Leishmaniasis

 Leishmaniasis

Overview

Leishmaniasis (pronounced “leesh-muh-NAI-uh-suhs”) is a group of illnesses caused by many types of Leishmania parasites. You get it from sand fly bites. It can cause disfiguring skin ulcers and life-threatening illnesses.

Leishmania parasites are protozoa, one-celled organisms that are too small to see without a microscope. The two most common kinds are cutaneous leishmaniasis and visceral leishmaniasis.

Leishmaniasis most often affects people living in rural areas of tropical regions or areas with inadequate sanitation. People with HIV and other conditions that weaken their immune system are more likely to get sick from a Leishmania infection

Types of leishmaniasis

Leishmaniasis falls into three main categories: cutaneous, mucosal (or mucocutaneous) and visceral.

Cutaneous leishmaniasis

Cutaneous leishmaniasis (CL) is an infection in your skin where a sand fly bit you. It causes bumps (nodules) that turn into large ulcers over time. It can take a long time to heal on its own. Symptoms start a few weeks or months after a sand fly bite.

Very rarely, you can have bumps or ulcers on many areas of your skin (diffuse cutaneous leishmaniasis). These can come back again and again (recur), even with treatment.

Mucosal (mucocutaneous) leishmaniasis

Mucosal, or mucocutaneous leishmaniasis (ML), is usually a complication of cutaneous leishmaniasis. Ulcers develop in your nose, mouth or throat (mucous membranes). ML rarely gets better on its own and is usually fatal if left untreated. It can cause facial disfigurement.

Visceral leishmaniasis (VL)

Visceral leishmaniasis (VL), also called kala-azar, is a serious form of the disease caused by specific types of Leishmania. It affects your internal organs, like your spleen and liver. Symptoms sometimes take a few months or a year or more to develop after an infected fly bites you. VL can cause severe disease quickly. It’s fatal if left untreated.

People can carry some species of Leishmania for long periods without becoming ill. Symptoms depend on the form of the disease.

Cutaneous leishmaniasis

The main symptom of this condition is painless skin ulcers. Cutaneous symptoms may appear a few weeks after being bitten by an infected sand fly. However, sometimes symptoms won’t appear for months or years.

Mucocutaneous leishmaniasis

In people with the mucocutaneous form of the disease, symptoms usually appear one to five years after the skin lesions. These are primarily ulcers in their mouth and nose or on their lips.

Other symptoms may include:

runny or stuffy nose

nosebleeds

difficulty breathing

Visceral leishmaniasis

Symptoms often don’t appear for months after the bite with this type of leishmaniasis. Most cases are apparent two to six months after the infection occurred. Common signs and symptoms include:

weight loss

weakness

fever that lasts for weeks or months

enlarged spleen

enlarged liver

decreased production of blood cells

bleeding

other infections

swollen lymph nodes

Risk for leishmaniasis

Socioeconomic conditions

According to the World Health Organization (WHO)Trusted Source, poverty is a determining factor for the disease. In addition, leishmaniasis often occurs in areas where the following conditions are common:

malnutrition

famine

lack of financial resources

large migrations of people caused by urbanization, emergency situations, war, environmental changes and climate change

Other infections

People who have weakened immune systems are at increased risk of this condition.

HIV can influence the transmission of leishmaniasis and increase the risk of visceral leishmaniasis. HIV and leishmaniasis affect similar cells of the immune system.

People infected with HIV are also often infected with leishmaniasis. In areas of Ethiopia, it’s estimated that as many as 35 percent Trusted Source of people with leishmaniasis have HIV too.

Diagnosis

A provider diagnoses leishmaniasis by looking at tissue samples from your body for Leishmania. These samples could include tissue from ulcers, your spleen, a lymph node or your bone marrow. In countries where leishmaniasis is common, providers often diagnose it based on hearing your symptoms or looking at your skin.

Tests your provider might perform to diagnose leishmaniasis include:

Needle biopsy. A provider will use a needle to get a sample of tissue from your spleen, lymph nodes or bone marrow. A lab technician will use a microscope to look for Leishmania. This is the best way to diagnose visceral leishmaniasis.

Skin biopsy. A provider will take a sample of tissue from an ulcer on your skin, nose or mouth. A lab technician will test the sample for Leishmania. This can diagnose cutaneous or mucosal leishmaniasis.

Blood tests (serology). Sometimes a provider might look for signs of a Leishmania infection in your blood. They’ll get a blood sample by inserting a small needle into a vein in your arm or by pricking your skin with a needle. Blood tests usually aren’t very useful for diagnosing a current Leishmania infection. Since people can have it without symptoms, sometimes your blood test can be positive even when you aren’t currently infected.

Treatment

There a several anti-parasitic medications available that treat leishmaniasis. The specific medication a provider prescribes depends on what type of leishmaniasis you have. Medication can come in different forms, including:

Pills you swallow.

Cream or lotion that you apply to your skin.

Liquids that your provider gives you in an IV catheter, which goes through a vein.

If you have cutaneous leishmaniasis, your provider may be able to apply thermotherapy, cryotherapy or laser therapy directly to your wounds. These can kill the parasite and help your wound heal.

Medications providers use to treat leishmaniasis include:

Amphotericin.

Miltefosine.

Pentavalent antimonials, such as sodium stibogluconate.

Paromomycin.

Providers can sometimes give you other therapies for cutaneous leishmaniasis. They include:

Thermotherapy: Your provider applies heat to an ulcer and the area around it.

Cryotherapy: Your provider cools an ulcer and the area around it for 10 to 30 seconds per treatment.

Laser therapy: Your provider uses a handheld device to apply a laser to an ulcer and the area around it.

Type of Doctor Department :Infectious Disease Specialist