Leishmaniasis

What is leishmaniasis?

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.

Who does leishmaniasis affect?

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.

How common is leishmaniasis?

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.

Where is leishmaniasis most commonly found?

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.

While it’s uncommon in the U.S., people have gotten cutaneous leishmaniasis in Texas and Oklahoma.

What are the 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.

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.

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.

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, 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.

What medications treat leishmaniasis?

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.

How can I prevent leishmaniasis?

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.

What can I expect if I have leishmaniasis?

The outlook for leishmaniasis depends on which type you have and whether you have a healthy immune system. Visceral and mucosal leishmaniasis need to be treated immediately. If left untreated, both are nearly always fatal.

Cutaneous leishmaniasis can go away on its own or with treatment. It can take months to fully resolve and leave permanent scars on your skin.

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.

Is leishmaniasis curable?

Leishmaniasis is often curable when a provider diagnoses and treats it with medication right away. The cure rate with prompt treatment is over 90% for visceral leishmaniasis and over 75% for mucosal leishmaniasis. Some people who get better and don’t have signs of parasites after treatment will get sick again within a few months (relapse).

Visceral and mucosal leishmaniasis get harder to cure the longer they’re left untreated. They’re also harder to cure in people with weakened immune systems.

Complications of leishmaniasis

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

• Bacterial infections. Also called secondary infections, these can make ulcers worse. They can allow bacteria to 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. Some people’s symptoms go away with treatment only to come back later. Skin ulcers that come back are called leishmaniasis recidivans. You’ll need additional treatment if this happens.
• 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.
• Pneumonia or GI (gastrointestinal) tract infections. Mucosal and visceral leishmaniasis can lead to infections in other organs in your body.

Additional complications of visceral leishmaniasis include:

• 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 can be fatal.
• Hemophagocytic lymphohistiocytosis. This is a life-threatening condition that causes organ damage.
• Sepsis. Sepsis is a life-threatening reaction to a severe infection.

How do I take care of myself?

Ask your provider about ways to take care of yourself until you recover. If you have cutaneous leishmaniasis, your provider will tell you how to clean and take care of your wounds until they heal. With all forms of leishmaniasis, watch for signs of your symptoms returning, even after you feel better.

When should I see a healthcare provider?

See your healthcare provider:

• If you live in or have been to an area where Leishmania is common and you have symptoms.
• If you have a wound that’s taking a long time to heal.
• If you have a weakened immune system, contact your provider if you have any signs of infection.

Should I see a doctor if I’ve been bitten by a sand fly?

You only need to see a healthcare provider if you have symptoms after a fly bite. Not all sand flies carry diseases. 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 get sick.

When should I go to the ER?

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 skin or eyes (jaundice).
• Blue skin, lips or nails (cyanosis, a sign of low oxygen in your blood).

What questions should I ask my doctor?

It might be helpful to ask your healthcare provider:

• What are my treatment options?
• How do I take care of my wounds?
• When can I expect to feel better/heal?
• How serious is my illness?
• How do I take my medication?
• When should I go to the ER?
• When should I follow up with you?

A note from Cleveland Clinic

Leishmaniasis can cause wounds that don’t heal and life-threatening illness. If you live in or are traveling to an area where Leishmania is common, take precautions to protect yourself. See your provider if you have symptoms of leishmaniasis or a wound that’s not healing or getting worse. Most people who are treated before they get seriously ill can fully recover.