Leishmaniasis : Causes, Symptoms, Treatment and Cost

Leishmaniasis is a parasitic disease caused by the Leishmania parasite. It is transmitted through the bites of infected sandflies, which are most commonly found in the tropics and subtropics. The illness can manifest in a variety of ways, from moderate to severe and even life-threatening.

The symptoms of leishmaniasis depend on the type of infection and the individual's immune response. While some people may not exhibit any symptoms, others may endure fever, skin sores, and enlarged spleen and liver. In some cases, the infection can spread to the bone marrow, causing a severe and potentially fatal form of the disease.

There are three main types of leishmaniasis: cutaneous leishmaniasis, visceral leishmaniasis, and mucocutaneous leishmaniasis. Cutaneous leishmaniasis affects the skin, while visceral leishmaniasis affects the internal organs. Mucocutaneous leishmaniasis affects the mucous membranes of the nose, mouth, and throat.

The disease's most widespread form of leishmaniasis is cutaneous leishmaniasis. It usually causes skin lesions, which can range from small, painless bumps to larger ulcers. The lesions may appear weeks or months after the sandfly bite, and can take months to heal. Cutaneous leishmaniasis can cause scarring, and in some cases, can affect the mucous membranes of the nose and mouth.

Visceral leishmaniasis, also known as kala-azar, affects the internal organs, such as the spleen, liver, and bone marrow. It can cause fever, weight loss, and enlargement of the spleen and liver. Visceral leishmaniasis can be fatal if left untreated.

Mucocutaneous leishmaniasis can occur in combination with cutaneous leishmaniasis, or on its own. It impacts the nose, mouth, and throat mucous membranes and can lead to deformity, difficulty breathing, or difficulty swallowing. Treatment for mucocutaneous leishmaniasis can be challenging and may need both medicine and surgery.

Note:- There are also other less common types of leishmaniasis, such as post-kala-azar dermal leishmaniasis (PKDL), which is a complication of visceral leishmaniasis. PKDL causes skin lesions, which can appear months or years after the initial infection.

Leishmaniasis is transmitted through the bites of infected female sandflies, which typically feed on the blood of mammals, including humans. When an infected sandfly bites a person, it injects the Leishmania parasite into the skin, where it can invade the immune system cells and spread to other parts of the body.

Here are some key points about the transmission of leishmaniasis;

• Sandflies become infected with the Leishmania parasite when they feed on the blood of infected animals, such as rodents, dogs, or foxes
• With their bites, parasite-carrying sand flies can spread the disease to people and other animals
• Sandflies are most active during the warmer months, and are typically found in rural and peri-urban areas, although they can also be found in cities
• The risk of leishmaniasis is higher in areas with poor sanitation and housing conditions, as well as in areas where conflict or displacement has disrupted public health and control programs
• Leishmaniasis can also spread through blood transfusions, organ transplants, and mother-to-child transmission during pregnancy and childbirth, albeit these are uncommon methods of transmission
• Severe types of leishmaniasis are more likely to affect people with compromised immune systems, such as those with HIV/AIDS or on immunosuppressive medicine.

Leishmaniasis and kala-azar are related but not exactly the same. Visceral leishmaniasis, often known as kala-azar, is a severe kind of leishmaniasis that mostly affects the spleen, liver, and bone marrow.

The term 'leishmaniasis' refers to a collection of parasitic illnesses that can affect the skin, mucous membranes, and internal organs. These illnesses are brought on by several species of the parasite Leishmania. There are several types of leishmaniasis, including cutaneous leishmaniasis, mucocutaneous leishmaniasis, and visceral leishmaniasis (kala-azar).

Therefore, kala-azar is a specific type of leishmaniasis that affects the internal organs and is typically associated with fever, weight loss, and enlargement of the spleen and liver. It is usually more severe than cutaneous leishmaniasis, which primarily affects the skin, and mucocutaneous leishmaniasis, which affects the mucous membranes of the nose, mouth, and throat.

Leishmaniasis can cause a range of symptoms, depending on the type of disease and the affected organs. Skin rashes, fever, exhaustion, weight loss, spleen and liver enlargement are a few possible symptoms. In some cases, leishmaniasis can be asymptomatic.

