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A leishmaniasis is a neglected group of protozoal diseases caused by infection with Leishmania species. It is found in part of tropical, subtropical, and southern Europe. Spread by the bite of phlebotomine species of sand flies.

It is in various forms of leishmaniasis in people: visceral, cutaneous, and mucocutaneous leishmaniasis. The most common form is Cutaneous leishmaniasis (CL) which causes skin sores, and Visceral leishmaniasis (VL) affects several of your internal organs (usually the spleen, liver, and bone marrow).

An estimated 0.7-1 million new cases occur annually, endemic diseases in 97 countries.

Signs and Symptoms

  • High-grade Fever 
  • Papules (bumps) or nodules (lumps)
  • One or more sores on your skin 
  • Skin ulcer (covered by scab or crust)
  • Splenomegaly  
  • Hepatomegaly 
  • Anaemia  
  • Weight loss  
  • Darkening of the skin of the face, hands, feet & abdomen (so, called black sickness)
  • Lymphadenopathy (atypical feature)

Cutaneous leishmaniasis

It is a common form in people without any symptoms or signs. People who develop clinical features of infection usually have one or more skin lesions (sores), mainly ulcers, on the exposed part of their body, leaving life-long scars and serious disability or stigma in their body.

The sores may start from small papules or nodules and may end in the form of an ulcer; a skin ulcer covered by a scab or crust in your body. Sores of skin generally are painless but can be painful. Sometimes some people present in clinical with swollen glands near the sore (under the arm, if sores are present on your arm and hand).


An estimated 0.6-1 million new cases occur annually worldwide. About 95% of CL cases were recorded in the Mediterranean basin, Americas, the Middle East and Central Asia.

Visceral leishmaniasis

It is also called Kala-azar is a silent infection of a fatal case if left untreated in around 95% of cases. People who develop clinical features of infection usually have a fever, weight loss, swelling of the spleen and liver, and abnormal blood tests in their bodies.

If your health care provider investigates your blood, it may be found low such as anaemia, leukopenia, and thrombocytopenia. An estimated 0.05-0.09 million new cases occur annually worldwide. It is one of the top parasitic diseases with potential outbreaks and mortality.

Mucocutaneous leishmaniasis

Some people have partial or complete destruction of the mucous membranes around the nose, mouth, and throat. Over 90% of cases occur in Brazil, Bolivia, Ethiopia, and Peru.

Mode of Transmission

Person to person transmitted through the bites of infected female phlebotomine sandflies, which feed your blood to produce eggs.

It is also transmitted by contamination of the wound or by contact when an insect is thrashed during the act of feeding. Leishmania parasites are transmitted through blood transfusion and contaminated needles and syringes.

Risk Factors

Various risk factors increase the risk for leishmaniasis disease. They are the following;

Malnutrition 

If your diets lack protein-energy, vitamin-A, iron, and zinc increase the risk of infection will progress to disease more severe. 

Environmental changes

More prominence in urbanization, and the human incursion into forested places. 

Socioeconomic conditions

In a rural areas of developing countries, it is an increased risk of leishmaniasis due to poverty. Poor housing and domestic sanitary conditions (lack of waste management or open sewerage) may increase the breeding of sandflies. Sandflies are mostly present in crowded housing areas and increase the risk when humans sleep outside. 

Mobility or migration of Population

Epidemics of VL and CL are often more associated with migration and the movement of non-immune individuals into places with existing transmission cycles. Occupational exposure, as well as deforestation, are major factors for increasing the risk of disease.

Climate change

Kala-azar is a climate-sensitive disease and affects several ways; changes in temperature, humidity, rainfall, famine, and flood increase the risk. 

Other risk factors

Soldiers, ecotourists, adventure travellers, ornithologists, missionaries, and some people who do research outdoors at night/twilight. 

Diagnosis

Diagnosis of leishmaniasis can be challenging in the laboratory because the disease can mimic diverse infective and neoplastic diseases. 

  • Tissue specimens- Skin sores for CL, Bone marrow for VL-can be examined for the parasite under a microscope, cultures, and by some molecular tests.
  • Parasitological test: Detect the LD bodies from smears of different tissue specimens such as bone marrow, blood, spleen, liver, lymph nodes, and culture of the organism from a biopsy or aspirated material. 
  • Molecular tests: showing high specificity and sensitivity together. 
  • Rapid Diagnostic K39 Dipsticks test
  • Aldehyde test (non-specific test)
  • Serological test:
    • Direct agglutination test (DAT): Positive
    • ELISA
    • Indirect fluorescent antibody test (IFAT)
    • Leishmanin (Montenegro) test
  • Haematological test with finding
    • Leucopenia
    • Anaemia
    • Reversed albumin-globulin ration with increased IgG level
    • WBC:RBC= 1:1500 or 1:2000
    • Erythrocyte Sedimentation Rate (ESR) raised

Treatment

Leishmaniasis is one of the treatable and curable parasitic diseases. But before considering treatment, make sure the diagnosis was correct. If you take a medication you can first consult with your health care provider (doctors). 

  • Liposomal Amphotericine B- 10 mg/Kg single dose I/V or 3 mg/Kg for 5 days, 1.5mg/kg for 3 days-first line
  • Oral miltefosine 
    • >25kg =50 mg two times a day      
    • <25kg =50mg once a day for 28 days   
  • Paromomycin 

Warning (Before starting treatment)

  1. The Kala-azar patient should be admitted to the health institution (hospital) while starting your treatment
  2. Make sure that the patient does not have liver or kidney-related disease, i.e. clinically no jaundice and oedema
  3. Insure and exclude any other contraindications
  4. Treat the case of severe anaemia and malnutrition condition
  5. Give adequate ORS if the patient is dehydrated
  6. Married women of reproductive age group should use any contraception
  7. Provide “observed therapy” of every dose supervised by a health worker (doctors, nurses, others) of the nearest health institution (hospital), local FCHV or responsible family member. 
  8. Supervise health workers/FCHVs of the nearest health institution (hospital/ health post/ primary health care) to fill and update the treatment card daily
  9. Monitor the patient daily for the probable side effects with information from the health worker of the nearest health institution (hospital/ health post/ primary health care), local FCHV or responsible family member

Prevention and control

Prevention of leishmaniasis can require intervention strategies because transmission occurs in a complex system involving the human or animal reservoir host, vector, and parasites.

They are the following strategies;

  • Early diagnosis and effective immediate treatment: 
    • Reduced transmission of disease from one person to another
    • Monitor the spread and burden of leishmaniasis in the local area
    • Prevent disabilities and death
  • Vector control:
    • Insecticide spray-on living/sleeping area
    • Using mosquito net
    • Environmental management and personal protection (Keeping a house clean and avoiding sleeping on the floor)
  • Control of animal reservoir host
  • Social mobilization and strengthening partnership
  • Effective disease surveillance
  • Stay in a well-screened area. 
  • Reduced the amount of exposed skin by using long-sleeved shirts, long pants, and shock
  • Apply insect repellent (N, N-diethyl-meta toluamide) to an exposed skin area

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