Leishmaniasis refers to several different illnesses caused by infection with an organism called a protozoan.
Protozoa are considered to be the most simple organisms in the animal kingdom. They are all single-celled. The types of protozoa that cause leishmaniasis are carried by the blood-sucking sandfly. The sandfly is referred to as the disease vector, simply meaning that the infectious agent (the protozoan) is carried by the sandfly and passed on to other animals or humans in whom the protozoan will set up residence and cause disease. The animal or human in which the protozoan then resides is referred to as the host.
Once the protozoan is within the human host, the human's immune system is activated to try to combat the invader. Specialized immune cells called macrophages work to swallow up the protozoa. Usually, this technique kills a foreign invader, but these protozoa can survive and flourish within macrophages. The protozoa multiply within the macrophages, ultimately causing the macrophage to burst open. The protozoa are released, and take up residence within other neighboring cells.
At this point, the course of the disease caused by the protozoa is dependent on the specific type of protozoa, and on the type of reaction the protozoa elicits from the immune system. There are several types of protozoa that cause leishmaniasis, and they cause different patterns of disease progression.
At any one time, about 20 million people throughout the world are infected with leishmaniasis. Between one million and one and one-half million cases of cutaenous leishmaniasis are reported yearly worldwide. While leishmaniasis exists as a disease in 88 countries on five continents, some countries are hit harder than others. These include Bangladesh, India, Nepal, Sudan, Afghanistan, Brazil, Iran, Peru, Saudi Arabia, and Syria. Other areas that harbor the causative protozoa include China, many countries throughout Africa, Mexico, Central and South America, Turkey, and Greece. Although less frequent, cases have occurred in the United States, in Texas.
As Americans travel to these countries, they will come in contact the protozoa that cause forms of leishmaniasis. Also, physicians were advised in 2004 to suspect cutaneous leishmaniasis in military personnel who were deployed to areas where the infection is present. From August 2002 to February 2004, staff from the U.S. Department of Defense identified 522 confirmed cases of the disease in American military personnel.
In some areas of southern Europe, leishmaniasis is becoming an important disease that infects people with weakened immune systems. In particular, individuals with acquired immunodeficiency
) are at great risk of this infection.
Causes and symptoms
There are a number of types of protozoa that can cause leishmaniasis. Each type exists in specific locations, and there are different patterns to the kind of disease each causes. The overall species name is Leishmania (commonly abbreviated L.). The specific types include: L. Donovani, L. Infantum, L. Chagasi, L. Mexicana, L. Amazonensis, L. Tropica, L. Major, L. Aethiopica, L. Brasiliensis, L. Guyaensis, L. Panamensis, L. Peruviana. Some of the names are reflective of the locale in which the specific protozoa is most commonly found, or in which it was first discovered.
Localized cutaneous leishmaniasis
This type of disease occurs most commonly in China, India, Asia Minor, Africa, the Mediterranean Basin, and Central America. It has occurred in an area ranging from northern Argentina all the way up to southern Texas. It is called different names in different locations, including chiclero ulcer, bush yaws
, uta, oriental sore, Aleppo boil, and Baghdad sore.
This is perhaps the least drastic type of disease caused by any of the Leishmania. Several weeks or months after being bitten by an infected sandfly, the host may notice an itchy bump (lesion) on an arm, leg, or face. Lymph nodes in the area of this bump may be swollen. Within several months, the bump develops a crater (ulceration) in the center, with a raised, reddened ridge around it. There may be several of these lesions near each other, and they may spread into each other to form one large lesion. Although localized cutaneous leishmaniasis usually heals on its own, it may take as long as one year. A depressed, light-colored scar usually remains behind. Some lesions never heal, and may invade and destroy the tissue below. For example, lesions on the ears may slowly, but surely, invade and destroy the cartilage that supports the outer ear.
Diffuse cutaneous leishmaniasis
This type of disease occurs most often in Ethiopia, Brazil, Dominican Republic, and Venezuela.
