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Leishmaniasis

Introduction

Leishmaniasis is a parasitic infection transmitted by the bites of sandflies. Sandflies are tiny 2-3 mm flies that mainly bite outdoors in the evening/overnight. The disease is found in Central and South America, Southern Europe, Africa, the Middle East and Asia and is linked to poverty.

The Illness

Symptoms start weeks to months after an infected sandfly bite and progress slowly. There are 3 main forms of infection:

Cutaneous Leishmaniasis

A painless red spot develops at site of bite and gradually progresses over weeks to months to an ulcer.  More than one ulcer may be present, and they can heal without treatment, but often scar.

Mucocutaneous Leishmaniasis

Infection occurs in the lining of the nose, mouth, or throat and can lead to destruction of the nasal septum, palate, mouth or throat causing severe disfigurement and breathing problems.

Visceral Leishmaniasis ( also known as Kala-azar)

The infection spreads to the liver, spleen and bone marrow causing fever, loss of appetite, weight loss and abdominal pain. This form is often fatal if untreated.

Treatment

Leishmaniasis can be cured with treatment. Treatment is variable and can be complex. It is influenced by the type of infection, and ranges from allowing self healing to the use of tablets and intravenous drug regimes. Treatment is undertaken in an Infectious Disease/Tropical Medicine unit.

Recommendations for Travellers

There is no vaccine against human leishmaniasis.

Travellers to rural and/or forested/jungle areas of regions where the infection is present will be most at risk.

Travellers should be advised to avoid Sandfly bites by:

  • Avoiding outdoor activities after dusk where possible.
  • Covering skin with clothing where possible.
    • Consider permethrin impregnation of clothing when outdoor activity is unavoidable.
  • Using insect repellent e.g. DEET on exposed skin.
  • Sleeping under insecticide-impregnated bednets (fine mesh size is required) or in air-conditioned rooms.
  • Using fans/ventilators which disrupt the movement of sandflies and sleeping elevated from the floor; sandflies are weak fliers.

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