Article title: Leishmania Infection: DPD
Conditions: Leishmaniasis, visceral leishmaniasis
Source: DPD
People who have cutaneous leishmaniasis have one or more sores on their skin. The sores can change in size and appearance over time. They often end up looking somewhat like a volcano, with a raised edge and central crater. Some sores are covered by a scab. The sores can be painless or painful. Some people have swollen glands near the sores (for example, under the arm if the sores are on the arm or hand).
People who
have visceral leishmaniasis usually have fever, weight loss, and an enlarged
spleen and liver (usually the spleen is bigger than the liver). Some patients
have swollen glands. Certain blood tests are abnormal. For example, patients
usually have low blood counts, including a low red blood cell count (anemia),
low white blood cell count, and low platelet count.
The number of new cases of cutaneous leishmaniasis each year in the world is thought to be about 1.5 million. The number of new cases of visceral leishmaniasis is thought to be about 500,000.
Leishmaniasis is found in parts of about 88 countries. Approximately 350 million people live in these areas. Most of the affected countries are in the tropics and subtropics. The settings in which leishmaniasis is found range from rain forests in Central and South America to deserts in West Asia. More than 90 percent of the world's cases of visceral leishmaniasis are in India, Bangladesh, Nepal, Sudan, and Brazil.
Leishmaniasis is found in some parts of the following areas:
Leishmaniasis
is not found in Australia or Oceania (that is, islands in the Pacific,
including Melanesia, Micronesia, and Polynesia).
Probably not. It is possible but very unlikely that you would get leishmaniasis in the United States. Very rarely, people living in rural southern Texas have developed skin sores from cutaneous leishmaniasis.
No cases of visceral leishmaniasis are known to have been acquired in the United States.
Leishmaniasis
is spread by the bite of some types of phlebotomine sand flies. Sand flies
become infected by biting an infected animal (for example, a rodent or
dog) or person. Since sand flies do not make noise when they fly, people
may not realize they are present. Sand flies are very small and may be
hard to see; they are only about one-third the size of typical mosquitos.
Sand flies usually are most active in twilight, evening, and night-time
hours (from dusk to dawn). Sand flies are less active during the hottest
time of the day. However, they will bite if they are disturbed, such as
when a person brushes up against the trunk of a tree where sand flies
are resting. Rarely, leishmaniasis is spread from a pregnant woman to
her baby. Leishmaniasis also can be spread by blood transfusions or contaminated
needles.
People of
all ages are at risk for leishmaniasis if they live or travel where leishmaniasis
is found. Leishmaniasis usually is more common in rural than urban areas;
but it is found in the outskirts of some cities. The risk for leishmaniasis
is highest from dusk to dawn because this is when sand flies are the most
active. All it takes to get infected is to be bitten by one infected sand
fly. This is more likely to happen the more people are bitten, that is,
the more time they spend outside in rural areas from dusk to dawn. Adventure
travelers, Peace Corps volunteers, missionaries, ornithologists (people
who study birds), other people who do research outdoors at night, and
soldiers are examples of people who may have an increased risk for leishmaniasis
(especially cutaneous leishmaniasis).
People with
cutaneous leishmaniasis usually develop skin sores within a few weeks
(sometimes as long as months) of when they were bitten.
People with
visceral leishmaniasis usually become sick within several months (rarely
as long as years) of when they were bitten.
Yes, it can
be. The skin sores of cutaneous leishmaniasis will heal on their own,
but this can take months or even years. The sores can leave ugly scars.
If not treated, infection that started in the skin rarely spreads to the
nose or mouth and causes sores there (mucosal leishmaniasis). This
can happen with some of the types of the parasite found in Central and
South America. Mucosal leishmaniasis might not be noticed until years
after the original skin sores healed. The best way to prevent mucosal
leishmaniasis is to treat the cutaneous infection before it spreads.
If not treated,
visceral leishmaniasis can cause death.
See your
health care provider, particularly if you have traveled to an area where
leishmaniasis is found and you have developed skin sores that aren't healing.
Be sure to tell your health care provider where you have traveled and
that you might be at risk for leishmaniasis.
It is very rare for travelers to get visceral leishmaniasis.
The first step is to find out if you have traveled to a part of the world where leishmaniasis is found. Your health care provider will ask you about any signs or symptoms of leishmaniasis you may have, such as skin sores that have not healed. If you have skin sores, your health care provider will likely want to take some samples directly from the sores. These samples can be examined for the parasite under a microscope, in cultures, and through other means. A blood test for detecting antibody (immune response) to the parasite can be helpful, particularly for cases of visceral leishmaniasis. However, tests to look for the parasite itself should also be done. CDC staff can help with the laboratory testing. Diagnosing leishmaniasis can be difficult. Sometimes the laboratory tests are negative even if a person has leishmaniasis.
Your health care provider can talk with CDC staff about whether your case of leishmaniasis should be treated, and, if so, how. Most people who have cutaneous leishmaniasis do not need to be hospitalized during their treatment.
The best
way for travelers to prevent leishmaniasis is by protecting themselves
from sand fly bites. Vaccines and drugs for preventing infection are not
yet available. To decrease their risk of being bitten, travelers should:
NOTE:
Bed nets, repellents containing DEET, and permethrin should be purchased
before traveling and can be found in hardware, camping, and military surplus
stores.
Yes. Some people have had cutaneous leishmaniasis more than once. Therefore, you should follow the preventive measures listed above whenever you are in an area where leishmaniasis is found.
Herwaldt BL. Leishmaniasis. Lancet 1999;354:1191-9.
Herwaldt
BL, Stokes SL, Juranek DD. American cutaneous leishmaniasis in U.S. travelers.
Ann Intern Med 1993;118:779-84.
Berman JD. Human leishmaniasis: clinical, diagnostic, and chemotherapeutic developments in the last 10 years. Clin Infect Dis 1997;24:684-703.
Desjeux P. Leishmaniasis: public health aspects and control. Clin Dermatol 1996;14:417-23.
This fact
sheet is for information only and is not meant to be used for self-diagnosis
or as a substitute for consultation with a health care provider. If you
have any questions about the disease described above or think that you
might have a parasitic infection, consult a health care provider.
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