Leishmaniasis

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Last reviewed: 10 Apr 2025

Last updated: 20 Jun 2023

Leishmaniasis has a range of clinical presentations; cutaneous leishmaniasis is more common, but visceral leishmaniasis is more serious and can be fatal if left untreated.

Diagnosis is confirmed by various tests, including microscopic exam, culture, or molecular testing, depending on the type of leishmaniasis and test availability.

Possible treatments depend on clinical presentations, parasite species and strain, and the country in which infection was acquired.

Treatment is less effective and sometimes more toxic in people who are immunocompromised than in those who are immunocompetent.

Definition

The leishmaniases are a group of protozoan diseases infecting humans and other animals, causing either skin lesions; mucosal involvement; or infiltration of the spleen, liver, and bone marrow.[1][2] They are caused by obligate intracellular (macrophage) protozoa of the genus Leishmania, and the main route of transmission is via the bite of an infected phlebotomine sand fly. Occasionally, infection occurs congenitally, through a blood transfusion or organ/tissue transplantation, or by laboratory infection.[3][4][5]

The leishmaniases can be broadly classified into two major clinicopathologic presentations: cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL).[1][2] CL is the more common form and may be subclassified into a range of different presentations, such as localized CL, diffuse CL, leishmaniasis recidivans, disseminated leishmaniasis, and mucosal leishmaniasis (ML); ML is sometimes classified as a separate subtype on its own. VL occurs when parasites disseminate through the reticuloendothelial system. It is potentially life-threatening without treatment. Post-kala-azar dermal leishmaniasis may present months or years following treatment of VL.[6] This condition exhibits a macular, maculopapular, or nodular rash.[7]

CDC: parasites – leishmaniasis Opens in new window

WHO: leishmaniasis Opens in new window

History and exam

Key diagnostic factors

previous stay in endemic area
immunosuppression
prolonged fever
weight loss
ulcerative skin lesions
multiple nonulcerative skin nodules
destructive mucosal inflammation
splenomegaly
skin darkening

Full details

Other diagnostic factors

fatigue
cough
headache
wasting
enlarged lymph nodes
hepatomegaly
previous antileishmanial treatment
epistaxis
abdominal pain

Full details

Risk factors

high exposure to sand fly bites
poverty
proximity to a patient with a history of infection
ownership of domestic animals
immunosuppression

Full details

Diagnostic tests

1st tests to order

CBC
liver function tests and BUN
serum human chorionic gonadotropin (hCG)

Full details

Tests to consider

microscopic exam of relevant specimen
blood (buffy coat) or tissue culture
polymerase chain reaction (PCR)
serology
serum HIV testing

Full details

Treatment algorithm

ACUTE

cutaneous leishmaniasis (CL)

mucosal leishmaniasis (ML)

visceral leishmaniasis (VL)

ONGOING

post-kala-azar dermal leishmaniasis (PKDL)

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Contributors

Authors

Naomi E. Aronson, MD

Professor of Medicine

Director, Infectious Diseases Division

Uniformed Services University of the Health Sciences

Bethesda

Disclosures

NEA receives federal grants to study leishmaniasis (received by NEA's institution USU), has given lectures on the topic of leishmaniasis at national and international meetings, and has a patent on biomarkers for leishmaniasis. NEA has received honoraria from the Welcome Trust. NEA's institution USU has received royalties for her writing and editorial work for UpToDate. NEA is an author of a number of references cited in this topic. The views expressed in this topic are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, the Department of Defense, or the US Government.

Nathanial K. Copeland, MD, MTM&H

Assistant Professor of Medicine

Uniformed Services University of the Health Sciences

Bethesda

Disclosures

NKC is an author of a number of references cited in this topic. The views expressed in this topic are those of the authors and do not reflect the official policy of the Department of Army/Navy/Air Force, the Department of Defense, or the US Government.

Acknowledgements

Professor Naomi E. Aronson and Dr Nathanial K. Copeland would like to gratefully acknowledge Professor Richard Reithinger and Professor François Chappuis, previous contributors to this topic.

Disclosures

RR and FC are authors of a number of references cited in this topic.

Peer reviewers

Roberto Arenas, MD

Chief of the Mycology Section

Dr. Manuel Gea Gonzalez General Hospital

Mexico

Disclosures

RA is the author of an article cited in this topic.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

Aronson N, Herwaldt BL, Libman M, et al. Diagnosis and treatment of leishmaniasis: clinical practice guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH). Clin Infect Dis. 2016 Dec 15;63(12):1539-57.Full text Abstract

Aronson NE, Joya CA. Cutaneous leishmaniasis: updates in diagnosis and management. Infect Dis Clin North Am. 2019 Mar;33(1):101-17. Abstract

National Institutes of Health, Centers for Disease Control and Prevention, HIV Medicine Association, and Infectious Diseases Society of America. Panel on Guidelines for the Prevention and Treatment of Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: Leishmaniasis. 2017 [internet publication].Full text

World Health Organization. Manual on case management and surveillance of the leishmaniases in the WHO European Region. July 2017 [internet publication].Full text

Burza S, Croft SL, Boelaert M. Leishmaniasis. Lancet. 2018 Sep 15;392(10151):951-70. Abstract

Chakravarty J, Sundar S. Current and emerging medications for the treatment of leishmaniasis. Expert Opin Pharmacother. 2019 Jul;20(10):1251-65. Abstract

Pan American Health Organization. Guideline for the treatment of Leishmaniasis in the Americas. Second edition. Sep 2022 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials
- Hyperreactive malarial splenomegaly (HMS)
- Malaria infection
- Schistosomiasis
More Differentials
Guidelines
- CDC Yellow Book: health information for international travel - visceral leishmaniasis
- Parasites - leishmaniasis. Resources for health professionals
More Guidelines
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Leishmaniasis

Summary

Definition

History and exam

Key diagnostic factors

Other diagnostic factors

Risk factors

Diagnostic tests

1st tests to order

Tests to consider

Treatment algorithm

cutaneous leishmaniasis (CL)

mucosal leishmaniasis (ML)

visceral leishmaniasis (VL)

post-kala-azar dermal leishmaniasis (PKDL)

relapse

Contributors

Authors

Naomi E. Aronson, MD

Disclosures

Nathanial K. Copeland, MD, MTM&H

Disclosures

Acknowledgements

Disclosures

Peer reviewers

Roberto Arenas, MD

Disclosures

References

Key articles

Reference articles

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

Differentials

Guidelines

Log in or subscribe to access all of BMJ Best Practice

Log in or subscribe to access all of BMJ Best Practice

Log in to access all of BMJ Best Practice