Leishmaniasis

Leishmaniasis is one of the world’s most neglected diseases and is caused by parasites spread by sandflies. It often occurs in poor nations prone to war and unrest, which have inadequate health infrastructure.

There are three main forms of the disease:

• cutaneous leishmaniasis (CL) is the most common type of infection. It affects the skin, causing skin ulcers;
• mucosal leishmaniasis (ML) affects the nose, mouth, and throat;
• visceral leishmaniasis (VL) affect the organs, including the spleen and liver. Also known as kala-azar, it is usually fatal without treatment.

The disease is endemic to 88 countries. Approximately 350 million people are at risk of contracting leishmaniasis, with 1.5 – 2 million new cases annually.

Visceral leishmaniasis, in particular, is associated with malnutrition, poor housing, and a lack of financial resources. Most cases occur in Brazil, East Africa, and India.

Symptoms of leishmaniasis vary greatly. It can be asymptomatic, cause localised skin lesions, or progress to visceral leishmaniasis (VL). VL is characterised by fever, anaemia, and an enlarged spleen and liver. It is fatal in around 95% of cases if left untreated.

There is no vaccine for leishmaniasis and the drugs used for treatment are toxic. Medication may need to be administered for long periods, which can lead to side effects.

Treatment varies depending on the severity of the infection. Mild cases of cutaneous leishmaniasis often don’t require treatment and will resolve on their own. In more severe cases, sores can affect the face and medication may be required. This usually takes the form of syrup or tablets.

Long-lasting infections may require repeated injections around skin sores or an intravenous drip for several days or weeks.

Mucosal and visceral forms of the disease are treated with oral or intravenous medicines – either antifungal, anticancer or antibacterial.

However, current medications do not cure the disease, leaving people vulnerable to relapse. Our immune system plays an important role in clearing the body of the parasite and autoimmune conditions can complicate this.

While no cases have been acquired locally, people contract the disease overseas and return to Australia each year. Cases have been reported in migrants, tourists, dogs and military personnel. This can present problems with diagnosis, as local clinicians are often unfamiliar with the disease. If you’ve travelled to an endemic region, you should notify your clinician if you present with any symptoms of skin sores or ill health.