Here are some common symptoms of leishmaniasis;

Cutaneous leishmaniasis

• Skin lesions, which may be small bumps, nodules, or ulcers
• Lesions may appear weeks or months after the sandfly bite
• Lesions may be painless or painful and may take months to heal
• Lesions may leave scars or cause disfigurement

Visceral leishmaniasis (kala-azar)

• Prolonged fever, which may be intermittent or continuous
• Fatigue, weakness, and anemia
• Enlargement of the spleen and liver
• Weight loss and loss of appetite
• Swelling of the lymph nodes
• In severe cases, complications such as bleeding disorders, respiratory distress, or secondary infections may occur

Mucocutaneous leishmaniasis

• Lesions on the mucous membranes of the nose, mouth, and throat
• Nasal congestion and discharge, nosebleeds
• Difficulty breathing or swallowing
• Hoarseness or voice changes
• Lesions may be disfiguring and may affect the sense of smell or taste

Post-kala-azar dermal leishmaniasis (PKDL)

• Skin lesions, which may appear months or years after the initial infection
• Lesions may be macular, papular, or nodular
• Lesions may be widespread and may affect the face, limbs, or trunk

The risk of leishmaniasis is higher in areas where the parasite and its vector, infected sandflies, are present. Factors that can increase the risk of infection include poor sanitation and housing conditions, poverty, malnutrition, displacement due to conflict or natural disasters, and weakened immune systems.

Here are some key risk factors for leishmaniasis;

• Geographic location: Leishmaniasis is most common in tropical and subtropical regions of the world, including South America, the Middle East, Africa, and parts of Asia and Europe
• Environmental factors: The risk of leishmaniasis is higher in rural and peri-urban areas, particularly where there are large populations of rodents or other reservoir hosts for the parasite. Moreover, sandflies are more active in the summer and in places with high humidity
• Socioeconomic factors: Poverty, malnutrition, and lack of access to safe water and sanitation can increase the risk of leishmaniasis, as can displacement due to conflict or natural disasters
• Immune status: People with weakened immune systems, such as those with HIV/AIDS or receiving immunosuppressive therapy, are at higher risk of developing severe forms of leishmaniasis
• Occupation: People who work or live in rural areas, such as farmers, herders, and military personnel, may be at higher risk of leishmaniasis due to their increased exposure to sandflies
• Travel: Travelers to endemic areas may be at risk of leishmaniasis, particularly if they engage in outdoor activities or have prolonged exposure to sandflies
• Age: Children and the elderly may be at higher risk of severe forms of leishmaniasis, as their immune systems may be less able to fight off the parasite.
• Genetics: Some genetic factors may increase the risk of leishmaniasis or affect the severity of the disease. For example, certain human leukocyte antigen (HLA) alleles have been associated with increased susceptibility to visceral leishmaniasis
• Animal exposure: People who have close contact with infected animals, such as dogs or rodents, may be at higher risk of leishmaniasis, particularly if the animals are carrying the parasite in their blood
• Coinfection: People who are infected with other diseases, such as tuberculosis or malaria, may be at higher risk of developing severe forms of leishmaniasis or experiencing treatment complications
• Gender: In some areas, males may be at higher risk of leishmaniasis, possibly due to differences in behavior or occupational exposure
• Personal protective measures: People who do not take measures to prevent sandfly bites, such as wearing protective clothing and using insect repellent, may be at higher risk of leishmaniasis.

Preventing leishmaniasis involves reducing the risk of exposure to sandflies and avoiding contact with infected animals or people. Personal protective measures and environmental controls can help prevent the spread of the disease.

Here are some key ways to prevent leishmaniasis;

• Personal protective measures: Wearing long-sleeved clothing, using insect repellent, and sleeping under bed nets can help reduce the risk of sandfly bites
• Environmental controls: Clearing vegetation around homes, using screens on doors and windows, and spraying insecticides in homes and surrounding areas can help reduce the number of sandflies
• Avoiding infected animals: Avoiding contact with infected animals, particularly dogs, can help reduce the risk of leishmaniasis. Vaccination of dogs is also available in some countries
• Safe burial practices: Proper burial and management of human and animal remains can help prevent the spread of leishmaniasis in endemic areas
• Health education: Educating communities about the risks of leishmaniasis and ways to prevent transmission can help reduce the spread of the disease
• Early diagnosis and treatment: Prompt diagnosis and treatment of leishmaniasis can help prevent severe disease and reduce the risk of transmission to others.