The lesions of diffuse cutaneous leishmaniasis are very similar to those of localized cutaneous leishmaniasis, except they are spread all over the body. The body's immune system apparently fails to battle the protozoa, which are free to spread throughout. The characteristic lesions resemble those of the dread biblical disease, leprosy
This form of leishmaniasis occurs primarily in the tropics of South America. The disease begins with the same sores noted in localized cutaneous leishmaniasis. Sometimes these primary lesions heal, other times they spread and become larger. Some years after the first lesion is noted (and sometimes several years after that lesion has totally healed), new lesions appear in the mouth and nose, and occasionally in the area between the genitalia and the anus (the perineum). These new lesions are particularly destructive and painful. They erode underlying tissue and cartilage, frequently eating through the septum (the cartilage that separates the two nostrils). If the lesions spread to the roof of the mouth and the larynx (the part of the wind pipe which contains the vocal cords), they may prevent speech. Other symptoms include fever
, weight loss, and anemia (low red blood cell count). There is always a large danger of bacteria infecting the already open sores.
This type of leishmaniasis occurs in India, China, the southern region of Russia, and throughout Africa, the Mediterranean, and South and Central America. It/is frequently called Kala-Azar or Dumdum fever.
In this disease, the protozoa use the bloodstream to travel to the liver, spleen, lymph nodes, and bone marrow. Fever may last for as long as eight weeks, disappear, and then reappear again. The lymph nodes, spleen, and liver are often quite enlarged. Weakness, fatigue
, loss of appetite, diarrhea
, and weight loss are common. Kala-azar translates to mean "black fever." The name kala-azar comes from a characteristic of this form of leishmaniasis. Individuals with light-colored skin take on a darker, grayish skin tone, particularly of their face and hands. A variety of lesions appear on the skin.
Diagnosis for each of these types of leishmaniasis involves taking a scraping from a lesion, preparing it in a laboratory, and examining it under a microscope to demonstrate the causative protozoan. Other methods that have been used include culturing a sample piece of tissue in a laboratory to allow the protozoa to multiply for easier microscopic identification; injecting a mouse or hamster with a solution made of scrapings from a patient's lesion to see if the animal develops a leishmaniasis-like disease; and demonstrating the presence in macrophages of the characteristic-appearing protozoan, called Leishman-Donovan bodies.
In some forms of leishmaniasis, a skin test (similar to that given for TB) may be used. In this test, a solution containing a small bit of the protozoan antigen (cell marker that causes the human immune system to react) is injected or scratched into a patient's skin. In a positive reaction, cells from the immune system will race to this spot, causing a characteristic skin lesion. Not all forms of leishmaniasis cause a positive skin test, however.
The treatment of choice for all forms of leishmaniasis is a type of drug containing the element antimony. These include sodium sitogluconate, and meglumin antimonate. When these types of drugs do not work, other medications with anti-protozoal activity are utilized, including amphotericin B, pentamidine, flagyl, and allopurinol. In 2004, it was reported that the world's first non-profit drug company was seeking approval in India for a drug to cure visceral leishmaniasis. An estimated 200,000 people die annually from the disease in that country. The company, called OneWorld Health, hoped to offer the drug called paromomycin for a day for a three-week treatment course.
The prognosis for leishmaniasis is quite variable, and depends on the specific strain of infecting protozoan, as well as the individual patient's immune system response to infection. Localized cutaneous leishmaniasis may require no treatment. Although it may take many months, these lesions usually heal themselves completely. Only rarely do these lesions fail to heal and become more destructive.
Disseminated cutaneous leishmaniasis may smolder on for years without treatment, ultimately causing death
when the large, open lesions become infected with bacteria.
Mucocutaneous leishmaniasis is often relatively resistant to treatment. Untreated visceral leishmaniasis has a 90% death rate, but only a 10% death rate with treatment.
Prevention involves protecting against sandfly bites. Insect repellents used around homes, on clothing, on skin, and on bednets (to protect people while sleeping) are effective measures.
Reducing the population of sandflies is also an important preventive measure. In areas where leishmaniasis is very common, recommendations include clearing the land of trees and brush for at least 984 ft (300 m) around all villages, and regularly spraying the area with insecticides. Because rodents often carry the protozoan that causes leishmaniasis, careful rodent control should be practiced. Dogs, which also carry the protozoan, can be given a simple blood test.
