.  They are prevalent in unscreened mud and stone dwellings, rubbish heaps; animal houses etc and they usually bite at night. Adventure travelers, who camp, stay in huts; long term visitors and individuals doing nighttime outdoor activities are at greatest risk.

How soon after exposure will one develop symptoms?

One can develop symptoms from 1 week to nearly 6 months after exposure.

What are the signs and symptoms?

The skin disease can begin weeks to months after the sandfly bite and manifests as a small nodule that progresses to an ulcer with a raised circular ridge. The ulcer can resolve by itself or persist for months. Mucosal disease with invasion of the nasal and throat areas can also occur months later with ulcerations that can progress to disfiguring lesions.

Multiple organ involvement presents years later and is manifested by fever, weight loss, enlarged spleen, liver and lymph nodes. If left untreated this illness can be fatal.

Are there any lab tests to diagnose the illness?

Biopsy of the skin or organ tissue can reveal the parasite when looked under a microscope. Specific blood antibody and DNA techniques are available as well.

Is there any treatment?

Antibiotics like pentostam and glucantime are available.

What preventive measures can be taken?

Stay in well-screened shelters with concrete floors.

Use fine mesh bed nets (18 holes/inch) that are impregnated with permethrin.

Wear long sleeve shirts, pants and socks.

Apply insect repellant containing DEET on exposed skin and clothing.

If you are a long-term visitor apply insecticide in your dwelling.

Examine your skin for any lesions daily, a red ring like spot without swelling could be a clue.

Please go to our insect safety section for more details.

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