Leishmaniasis

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Overview

Leishmaniasis is a tropical and subtropical disease caused by an intracellular parasite transmitted to humans by the bite of a sand fly, mainly Phlebotomus and Lutzomyia (Europe, Northern Africa, the Middle East, Asia, and part of South America); exceptionally, transmission has also been reported as a laboratory accident 1. According to the World Health Organization (WHO), leishmaniasis is one of the seven most important tropical diseases and it represents a serious world health problem that presents a broad spectrum of clinical manifestations with a potentially fatal outcome 2, 3. It is found in all continents except Oceania 2, 4 and is endemic in circumscribed geographic areas in Northeastern Africa, Southern Europe, the Middle East, Southeastern Mexico, and Central and South America.

The clinical features include a broad range of manifestations with different degrees of severity that depend on the species of Leishmania involved and the immune response of the host 3. In Mexico, the most characteristic form is the cutaneous-chondral form 1, 4, also called “chiclero’s ulcer”.


Symptoms

Breathing difficulty.

Skin sores, which may become a skin ulcer that heals very slowly.

Stuffy nose, runny nose, and nosebleeds.

Swallowing difficulty.

Causes

Leishmaniasis is caused by infection with Leishmania parasites, which are spread by the bite of phlebotomine sand flies. There are several different forms of leishmaniasis in people.


Risk factors

Poverty increases the risk for leishmaniasis. Poor housing and domestic sanitary conditions (such as a lack of waste management or open sewerage) may increase sandfly breeding and resting sites, as well as their access to humans.

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Complications

Secondary bacterial infection, including pneumonia and tuberculosis.

Septicemia.

Disfigurement of nose, lips, and palate (eg, cancrum oris)

Uncontrolled bleeding.

Splenic rupture.

Late stages: Edema, cachexia, and hyperpigmentation.

Prevention

No vaccines or drugs to prevent infection are available. The best way for travelers to prevent infection is to protect themselves from sand fly bites. To decrease the risk of being bitten, follow these preventive measures:

Avoid outdoor activities, especially from dusk to dawn, when sand flies generally are the most active.

When outdoors (or in unprotected quarters):

Minimize the amount of exposed (uncovered) skin. To the extent that is tolerable in the climate, wear long-sleeved shirts, long pants, and socks; and tuck your shirt into your pants. (See below about wearing insecticide-treated clothing.)

Apply insect repellent to exposed skin and under the ends of sleeves and pant legs. Follow the instructions on the label of the repellent. The most effective repellents generally are those that contain the chemical DEET (N,N-diethylmetatoluamide).

Note: Bed nets, repellents, and insecticides should be purchased before traveling and can be found in hardware, camping, and military surplus stores. Bed nets and clothing that already have been treated with a pyrethroid-containing insecticide also are commercially available.

When indoors:

Stay in well-screened or air-conditioned areas.

Keep in mind that sand flies are much smaller than mosquitoes and therefore can get through smaller holes.

Spray living/sleeping areas with an insecticide to kill insects.

If you are not sleeping in a well-screened or air-conditioned area, use a bed net and tuck it under your mattress. If possible, use a bed net that has been soaked in or sprayed with a pyrethroid-containing insecticide. The same treatment can be applied to screens, curtains, sheets, and clothing (clothing should be retreated after five washings).