Causes and Symptoms
Leishmaniasis is caused by protozoan parasites of the genus Leishmania. These parasites are transmitted through the bite of infected female sand flies. The symptoms of leishmaniasis depend on the type and can include skin sores, skin ulcers, skin nodules, fever, weight loss, swelling of the spleen and liver, and anaemia. Cutaneous leishmaniasis leads to skin sores, often on exposed areas of the body like the face, arms and legs. Visceral leishmaniasis affects internal organs like the liver, spleen and bone marrow. Symptoms of visceral leishmaniasis include prolonged fever, weight loss, swelling of the spleen and liver, and anaemia.
Diagnosis
Several methods are used to diagnose Leishmaniasis Treatment depending on the type. For cutaneous leishmaniasis, a doctor will physically examine skin sores and take a small tissue sample for microscopic examination or polymerase chain reaction (PCR) analysis to identify the parasite. Diagnosis of visceral leishmaniasis involves serological tests like K39 strip test, rK39 antibody test or ELISA to detect antibodies produced against Leishmania parasites along with tests like spleen or bone marrow aspiration for microscopic examination or PCR analysis. Imaging tests like ultrasonography and chest X-rays may also be done to check organ enlargement for visceral disease.
Leishmaniasis Treatment Options
The treatment depends on the type and severity of leishmaniasis. For cutaneous leishmaniasis, topical treatments using creams or ointments containing paromomycin or methylbenzethonium chloride are generally the first line of treatment. For widespread or severe disease, systemic drug treatments like oral miltefosine, pentamidine or antimony compounds may be given. For visceral leishmaniasis, first choice treatments include intravenous or intramuscular sodium stibogluconate or liposomal amphotericin B. Oral miltefosine is also used. Additional options include paromomycin injections or combination therapies. Leishmaniasis treatment lasts for 1-6 months depending on the drug and may need to be extended for non-responsive cases. Treatment of mucocutaneous disease usually requires systemic antifungal agents along with pentamidine or antimony compounds.
Prevention
The following measures can help prevent leishmaniasis:
- Applying insect repellents containing DEET or plant-based repellents on exposed skin when in endemic areas.
- Wearing long-sleeved, light coloured clothes and trousers that cover as much skin as possible when outdoors at dawn and dusk when sand flies are most active.
- Using bed nets treated with insecticide in endemic areas.
- Eliminating standing water and clutter near houses to deny breeding spaces to sand flies.
- Screening houses helps to keep sand flies out especially in endemic areas.
- Treating dogs for canine leishmaniasis has shown to reduce human infection rates as dogs can act as reservoir hosts.
- Travellers to endemic areas should consult their doctor for appropriate chemoprophylaxis before travel.
- Visceral leishmaniasis elimination programs involving vector control and improved case detection help to reduce cases.
Prognosis
With timely leishmaniasis treatment, about 90% of cutaneous leishmaniasis cases heal without scarring. Visceral leishmaniasis if left untreated has a case fatality rate as high as 100% within 2 years. With appropriate treatment, the case fatality rate of visceral leishmaniasis is less than 10%. Treated muco-cutaneous disease may leave scarring and disfigurement even after recovery. A small number of cases may become chronic or relapse necessitating additional treatment. Prognosis depends on early diagnosis and leishmaniasis treatment, and may be worse in immunosuppressed patients, very young children or uncontrolled diabetes sufferers.
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