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Leishmaniasis: Types, Causes, Symptoms and Treatment

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Leishmaniasis is known as the parasitic disease that’s caused by the Leishmania parasite. This parasite commonly lives in sand flies that are infected. A person can contract leishmaniasis from a bite of a sandfly that is infected.

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The sandfly that harbors the parasite naturally resides in tropical and sometimes subtropical environments. Deadly epidemics have occurred in areas of East Africa, Asia, and South America.

Areas that are affected are often isolated and unstable, with minimal resources to treat the disease. Doctors Borders (DWB) refer to leishmaniasis as one of the most dangerously ignored tropical diseases.

It is also classified as the second to malaria when discussing parasitic causes of death.

Types of leishmaniasis

There are three forms of leishmaniasis, which include cutaneous, visceral, and mucocutaneous. Diverse species of leishmania parasites are connected with each form. According to experts, there are about 20 species of Leishmania that can spread the disease to humans.

Cutaneous leishmaniasis

Cutaneous leishmaniasis causes ulcers on the skin. Cutaneous leishmaniasis is the most common of leishmaniasis, and treatment may not really be needed, depending on the person involved, but it can improve recovery and prevent any complications.

Mucocutaneous leishmaniasis

A mucocutaneous leishmaniasis is a rare form of the disease, and the cutaneous type of the parasite causes it. Mucocutaneous leishmaniasis can occur many months after skin ulcers are healed.

When a person is affected by mucocutaneous leishmaniasis, the parasites spread to the mouth, nose, and throat and can cause partial or complete disruption of the mucous membranes.

While mucocutaneous leishmaniasis is commonly considered a branch of cutaneous leishmaniasis, but it’s a more severe condition. Mucocutaneous leishmaniasis doesn’t heal on its own, and it always requires treatments.

Visceral leishmaniasis

Visceral leishmaniasis is sometimes referred to as kala-azar or systemic leishmaniasis. Visceral leishmaniasis usually manifests after two to eight months of being bitten by sand flies.

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The parasite causes damage to internal organs such as the liver and spleen. It’s can to also affect the bone marrows, as well as a person’s immune system caused by damages to the organs. This a condition that’s almost always fatal if left untreated.

Causes

A person can be affected by leishmaniasis diseases due to protozoan parasites found in the Leishmania species. The parasite stays and multiplies in the female sandfly, and it is transmitted from being bitten by one.

Sandflies are most active in swampy environments when the months are warmer. The parasite can also host itself in domestic animals, like dogs. Transmission may develop from animal to sand flies than to humans.

The parasite can also be passed from one human to another through share needles or blood transfusions, or from human to sandflies and other humans.

Who is at risk?

Geography

Leishmaniasis can be found anywhere in the world except Antarctica and Australia. Nevertheless, about 95% of cutaneous cases commonly occur in:

  • The Middle East
  • Central Asia
  • The Americas
  • The Mediterranean basin

In 2015 over 90% of visceral cases developed in:

  • India
  • Kenya
  • Somalia
  • South Sudan
  • Sudan
  • Brazil
  • Ethiopia

If you travel or you live in the tropical or subtropical regions of the countries or regions mentioned above, you are at a higher risk of contracting leishmaniasis. Climatic and environmental factors have a significant influence on the spread of the disease.

Socioeconomic conditions

According to the World Health Organization (WHO), poverty is a dominant factor for the disease. More-so, leishmaniasis often occurs in regions where the following conditions are prevalent:

  • Malnutrition
  • Famine
  • Lack of financial resources
  • A major migration of people caused by emergencies, urbanization, environmental changes, war, and climate change

Other infections

People with weakened immune systems are at higher risk of this condition. HIV can encourage the transmission of the disease and can also maximize the risk of visceral leishmaniasis. Leishmaniasis and HIV affect similar cells of the body’s immune system.

Individuals infected with HIV are also often affected by leishmaniasis. It is estimated areas of Ethiopia that as many as 35% of people with leishmaniasis also have HIV.

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Symptoms

A person can host some species of Leishmania for very long periods without getting sick. Symptoms may depend on the type of disease.

Cutaneous leishmaniasis

The chief symptom of this disease is painless skin ulcers. Symptoms may manifest a few weeks after being bitten by an infected fly. Notwithstanding, symptoms sometimes don’t appear for months or even years.

