Leishmaniasis

leishmaniasis, human protozoal infection spread by the bite of a sandfly. Leishmaniasis occurs worldwide but is especially prevalent in tropical areas. Three major forms of the disease are recognized: visceral, cutaneous, and mucocutaneous.

Leishmaniasis is caused by various species of the flagellate protozoan Leishmania, of the order Kinetoplastida. These parasites infect a variety of vertebrate animals, such as rodents and canines. They are transmitted to humans by the bite of a bloodsucking sandfly, which belongs to the genus Lutzomyia in the Americas and to Phlebotomus in the Old World. Leishmanial parasites have two morphologic stages in their life cycle. One form, which inhabits the digestive tract of the sandfly, is an elongated, motile, flagellated form called a promastigote or leptimonad. The other, a round or oval, nonmotile form, called an amastigote, is found in certain cells (i.e., macrophages) of vertebrates. If a sandfly dines on an infected vertebrate, it will ingest cells containing amastigotes, which develop into promastigotes in its gut. There the promastigotes multiply, eventually entering the fly’s saliva. From here they can enter another vertebrate through the wound made during the sandfly’s next blood meal, thus initiating a new infection.

Depending on the species of Leishmania that invades a host and on the host’s immunologic response to the infection, one of three principal types of leishmaniasis can arise. Visceral leishmaniasis, also called kala-azar, is produced by several subspecies of L. donovani. It occurs throughout the world but is especially prevalent in the Mediterranean area, Africa, Asia, and Latin America. This form of the disease is systemic, primarily affecting the liver, spleen, bone marrow, and other viscera. Symptoms, which include fever, weight loss, reduction in the number of white blood cells, and enlargement of the spleen and liver, usually appear two months or more after infection. The disease is usually fatal if not treated.

Cutaneous leishmaniasis is caused by several Leishmania species. It is characterized by lesions that range from pimples to large ulcers located on the skin of the legs, feet, hands, and face, most of which heal spontaneously after many months. A distinction is made between cutaneous leishmaniasis of the Old World and of the New World. That of the Old World, also called Oriental sore, is endemic in areas around the Mediterranean, in central and northeast Africa, and in south and west Asia. It is caused primarily by L. major, L. tropica, and L. aethiopica. Cutaneous leishmaniasis of the New World, which is found in Central and South America and parts of the southern United States, is caused mainly by L. mexicana and L. viannia braziliensis. This infection may spread to the oral and nasal mucous membranes, a complication referred to as mucocutaneous leishmaniasis, or espundia. Destruction of the lips, throat, palate, and larynx can ensue. Mucocutaneous leishmaniasis may not appear until years after an initial cutaneous lesion has healed.

Leishmaniasis is treated with various agents, including antimicrobial drugs, such as miltefosine; antifungal drugs, such as amphotericin B, fluconazole, ketoconazole, or itraconazole; and compounds of antimony, such as sodium stibogluconate. Spread of the disease is prevented by controlling sandfly populations.