Leishmaniasis

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What is it about ?

Leishmaniasis is a tropical and subtropical disease caused by Leishmania, a parasite composed of a single cell. This parasite lives in the blood of rodents and dogs. It is transmitted to humans through the bite of a sand fly (a sandfly). There are three important forms of the disease:

  • leishmaniasis of the skin (cutaneous leishmaniasis),
  • leishmaniasis of the skin and mucous membranes (mucous cutaneous leishmaniasis)
  • leishmaniasis of the intestines (visceral leishmaniasis, also called “kala-azar” or black fever).

What is its frequency?

Cutaneous leishmaniasis is the most common form and can occur worldwide, especially on the Mediterranean coast, Asia Minor, India, Africa, Central America and South America. Most contaminations are observed in Afghanistan, Iran, Syria, Algeria, Brazil and Colombia.

Mucocutaneous leishmaniasis is found in Central and South America, mainly in Brazil, Peru and Bolivia.

Visceral leishmaniasis is present in particular in Spain (east coast), the Middle East, Central Asia, China, South America, East Africa and India. 90% of cases are observed in these 6 countries: Bangladesh, India, Ethiopia, South Sudan, Sudan and Brazil.

In 2012, there were 15 new cases in Belgium, mainly for mucocutaneous leishmaniasis. These were only tourists or immigrants from regions where the disease is present.

How to recognize it?

Cutaneous leishmaniasis causes skin damage. A scab forms at the bite of the fly several months after contamination. It develops into a large 2 cm ulcer. The skin lesion heals on its own within months, sometimes over several years, and leaves a discolored scar.

Mucocutaneous leishmaniasis causes skin lesions and lesions of the mucous membranes. First a lesion forms in the face. She heals spontaneously. Months, sometimes years later, ulcers appear on the mucous membranes. They cause partial or complete destruction of the septum of the nose and the soft structures of the mouth and nose, which can lead to significant deformation of the face.

Visceral leishmaniasis causes damage to the intestines. It is the most serious form of the disease. On average 3 to 8 months after contamination, serious symptoms occur: general feeling of discomfort, fever, weight loss, anemia, diarrhea and bleeding. Darker skin pigmentation is also possible. One can suffer from stomach aches because of the enlargement of the spleen and liver. Usually the lymph nodes are painful and swollen.

How is the diagnosis made?

The doctor will ask if you have recently traveled to areas where the disease is present. A clinical examination and a blood test can already give an indication. Taking a tissue sample and analyzing it in the laboratory will confirm the diagnosis of cutaneous leishmaniasis or cutaneomucosal leishmaniasis. Visceral leishmaniasis can be diagnosed by seeing the presence of antibodies in the blood or by puncturing the lymph node, bone marrow, spleen, or liver.

What can you do ?

There is no vaccine or medication that protects against leishmaniasis. It is therefore especially important to protect yourself against sand flies: wear sufficiently covering clothing, apply a product containing DEET to the uncovered skin and sleep under a mosquito net impregnated with insecticides.

What can your doctor do?

The doctor will refer you to a hospital specializing in the treatment of this disease.

Even though the cutaneous leishmaniasis Often goes away spontaneously, sometimes treatment is started or a small intervention is planned.

The visceral leishmaniasis is fatal without prompt treatment. In recent years, there has been an increased resistance of the parasite to existing drugs. It is not yet clear what the reason is, and studies are underway on this subject.

We treat the mucocutaneous leishmaniasis similar to visceral leishmaniasis, but the mucocutaneous form is often the least responsive to drugs.

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