LEISHMANIASIS

Leishmaniasis 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.

Since many people can get infected with Leishmania without developing symptoms, it can be
hard to know how common leishmaniasis is. Experts estimate that there are 1.5 million to 2
million people worldwide who develop symptoms per year.

Leishmania exists in over 90 countries around the world. Different types of Leishmania are
found in different parts of the world. Experts use the terms “Old World leishmaniasis” and
“New World leishmaniasis” depending on where it’s found.

Old World leishmaniasis is found in the Eastern Hemisphere, including:

Certain parts of Asia.

Parts of Africa, including tropical regions and North Africa.
Southern Europe.
The Middle East.

New World leishmaniasis is found in the Western Hemisphere, including:

Central America.
South America.
Some areas of Mexico.

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.

Symptoms and Causes

What are the signs and symptoms of leishmaniasis?

Symptoms of leishmaniasis depend on what type you have. Cutaneous and mucosal
leishmaniasis cause large, slow-healing ulcers. Visceral leishmaniasis causes general
symptoms, like fever, weight loss and abdominal swelling.

What are the symptoms of cutaneous leishmaniasis?

Cutaneous leishmaniasis causes a bump on your skin where a sand fly bit you. It can have
scabs or a crust. Over time, it changes to an ulcer, with a hard border and a sunken center (like
a volcano).

What are the symptoms of mucosal leishmaniasis?

Mucosal leishmaniasis causes ulcers or sores in your nose, mouth or throat (mucous
membranes). You usually have one or more ulcers on your skin that appear at the same time
or before those in your mucous membranes.

What are the symptoms of visceral leishmaniasis?

Visceral leishmaniasis symptoms include:

Fever. This can start suddenly and come and go for several weeks.

Chills.

Cold sweats.

Swollen lymph nodes.

Swollen abdomen (belly) from an enlarged spleen.

Weight loss.
Fatigue.

Weakness.

Dark or discolored patches of skin.

What causes leishmaniasis?

Leishmania parasites cause leishmaniasis. They live in humans and animals, including dogs,
cats, possums, rodents and foxes.

How is leishmaniasis transmitted?

Leishmaniasis spreads through the bite of the phlebotomine sand fly. The sand fly bites an
infected person or animal, then bites someone else, injecting them with the parasite
Leishmania. Less common ways Leishmania can infect you include:

Through sharing needles.

Through a blood transfusion.

From a pregnant person to the fetus.

Can humans get leishmaniasis from dogs?

No, you can’t get leishmaniasis directly from a dog or any other animal. But there’s evidence
that dogs can infect other dogs. Since it can spread from dogs to people through sand fly bites,
it’s still important to prevent dogs from getting infected.

Diagnosis and Tests

How is leishmaniasis diagnosed?

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.

What tests are done to diagnose leishmaniasis?

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.

Management and Treatment

How is leishmaniasis treated?

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.

What medications treat leishmaniasis?

Medications providers use to treat leishmaniasis include:

Amphotericin B.

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.

Prevention: The best way to prevent all forms of leishmaniasis is to avoid sand fly bites,
especially in areas where Leishmania is common. Ways to avoid bites include:
Cover exposed skin with clothing, including long pants, long-sleeved shirts and socks.

Wear EPA-registered insect repellant. The most effective repellants usually contain DEET.

Kill sand flies indoors by spraying living and sleeping areas with insecticide.

Sleep in a room with the windows closed or with screens in the windows.

Sleep under mosquito bed netting. Some netting is pre-treated with insect repellant for added
protection.

Sand flies are much smaller than mosquitoes. Netting and screens should have very small
holes to keep flies out.