Leishmaniasis Overview

Leishmaniasis is a disease caused by protozoan parasites and transmitted to humans by the bite of infected female phlebotomine sandflies. The disease is found across much of SW Asia and the Middle East, partly because of poor sanitation and uncollected waste, which provides a suitable breeding environment for sandflies.

Leishmaniasis Types

Four main types of leishmaniasis:

  • Cutaneous leishmaniasis (CL) – the most common form which causes a sore at the bite site which heals in a few months to a year and can cause unpleasant scarring. This type can progress to any of the other three forms listed below.
  • Diffuse cutaneous leishmaniasis – This form produces widespread skin lesions which resemble those of leprosy and is particularly difficult to treat.
  • Mucocutaneous leishmaniasis (ML) – Commences with skin ulcers which spread, causing tissue damage, particularly to the nose and throat.
  • Visceral leishmaniasis (VL) – The most serious form if left untreated; can cause potentially fatal damage to internal organs.

Leishmaniasis Signs and Symptoms

The symptoms of leishmaniasis are skin sores which erupt weeks to months after the person affected is bitten by sandflies. Other consequences, which can become manifest anywhere from a few months to years after the infection, include fever, damage to the liver, and spleen including a markedly enlarged spleen, and anemia.

Cutaneous leishmaniasis (CL)

  • Skin sores — usually (but not always) painless
  • Can change in size and appearance over time
  • May start out as papules (bumps) or nodules (lumps)
  • May go on to become ulcers (like shape of volcano, with raised edges and central crater)
  • Ulcers may be covered in a scab or crust.
  • Some people may have swollen glands near the sores

Visceral Leishmaniasis (VL)

VL is a very severe form of leishmaniasis that can affect internal organs (usually the spleen, liver, and bone marrow) and can be life threatening. Symptoms include:

  • Fever
  • Weight loss
  • Enlargement (swelling) of the spleen and liver
  • Abnormal blood tests

May also include:

  • Low blood counts
  • Low red blood cell count (anemia)
  • Low white blood cell count (leukopenia)
  • Low platelet count (thrombocytopenia)

Mucosal leishmaniasis (ML)

ML is an aggressive form of CL that can affect and cause sores in the mucous membranes. Most commonly in the nose, mouth, and throat.

Leishmaniasis Risk Factors

Anyone who lives in or travels to an area where Leishmania parasites occur and is bitten by an infected sand fly is at risk for leishmaniasis. It is usually more common in rural areas but can also occur in the outskirts of some cities. Dusk to dawn is the time when people are most likely to be bitten.

Leishmaniasis occurs in parts of approximately 90 countries, usually in tropical or subtropical climates. Most cases of leishmaniasis that are diagnosed in the US are in people who were infected while traveling or living in other countries.

Leishmaniasis is recognized by VA as a presumptive condition related to military service in the Southwest Asia theater of operations during the Gulf War August 2, 1990 to present and in Afghanistan on or after September 19, 2001.

Leishmaniasis Treatment

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

  • Cutaneous leishmaniasis (CL) — Different types of treatment are available for CL and choice of treatment depends on multiple factors, including species of Leishmania parasite involved. In some cases, skin sores from CL might heal on their own without treatment depending on species involved. Leishmania skin sores can take months to years to heal and sores can leave significant scars.
  • Mucosal leishmaniasis (ML) — For Leishmania species that cause ML, it is important to have proper treatment to prevent mucosal tissue destruction in the nose, mouth, or throat. Without treatment, ML can be life threatening if it affects the throat.
  • Visceral leishmaniasis (VL) — It is important to recognize and treat VL early. If not treated, severe (advanced) cases of VL are typically deadly. In people with compromised immune systems (e.g., HIV, malnutrition), VL can be difficult to treat.

Other Resources And Support

https://www.publichealth.va.gov/exposures/gulfwar/infectious_diseases.asp

https://www.cdc.gov/leishmaniasis/about/

https://www.cdc.gov/leishmaniasis/signs-symptoms/index.html

https://www.cdc.gov/leishmaniasis/about/index.html#cdc_disease_basics_treatment-treatment-and-recovery