Mucocutaneous leishmaniasis

In people with this form of the disease, symptoms typically appear a year to five years after the skin lesions. These are basically ulcers in the nose and mouth or on their lips.

Other symptoms of mucocutaneous may include:

Visceral leishmaniasis

Symptoms often don’t appear for months after a bite with this type of leishmaniasis. Most cases are apparent 2-6 months after the infection occurred.

Common signs and symptoms include:

  • Weight loss
  • General weakness
  • Bleeding
  • Swollen lymph nodes
  • Enlarged liver
  • Enlarged spleen
  • Fever that lasts for weeks or sometimes months
  • Decreased production of blood cells

Diagnosing leishmaniasis

You must inform your doctor if you visited or lived in regions where leishmaniasis is common. This would help your doctor to diagnose the disease better.

Your doctor would have to run some tests to determine better what species of the parasite you’re infected with.

Diagnosing cutaneous leishmaniasis

Some of your skin samples (from the ulcers) would be taken for biopsy. Your doctor would check your DNA or genetic material for the parasite. Several methods may be used to identify what species of parasite is causing the infection.

Diagnosing visceral leishmaniasis

Most times, people don’t usually remember the bite they get from a sandfly. This can make diagnosing the condition a bit difficult. It would be helpful if a record of places traveled or lived in is kept.

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A physical exam may be necessary to check for an enlarged liver or spleen. A blood sample may be taken, or a bone marrow biopsy may be done.

Treatments

Antiparasitic drugs like amphotericin B (Ambisome), can be used to treat the disease. Treatments are usually recommended based on the type of leishmaniasis a person has.

Cutaneous leishmaniasis

Cutaneous ulcers do not require treatment as the condition often heals on its own. Nonetheless, treatment can help to speed up recovery, decrease the risk of further complications, and reduces scarring.

Disfiguration of the skin caused by skin ulcers may require plastic surgery.

Mucocutaneous leishmaniasis

Lesions caused by mucocutaneous leishmaniasis always requires treatment. Paromomycin and liposomal amphotericin B can be used to treat the condition.

Visceral leishmaniasis

People with visceral leishmaniasis disease always need treatment. Some medications are available, and they include miltefosine (Impavido), sodium stibogluconate (Pentostam), and amphotericin B, paromomycin.

Potential complications of leishmaniasis

Cutaneous complications may include:

Visceral leishmaniasis is commonly fatal due to the health complications it has on both the immune system and internal organs. You’re at a higher risk of having the disease if you have AIDS or HIV.

Having AIDS or HIV can also complicate the treatment of leishmaniasis.

Preventing leishmaniasis

There are no prophylactic medications or vaccines available. The best way to prevent yourself from having the disease is to avoid being bitten.

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The following steps should be followed to help prevent sandfly bites:

  • Spray insecticide in your sleeping areas.
  • Use insect repellents on the ends of your sleeves and pants and any exposed parts of your skin.
  • Try wearing clothes that cover as much skin as possible. Long-sleeved shirts, long pants, and socks are recommended.
  • Avoid outdoor activities between dusk and dawn. Sandflies are most active around this time.
  • Get insecticides, repellants, and bed nets before traveling to regions with sand fly infestations.
  • Because sand flies are poor fliers, it’s best to sleep in higher areas of your building.
  • Having your fan active might make flying difficult for the sand flies.

Long-term outlook

Sores can result in disfiguration and permanent scars. Treatment of leishmaniasis may minimize the severity of the disease.

Although medication can be taken to cure the disease, it is best that treatment is administered before extensive damage occurs in the immune system. Visceral leishmaniasis is often fatal if not adequately treated within two years.

Have you ever had to treat Leishmaniasis? What was the experience like? Do you have any thoughts you’d like to share with us? Kindly share with us in the comments below.

Leishmaniasis
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Disclaimer: This article is purely informative & educational in nature and should not be construed as medical advice. Please use the content only in consultation with an appropriate certified medical or healthcare professional.

Oluwafemi Michael
Oluwafemi Michael is an online Mental Health Therapist, Advocate for Mental Health Awareness, a programmer, and also a content creator from Edo state, Akoko-Edo LG.
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