Clinical examination, laboratory tests, and imaging studies are frequently used to diagnose leishmaniasis. Samples of blood, tissue, or bone marrow may be collected and tested for the presence of the parasite or antibodies to the parasite.Here are some common tests and methods used to diagnose leishmaniasis;

Clinical examination
A healthcare provider may examine the skin, mucous membranes, and lymph nodes for signs of leishmaniasis, such as ulcers, nodules, or swelling.

Laboratory tests
Samples of blood, tissue, or bone marrow may be collected and tested for the presence of the parasite or antibodies to the parasite. These tests may include direct visualization of the parasite under a microscope, culture of the parasite, or molecular tests such as polymerase chain reaction (PCR).

Serological tests
Blood tests can detect antibodies to the parasite, which can be useful for diagnosing past or asymptomatic infections. However, these tests may not always be reliable for diagnosing active infection or differentiating between different types of leishmaniasis.

Imaging studies
Imaging tests such as ultrasound or X-ray may be used to evaluate the internal organs for signs of leishmaniasis,particularly in cases of visceral or mucocutaneous disease.

Histopathology
To check for granulomas, the parasite, or indications of inflammation, tissue samples can be examined under a microscope. This method is particularly useful for diagnosing mucocutaneous leishmaniasis.

Depending on the type and degree of the illness, leishmaniasis can result in a variety of consequences. These may include secondary infections, organ damage, or long-term disability.

Here are some possible complications of leishmaniasis;

• Secondary infections: Open sores and ulcers caused by cutaneous or mucocutaneous leishmaniasis can become infected with bacteria, leading to additional health problems
• Scarring: Healing of skin lesions caused by leishmaniasis can result in scarring or disfigurement, particularly in cases of mucocutaneous leishmaniasis
• Organ damage: Visceral leishmaniasis can cause damage to internal organs such as the liver, spleen, and bone marrow, leading to anemia, bleeding, and other health problems
• Immune dysfunction: Chronic or recurrent leishmaniasis may lead to dysfunction of the immune system, making individuals more susceptible to other infections or health problems
• Post-kala-azar dermal leishmaniasis: This is a complication that can occur in people who have been successfully treated for visceral leishmaniasis, where skin lesions develop months to years later
• Social stigma: In some areas, leishmaniasis may be associated with social stigma or discrimination due to the disfiguring nature of the disease
• Economic burden: Leishmaniasis can be extremely expensive, especially in developing nations where the disease is endemic. The costs of diagnosis, treatment, and prevention may be prohibitive for affected individuals and communities
• Psychological impact: The disfiguring nature of mucocutaneous leishmaniasis and the stigma associated with the disease can have a significant psychological impact on affected individuals, leading to depression, anxiety, and social isolation
• Relapse: In some cases, leishmaniasis may relapse after treatment, particularly in immunocompromised individuals or those with a weakened immune system
• Drug resistance: There have been reports of drug-resistant strains of leishmaniasis, particularly in areas where the disease is endemic and treatment is frequently used. This can make treatment more difficult and costly.

Preventing leishmaniasis involves avoiding contact with sandflies, reducing exposure to infected animals, and taking appropriate measures to control sandfly populations. Here are some preventive measures that can help reduce the risk of leishmaniasis;

• Use insect repellent: Apply insect repellent to exposed skin to prevent sandflies from biting. The most efficient products are those that contain picaridin or DEET
• Wear protective clothing: Wear long sleeves and long pants to stay covered, especially when there are a lot of sandflies about (dusk to dawn)
• Use bed nets: Sleep under a bed net treated with insecticide to prevent sandflies from entering
• Control sandfly populations: Use insecticides to control sandfly populations in and around homes, particularly in areas where the disease is endemic
• Vaccination: Although there is currently no vaccine available for leishmaniasis, research is ongoing in this area
• Avoid contact with infected animals: Do not touch or handle animals that may be infected with leishmaniasis, such as dogs in endemic areas
• Seek early treatment: If you experience leishmaniasis symptoms, especially if you have recently been to a region where the disease is endemic, get medical help right away. Early detection and treatment can lessen the progress of the disease and help minimize consequences
• Education and awareness: Educate yourself and others about leishmaniasis and how to prevent it, particularly if you live or travel to areas where the disease is endemic
• Screening blood donors: In areas where leishmaniasis is endemic, blood donors should be screened for the disease to prevent transmission through blood transfusions
• Avoid sharing needles: People who inject drugs should avoid sharing needles or other injection equipment to prevent the spread of leishmaniasis and other blood-borne diseases
• Control stray dog populations: Visceral leishmaniasis is commonly transmitted through infected dogs. Controlling stray dog populations through vaccination, sterilization, or euthanasia can help prevent the spread of the disease
• Environmental modifications: Modifying the environment to reduce the number of sandflies can also help prevent the spread of leishmaniasis. This may include removing organic matter and standing water, or using screens on windows and doors to prevent sandflies from entering homes.

