Health Encyclopedia

Leishmaniasis

Definition

Leishmaniasis is an infectious disease spread by the bite of the female sandfly.

Alternative Names

Kala-azar; Cutaneous leishmaniasis; Visceral leishmaniasis; Old world leishmaniasis; New world leishmaniasis

Causes

Leishmaniasis is caused by a tiny parasite called leishmania protozoa. Protozoa are one-celled organisms.

The different forms of leishmaniasis are:

Cutaneous leishmaniasis affects the skin and mucous membranes. Skin sores usually start at the site of the sandfly bite. In a few people, sores may develop on mucous membranes.
Systemic, or visceral, leishmaniasis affects the entire body. This form occurs 2 to 8 months after a person is bitten by the sandfly. Most people do not remember having a skin sore. This form can lead to deadly complications. The parasites damage the immune system by decreasing the numbers of disease-fighting cells.

Cases of leishmaniasis have been reported on all continents except Australia and Antarctica. In the Americas, the disease can be found in Mexico and South America. It has also been reported in military personnel who have returned from the Persian Gulf.

Symptoms

Symptoms of cutaneous leishmaniasis depend on where the lesions are located and may include:

Breathing difficulty
Skin sores, which may become a skin ulcer that heals very slowly
Stuffy nose, runny nose, and nosebleeds
Swallowing difficulty
Ulcers and wearing away (erosion) in the mouth, tongue, gums, lips, nose, and inner nose

Systemic visceral infection in children usually begins suddenly with:

Cough
Diarrhea
Fever
Vomiting

Adults usually have a fever for 2 weeks to 2 months, along with symptoms such as fatigue, weakness, and appetite loss. Weakness increases as the disease gets worse.

Other symptoms of systemic visceral leishmaniasis may include:

Abdominal discomfort
Fever that lasts for weeks; may come and go in cycles
Night sweats
Scaly, gray, dark, ashen skin
Thinning hair
Weight loss

Exams and Tests

Your health care provider will examine you and may find that your spleen, liver, and lymph nodes are enlarged. You will be asked if you recall being bitten by sandflies or if you've been in an area where leishmaniasis is common.

Tests that may be done to diagnose the condition include:

Biopsy of the spleen and culture
Bone marrow biopsy and culture
Direct agglutination assay
Indirect immunofluorescent antibody test
Leishmania-specific PCR test
Liver biopsy and culture
Lymph node biopsy and culture
Montenegro skin test (not approved in the United States)
Skin biopsy and culture

Other tests that may be done include:

Treatment

Antimony-containing compounds are the main medicines used to treat leishmaniasis. These include:

Meglumine antimoniate
Sodium stibogluconate

Other medicines that may be used include:

Amphotericin B
Ketoconazole
Miltefosine
Paromomycin
Pentamidine

Plastic surgery may be needed to correct the disfigurement caused by sores on the face (cutaneous leishmaniasis).

Outlook (Prognosis)

Cure rates are high with the proper medicine, mostly when treatment is started before it affects the immune system. Cutaneous leishmaniasis may lead to disfigurement.

Death is usually caused by complications (such as other infections), rather than from the disease itself. Death often occurs within 2 years.

Possible Complications

Leishmaniasis may lead to the following:

Bleeding (hemorrhage)
Deadly infections due to immune system damage
Disfigurement of the face

When to Contact a Medical Professional

Contact your provider if you have symptoms of leishmaniasis after visiting an area where the disease is known to occur.

Prevention

Taking measures to avoid sandfly bites can help prevent leishmaniasis:

Putting fine mesh netting around the bed (in areas where the disease occurs)
Screening windows
Wearing insect repellent
Wearing protective clothing

Public health measures to reduce sandflies are important. There are no vaccines or medicines that prevent leishmaniasis.

References

Aronson NE, Copeland NK, Magill AJ. Leishmania species: visceral (kala-azar), cutaneous, and mucosal leishmaniasis. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 275.

Dinulos JGH. Infestations and bites. In: Dinulos JGH, ed. Habif's Clinical Dermatology. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 15.

Review Date:8/26/2023
Reviewed By:Jatin M. Vyas, MD, PhD, Associate Professor in Medicine, Harvard Medical School; Associate in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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