Leishmaniasis

Leishmaniasis is the name of many types of parasitic infections that spread through sandfly bites. Leishmania parasites cause it. Some types, like cutaneous leishmaniasis (pronounced “leesh-muh-NAI-uh-suhs”), can cause disfiguring skin ulcers. Others, like visceral leishmaniasis, cause life-threatening illness.

Leishmania parasites are protozoa, one-celled organisms that are too small to see without a microscope. The parasites are found in many areas of the world. Leishmaniasis is uncommon in the U.S.

See a healthcare provider right away if you think you could have leishmaniasis. Some forms are fatal if not treated promptly.

Types

Healthcare providers categorize leishmaniasis based on which type of body tissue it affects (cutaneous, mucosal and visceral). Different types of Leishmania cause different infections.

Cutaneous leishmaniasis

Cutaneous leishmaniasis (CL) is an infection on your skin where a sandfly bit you. It causes bumps (nodules) that get larger and turn into ulcers over time. They can last for months or, in some cases, years. Symptoms start a few weeks or months after a sandfly bite.

Very rarely, you can have bumps or ulcers on many areas of your skin. Some forms of cutaneous leishmaniasis, like leishmaniasis recidivans, can come back again and again, even with treatment.

Cases of cutaneous leishmaniasis happen in:

• Africa, especially North Africa
• Asia, especially Central and Southwest Asia
• Central America, South America and some areas of Mexico
• Southern Europe
• The Middle East

In the U.S., there have been a few cases in Texas, Oklahoma and Arizona.

Mucosal (mucocutaneous) leishmaniasis

Mucosal leishmaniasis (ML) causes ulcers in your nose, mouth or throat (mucous membranes). It usually happens after you’ve had cutaneous leishmaniasis — sometimes years later. You usually have ulcers on your skin that appear at the same time or before the ones in your mucous membranes.

ML rarely gets better on its own and can be fatal if left untreated. It can cause facial disfigurement. It’s most common in Central and South America.

Visceral leishmaniasis

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. It’s fatal if it’s not treated.

Visceral leishmaniasis happens in parts of Africa, South America, Asia, Southern Europe, and the Middle East. But most cases are in Brazil, India, Nepal, Yemen and countries in East Africa.

Symptoms of leishmaniasis

Symptoms of leishmaniasis depend on the type you have. Cutaneous and mucosal leishmaniasis cause large, slow-healing wounds. They might:

• Be scabbed or crusty
• Grow larger over time
• Develop into an ulcer with a hard border and a sunken center (like a volcano)

You might also have swollen lymph nodes. Mucosal leishmaniasis causes ulcers or sores in your nose, mouth or throat. Depending on their location, you might have additional symptoms, like nose bleeds, hoarse voice and difficulty swallowing.

Visceral leishmaniasis symptoms include:

• Fever (this can start suddenly and come and go for several weeks)
• Chills
• Cold sweats
• Swollen lymph nodes
• Swollen belly from an enlarged spleen
• Weight loss
• Fatigue
• Weakness
• Dark or discolored patches of skin

Leishmaniasis causes

Leishmania parasites, a type of protozoan, cause leishmaniasis. They live in humans and animals, including dogs, cats, possums, rodents and foxes. Leishmania parasites exist in many countries around the world. Different types are found in different parts of the world.

Leishmaniasis spreads through the bite of the phlebotomine sandfly. The sandfly bites an infected person or animal, then bites someone else, injecting them with the parasite. Not all sandflies carry diseases.

Less common ways Leishmania can infect you include:

• Sharing needles
• Blood transfusion
• Vertical transmission (from a pregnant woman to the fetus)

Leishmaniasis isn’t contagious.

Risk factors

Leishmaniasis most often affects people living in rural areas of tropical regions or areas without modern sanitation practices. You’re more likely to get sick from Leishmania if you have HIV or another conditions that weaken your immune system.

