Leishmaniasis

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.

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]Reithinger R, Dujardin JC, Louzir H, et al. Cutaneous leishmaniasis. Lancet Infect Dis. 2007 Sep;7(9):581-96. http://www.ncbi.nlm.nih.gov/pubmed/17714672?tool=bestpractice.com [2]Chappuis F, Sundar S, Hailu A, et al. Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nat Rev Microbiol. 2007 Nov;5(11):873-82. http://www.ncbi.nlm.nih.gov/pubmed/17938629?tool=bestpractice.com 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]Killick-Kendrick R. The biology and control of phlebotomine sand flies. Clin Dermatol. 1999 May-Jun;17(3):279-89. http://www.ncbi.nlm.nih.gov/pubmed/10384867?tool=bestpractice.com [4]Herwaldt BL. Laboratory-acquired parasitic infections from accidental exposures. Clin Microbiol Rev. 2001 Oct;14(4):659-88. https://journals.asm.org/doi/10.1128/CMR.14.3.659-688.2001 http://www.ncbi.nlm.nih.gov/pubmed/11585780?tool=bestpractice.com [5]Antinori S, Cascio A, Parravicini C, et al. Leishmaniasis among organ transplant recipients. Lancet Infect Dis. 2008 Mar;8(3):191-9. http://www.ncbi.nlm.nih.gov/pubmed/18291340?tool=bestpractice.com

The leishmaniases can be broadly classified into two major clinicopathologic presentations: cutaneous leishmaniasis (CL) and visceral leishmaniasis (VL).[1]Reithinger R, Dujardin JC, Louzir H, et al. Cutaneous leishmaniasis. Lancet Infect Dis. 2007 Sep;7(9):581-96. http://www.ncbi.nlm.nih.gov/pubmed/17714672?tool=bestpractice.com [2]Chappuis F, Sundar S, Hailu A, et al. Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nat Rev Microbiol. 2007 Nov;5(11):873-82. http://www.ncbi.nlm.nih.gov/pubmed/17938629?tool=bestpractice.com 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]Zijlstra EE, Musa AM, Khalil EA, et al. Post-kala-azar dermal leishmaniasis. Lancet Infect Dis. 2003 Feb;3(2):87-98. http://www.ncbi.nlm.nih.gov/pubmed/12560194?tool=bestpractice.com This condition exhibits a macular, maculopapular, or nodular rash.[7]World Health Organization. The post kala-azar dermal leishmaniasis (PKDL) atlas: a manual for health workers. 2012 [internet publication]. https://apps.who.int/iris/bitstream/handle/10665/101164/9789241504102_eng.pdf

CDC: parasites – leishmaniasis Opens in new window

WHO: leishmaniasis Opens in new window