Leishmaniasis

Leishmaniasis General Information

Leishmaniasis is a parasitic disease, well known in the areas of the world where its carriers, a certain species of sand flies, lives. Such areas are parts of the Middle East, southern Europe, Central and South America, Asia and Africa. In all, 88 countries have recorded cases of such infections over the world. Generally the disease can only be transmitted from animals to humans, but there have been cases where the humans were carriers as well, and could infect others.

There are several types of Leishmaniasis, the most common of them being the cutaneous type, which affects the infected person’s skin, and the visceral type where the parasites have moved to the internal organs, such as the liver, spleen or bone marrow. The visceral version of the disease is by far the most serious – and most lethal – type of infection. There is also the mucocutaneous type, in which the parasites infect the person’s mucous membranes, but this variation of the disease is rarely encountered.

As stated, the infection is generally spread through the bite of certain species of sand flies, from the Lutzomyia and Phlebotomus families. In rare cases, the disease may also be spread through contaminated needles, blood transfusion and from a pregnant mother to her baby at birth. It is highly recommended that if you travel in parts of the world that are known to have recorded cases of such infections, you should protect yourself from the bite of sand flies.

Leishmaniasis Symptoms

There are several symptoms associated with Leishmaniasis, but not all of them may be present in a given case. The organism of different people reacts in different ways to the infection, and while some signs are present in most of the cases, others may be rare or even unique to a single patient. The symptoms of the infection may appear weeks or even months after the parasites entered the patient’s system, so it is important that you let your specialized health care professional know about any trips that you have taken recently as it may help in placing the diagnosis.

Generally, patients with cutaneous Leishmaniasis will present a sore at the place where the insect has bit them. The papule will enlarge and become an ulcer, often developing a volcano-like appearance as the edges rise forming a crater in the middle. In some cases, the sores may be multiple, but in most cases the patient presents a single papule. The sore will eventually heal, but it will leave behind a scar. This form of the infection is possible to evolve in any of the other types.

Diffuse cutaneous Leishmaniasis presents the same symptoms, the main difference being that it affects large parts of the patient’s skin; the mucocutaneous type of the infection appears when the parasites have also affected the mucous membranes, and it is generally present on the patient’s face and nose – this affection will disfigure the patient in most cases. The most severe type of the infection, the visceral one, is characterized by chronic fever, anemia, weakness and weight loss, while at the same time the patient suffers severe spleen and / or liver damage.

Leishmaniasis Treatment

Leishmaniasis can be a difficult affection to diagnose. Typically, the diagnosis is placed after observing any skin sores that do not heal in short time. The examining health care specialist may take a tissue sample from the sore and observe it through a microscope in order to identify the parasite, but blood tests may also be performed especially to identify cases of visceral infection. The most common therapy that is employed to treat patients suffering from Leishmaniasis includes pentavalent antimonials, meglumine antimoniate and sodium stibogluconate, although the exact way in which these drugs work against the parasite is not fully understood. However, it has been noted that the parasite’s resistance to such drugs has increased in some parts of the world, depending on species. Amphotericin B and AmBisome have also been used during treatment of infected patients with success; however they are not commonly used in Leishmaniasis treatment.

Miltefosine (Impavido) is a new drug that has been recently employed in the treatment of the infection, and the results show that it is particularly effective, leading to a 95% cure rate. Even in patients who are also suffering from aggravating diseases such as AIDS the success rate is of 65%, which is much more than any of the previous drugs would yield. Apart from that, this drug has generally shown that it has a much lower risk of side effects and is better tolerated by the patients’ organisms. The most common side effect that therapy with this drug may induce is a gastrointestinal disturbance which lasts for one to two days; however this does not affect the efficiency of the treatment. Also, the drug is available under the form of pills, which prevents the need to hospitalize the patient and making it a much more attractive option.

In cases of Leishmaniasis where the parasite has developed drug resistance, the treatment of choice consists of immunotherapy, typically by inoculating the patient with parasite antigens and an adjuvant. This type of therapy aims at stimulating the patient’s immune system making it able to kill the parasite. Specialized health care professionals are currently trying to develop a vaccine against Leishmaniasis; however this presents little success at this time. The best way to prevent the infection remains to protect yourself against the bite of infected insects. Wearing proper clothing as well as using approved repellents may greatly contribute at keeping carrier insects away thus greatly reducing the chances of becoming infected.

It is highly advised that once the examining physician has placed the diagnosis and provided you with the prescription, you should closely follow the intake guidelines. Never modify the dosage of the drugs, either by altering the doses themselves or by changing the intake schedule. Such actions may lead to the failure of the treatment, and also they may increase the risks for side effects and complications to occur. Taking larger doses of the prescribed medication may lead to overdose, and possibly even death. For further information regarding the potential therapy options against this type of medical condition please refer to your personal doctor.