Leishmaniasis

Answer 1

Definition

Leishmaniasis is a parasitic disease spread by the bite of the sandfly.

Alternative Names

Kala-azar

Causes, incidence, and risk factors

There are different forms of leishmaniasis.

• Cutaneous leishmaniasis affects the skin and mucus membranes. Skin sores usually start at the site of the sandfly bite. They can last for months or years before healing on their own. In a few people, sores may develop on mucus membranes.
• Systemic, or visceral leishmaniasis affects the entire body. This form occurs 2 - 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, leishmaniasis can be found in Mexico and South America. Leishmaniasis has been reported in military personnel returning from the Persian Gulf.

Symptoms

Cutaneous leishmaniasis affects the skin and sometimes the mucus membranes. Symptoms may include:

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

Systemic visceral infection in children usually begins suddenly with vomiting, diarrhea, fever, and cough. 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:

• Belly area (abdominal) discomfort
• Cough (children)
• Diarrhea (children)
• Fever that lasts for weeks; may come and go in cycles
• Night sweats
• Scaly, gray, dark, ashen skin
• Thinning hair
• Vomiting (children)
• Weight loss

Signs and tests

A physical exam may show signs of an enlarged spleen, liver, and lymph nodes. The patient may have been bitten by sandflies, or was in an area known for leishmaniasis.

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
• Lymph node biopsy and culture
• Montenegro skin test
• Skin biopsy

Other tests that may be done include:

• Complete blood count
• Serum immunoglobulin levels
• Serum protein
• Serum albumin
• Serologic testing

Treatment

Medicines called antimony-containing compounds are the main drugs used to treat leishmaniasis. These include:

• Meglumine antimonate
• Sodium stibogluconate

Other drugs that may be used include:

• Amphotericin B
• Fluconazole
• Pentamidine

Plastic surgery may be needed to correct the disfigurement caused by sores on the face (cutaneous leishmaniasis). Patients with drug-resistant viral leishmaniasis may need to have their spleen removed (splenectomy).

Expectations (prognosis)

Cure rates are high with the proper medicine. Patients should get treated before damage to the immune system occurs. 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.

Complications

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

Calling your health care provider

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

Prevention

Preventing sandfly bites is the most immediate form of protection. You can prevent a bite by:

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

Public health measures to reduce the sandfly population and animal reservoirs are important. There are no preventive vaccines or drugs for leishmaniasis.

References

Jeronimo SMB, DeQueiroz-Sousa A, Pearson RD. Leishmaniasis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier;2007:chap 369.

Answer 2

Definition

Leishmaniasis is a disease spread by the bite of the female sandfly.

Alternative Names

Kala-azar

Causes, incidence, and risk factors

There are different forms of leishmaniasis.

• 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 - 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, leishmaniasis can be found in Mexico and South America. Leishmaniasis has been reported in military personnel returning from the Persian Gulf.

Symptoms

Symptoms of cutaneous leishmaniasis 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

Signs and tests

A physical exam may show signs of an enlarged spleen, liver, and lymph nodes. The patient may have been bitten by sandflies, or was in an area known for leishmaniasis.

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 biopsyand culture
• Lymph node biopsy and culture
• Montenegro skin test
• Skin biopsy and culture

Other tests that may be done include:

• Complete blood count
• Serologic testing
• Serum albumin
• Serum immunoglobulin levels
• Serum protein

Treatment

Medicines called antimony-containing compounds are the main drugs used to treat leishmaniasis. These include:

• Meglumine antimoniate
• Sodium stibogluconate

Other drugs 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). Patients with drug-resistant viral leishmaniasis may need to have their spleen removed (splenectomy).

Expectations (prognosis)

Cure rates are high with the proper medicine. Patients should get treated before damage to the immune system occurs. 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.

Complications

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

Calling your health care provider

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

Prevention

Preventing sandfly bites is the most immediate form of protection. You can prevent a bite by:

• 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 the sandfly population and animal reservoirs are important. There are no vaccines or drugs that prevent leishmaniasis.

References

Croft SL, Buffet PA. Leishmaniasis. In: Goldman L, Ausiello D, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 356.

Magill AJ. Leishmania species. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 256.

Reviewed By

Review Date: 08/24/2011

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; and Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.