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Medical Author:

Mary D. Nettleman, MD, MS, MACP

Mary D. Nettleman, MD, MS, MACP

Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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In this Article

• Leishmaniasis facts
• What is leishmaniasis?
• What are the different types of leishmaniasis?
• What causes leishmaniasis? How is leishmaniasis transmitted?
• What are risk factors for leishmaniasis?
• What are leishmaniasis symptoms and signs?
• How is leishmaniasis diagnosed?
• What is the treatment for leishmaniasis?
• What is the prognosis of leishmaniasis?
• Can leishmaniasis be prevented?
• Where can people get more information about leishmaniasis?
• Leishmaniasis Index

Visceral leishmaniasis (VL) may be mild or severe. Some patients are asymptomatic and do not realize that they carry the parasite. Symptoms appear in weeks to months after the bite of the sand fly. Less commonly, symptoms arise only years later when a person's immune system becomes suppressed. The five classic symptoms of more severe disease are

1. weight loss, which may be severe,
2. low blood counts (pancytopenia),
3. enlargement of the liver and spleen (hepatosplenomegaly),
4. fever, which is usually intermittent,
5. high levels of immune globulin in the blood (hypergammaglobulinemia).

The skin may turn dark, causing VL to be called "kala-zar," which means "black sickness." Some people who recover will have a persistent rash or pigment changes in the skin. The kidney is also affected, which may lead to renal failure. Other organs, including the bowel and the lung, may be affected.

Cutaneous leishmaniasis (CL) is known by a host of other names, including Oriental sore. The site of the sand fly bite usually forms a raised papule that expands and ulcerates, with a heaped up border on the edges. The disease becomes manifest over several weeks. There may be only one lesion, or multiple lesions may appear over time. The skin lesions take on a variety of appearances and may resemble acne, warts, or psoriasis. They may look like large scaly, ulcerated plaques, or form shallow ulcerated nodules. The lesions may be dry or weeping and are not usually painful unless they are secondarily infected by bacteria. Sores occur predominately on the extremities and face. They heal over months to years, leaving scars that often resemble old burns. In severe cases, known as diffuse cutaneous leishmaniasis, nodular lesions may occur widely and last for years or even for life.

Figure 3: Picture of a crater lesion of leishmaniasis, skin. SOURCE: CDC

Figure 4: Picture of a skin ulcer due to leishmaniasis, hand of Central-American adult. SOURCE: CDC/Dr. D.S. Martin

Mucocutaneous leishmaniasis (ML) involves the nose, mouth, and larynx. It is less common than VL and CL. Initially, the patient experiences a nodule at the site of the sand fly bite with symptoms consistent with CL. Subsequently, mucocutaneous involvement leads to nodules inside the nose, perforation of the nasal septum, and enlargement of the nose or lips. If the larynx is involved, the voice changes as well. Ulcerated lesions may lead to scarring and tissue destruction that can be disfiguring. The disease occurs predominately in Bolivia, Brazil, and Peru.