MacReady, Norma. "Leishmaniasis Hits Military Hot Spots." Internal Medicine News June 15, 2004: 58.
"Seeking First-time Approval." Chemist & Druggist May 8, 2004: 12.
"Treatment of Cutaneous Leishmaniasis Among Travelers Reviewed." Vaccine Weekly April 28, 2004: 58.
Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.
— The organism (such as a monkey or human) in which another organism (such as a virus or bacteria) is living.
— The part of the airway lying between the pharynx and the trachea.
— A body of a (trypanosomatid) protozoa at a particular and characteristic stage in its life cycle; the infectious (trypanosomatid) protozoa can cause leishmaniasis, and is relatively easy to identify at that stage.
— A disruption of the normal structure and function of a tissue by some disease process.
— A cell of the immune system that engulfs and digests foreign invaders such as bacteria and viruses in an attempt to stop them from causing disease within the body.
— A group of organisms which are the smallest members of the animal kingdom, consisting of a single cell.
— A carrier organism (such as a fly or mosquito) that to delivers a virus (or other agent of infection) to a host.
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cutaneous leishmaniasis an endemic disease transmitted by the sandfly and characterized by the development of cutaneous papules that evolve into nodules, break down to form ulcers, and heal with scarring. It has been divided into Old World and New World forms, and the Old World form is subdivided into urban and rural types. The Old World form is caused by organisms of the Leishmania tropica complex; the New World form is caused by organisms of the L. mexicana and L. viannia complexes. It is endemic in the tropics and subtropics, and has been called by various names such as Aleppo boil, Delhi sore, Baghdad sore, and Oriental sore. Treatment consists of injections of pentavalent antimonial compounds. Antibiotics are used to combat secondary infection. Simple lesions may be cleaned, curetted, and left to heal.
cutaneous leishmaniasis, diffuse a rare chronic form of cutaneous leishmaniasis caused by Leishmania aethiopica in Ethiopia and Kenya, L. pifanoi in Venezuela, and species of the L. viannia and L. mexicana subclass in South and Central America, respectively, in which the lesions resemble those of nodular leprosy or of keloid. Pentavalent antimonial compounds are useful in some forms, while others are antimony-resistant. The prognosis for a complete cure is not good; relapses are common.
mucocutaneous leishmaniasis a disease endemic in South and Central America caused by Leishmania viannia, marked by ulceration of the mucous membranes of the nose, mouth, and pharynx; widespread destruction of soft tissues in nasal and oral regions may occur. Called also espundia. Treatment consists of injections of pentavalent antimonial compounds.
leishmaniasis reci´divans a prolonged, relapsing form of cutaneous leishmaniasis resembling tuberculosis of the skin; it may last for many years.
a chronic, highly fatal if untreated, infectious disease endemic in the tropics and subtropics, caused by the protozoon Leishmania donovani.
Sandflies of the genus Phlebotomus
are the vectors. Called also kala-azar
Symptoms. Symptoms are usually vague, resembling those of incipient pulmonary tuberculosis; the disease is often confused with malaria. There may be fever, chills, malaise, cough, anorexia, anemia, and wasting. The Leishmania organisms multiply in the cells of the reticuloendothelial system, eventually causing hyperplasia of the cells, especially those of the liver and spleen. Diagnosis is confirmed by demonstration of the parasite.
Treatment. Two groups of compounds are recommended: pentavalent organic antimonials, such as sodium antimony gluconate, and aromatic diamidines, such as pentamidine, if the antimonials are ineffective. Rest is prescribed for patients debilitated by anemia. A decrease in white cell count (leukopenia) often accompanies the disease, and therefore the patient's resistance to secondary infections is lowered. In some cases transfusion may be necessary to bring blood values back to normal. The patient is given a well balanced diet and liberal amounts of fluids. Special mouth care and attention to the skin are necessary to avoid complications.
Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition. © 2003 by Saunders, an imprint of Elsevier, Inc. All rights reserved.