Complications

Complications of leishmaniasis can be serious or life-threatening, especially in visceral and mucosal types. They include:

• Bacterial infections: Also called secondary infections, these can make ulcers worse. Bacteria can get deep into your body, which can lead to serious illness.
• Scarring: Cutaneous and mucosal leishmaniasis can cause permanent damage to your skin, mouth and nose, including severe scarring.
• Relapse: Your symptoms might go away with treatment, only to come back later. You’ll need additional treatment if this happens.
• Pneumonia or GI (gastrointestinal) tract infections: Mucosal and visceral leishmaniasis can lead to infections in other organs in your body.
• Septal perforation or collapse: Mucosal leishmaniasis can cause a hole in the tissue between the passages of your nose (septum). The structure of your nose may break down. This can cause disfigurement, infections and breathing problems.
• Post kala-azar dermal leishmaniasis (PKDL): PKDL is a large, bumpy rash on your face or other areas of your skin. It can appear while you have visceral leishmaniasis or after you’ve recovered. It can last a long time and cause severe scarring.
• Severe bleeding: Excessive bleeding from visceral leishmaniasis can be fatal.
• Hemophagocytic lymphohistiocytosis: This is a life-threatening condition that causes organ damage.
• Sepsis: This is a life-threatening reaction to a severe infection.

How doctors diagnose leishmaniasis

A healthcare provider diagnoses leishmaniasis by looking at tissue samples from your body for Leishmania parasites. In countries where leishmaniasis is common, providers often diagnose it based on your symptoms or by looking at your skin.

Tests your provider might need to diagnose leishmaniasis include:

• 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.
• 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. Sampling bone marrow is the preferred way to diagnose visceral leishmaniasis.
• Blood tests (serology): Sometimes, a provider might look for signs of a Leishmania infection in your blood.

Blood tests usually aren’t very useful for diagnosing a current Leishmania infection. Sometimes, the test can be positive from a previous infection, even when you aren’t currently infected.

How is leishmaniasis treated?

Several antiparasitic medications treat leishmaniasis. The specific medication a provider prescribes depends on the type of leishmaniasis you have. They could include:

• Amphotericin B
• Miltefosine
• Pentavalent antimony compounds, like sodium stibogluconate
• Paromomycin

You might get these in pill form, as a cream or lotion you apply to your skin or into a vein through an IV.

Providers can sometimes give you other treatments for cutaneous leishmaniasis. These can kill the parasite and help your wound heal. 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.

When should I see my healthcare provider?

See your healthcare provider if you:

• Live in or have been to an area where Leishmania is common and you have symptoms
• Have a wound that’s taking a long time to heal
• Have a weakened immune system and have any signs of infection

It’s common for people’s bodies to fight off a Leishmania infection without getting sick. Unless you have a weakened immune system, your provider usually doesn’t need to treat you if you don’t have symptoms.

Go to the nearest emergency room if you have symptoms of serious illness, including:

• High fever (over 103 degrees Fahrenheit/40 degrees Celsius) that’s not coming down
• Difficulty breathing
• A noticeably swollen abdomen
• Yellow or gray skin or eyes (jaundice)
• Blue skin, lips or nails (cyanosis)

What can I expect if I have leishmaniasis?

The outlook for leishmaniasis depends on which type you have and whether you have a weakened immune system. Visceral and mucosal leishmaniasis need immediate treatment. If left untreated, VL is nearly always fatal. With early treatment, you should begin to feel better within about a week.

Cutaneous leishmaniasis can go away on its own or with treatment. It can take months to fully resolve. It can leave permanent scars on your skin. Ask your provider how to clean and take care of wounds until they heal.

You may need to take medication for a long time — several weeks or months — to make sure your infection is completely gone. Ask your provider what to expect in terms of treatment and recovery time. With all forms of leishmaniasis, watch for signs of your symptoms returning, even after you feel better.

Is leishmaniasis curable?

Leishmaniasis is often curable when a provider diagnoses and treats it right away. But sometimes, your symptoms can return.

Visceral and mucosal leishmaniasis get harder to cure the longer they’re left untreated. They’re also harder to cure if you have a weakened immune system.

How can I prevent leishmaniasis?

The best way to prevent all forms of leishmaniasis is to avoid sandfly bites, especially in areas where Leishmania is common. Ways to avoid bites include:

• Cover exposed skin with clothing. This includes long pants, long-sleeved shirts and socks.
• Wear EPA-registered insect repellent. The most effective repellants usually contain DEET.
• Kill sand flies indoors. Spray living and sleeping areas with insecticide.
• Take precautions when you sleep. Sleep in a room with the windows closed or with screens. You can also sleep under mosquito bed netting. Sand flies are much smaller than mosquitoes. Netting and screens should have very small holes to keep flies out. Some netting is pre-treated with insect repellent for added protection.