It is important to seek medical treatment for leishmaniasis. However, some home remedies may help manage symptoms and promote healing. Here are some home remedies for leishmaniasis;

• Aloe vera: Aloe vera gel may help soothe skin lesions and promote healing
• Honey: Applying honey to skin lesions may have antibacterial and anti-inflammatory effects
• Tea tree oil: Diluted tea tree oil may help reduce inflammation and promote wound healing
• Turmeric: Turmeric has anti-inflammatory and antioxidant properties. Applying a paste made from turmeric and water to skin lesions may help reduce inflammation and promote healing
• Coconut oil: Applying coconut oil to skin lesions may help soothe and moisturize the skin
• Neem: Neem leaves have antimicrobial properties. Applying a paste made from neem leaves to skin lesions may help fight infection and promote healing.

A balanced and healthy diet can help support the immune system and aid in recovery from leishmaniasis. Here are some foods that may be beneficial for the patients of leishmaniasis;

• Lean meats
• Fish
• Beans
• Lentils
• Tofu
• Dark-leafy greens
• Berries
• Citrus fruits
• Bell peppers
• Oats
• Quinoa
• Brown rice
• Whole wheat bread

Certain foods and drinks may exacerbate symptoms of leishmaniasis and should be avoided. These include;

• Alcohol
• Sugary and processed foods
• Fatty and fried foods
• Spicy foods
• Caffeine

Leishmaniasis can be treated with medications and other medical interventions. The specific treatment approach will depend on the type and severity of the disease, as well as the individual's overall health.

Here are some common treatments for leishmaniasis;

Medications
Antiparasitic drugs are the primary treatment for leishmaniasis. The specific medication and treatment regimen will depend on the type and severity of the disease, as well as the individual's overall health.

Wound care
Proper wound care is important for preventing infection and promoting healing. This may include cleaning the affected area, applying topical treatments, and covering the wound to prevent further damage.

Surgery
Surgery might be required in extreme situations to drain abscesses or remove affected tissue.

Immunotherapy
Immunotherapy involves stimulating the immune system to fight the infection. Vaccines or prescription drugs may be used in this situation.

Blood transfusions
In rare cases, a blood transfusion may be necessary to replace damaged or infected blood cells.

It is advised to seek medical advice as soon as you can if you think you may have leishmaniasis. Depending on the severity and type of the disease, you may be referred to a specialist for further evaluation and treatment. Here are some healthcare professionals who may be involved in the diagnosis and treatment of leishmaniasis;

• Primary care physician: Your primary care physician is often the first healthcare professional you will see if you have symptoms of leishmaniasis. If additional testing and treatment are required, they might recommend you to a specialist.
• Infectious disease specialist: An infectious disease specialist is a doctor who specializes in the diagnosis and treatment of infections caused by viruses, bacteria, parasites, and other microorganisms. In severe or complex instances, they may be involved in the diagnosis and treatment of leishmaniasis.
• Dermatologist: A dermatologist is a medical professional who focuses on the identification and management of skin problems. They could be implicated in the detection and management of cutaneous leishmaniasis, which primarily affects the skin.
• Tropical medicine specialist: A tropical medicine specialist is a doctor who specializes in the diagnosis and treatment of diseases that occur primarily in tropical and subtropical regions. Particularly in regions where the disease is endemic, they may be involved in the diagnosis and treatment of leishmaniasis.

The choice of medication for leishmaniasis will depend on the type and severity of the disease, as well as the individual's overall health.

Here are a few typical drugs for leishmaniasis treatment;

Pentavalent antimonials
These medications are often used to treat visceral leishmaniasis and cutaneous leishmaniasis. Examples include;

• Sodium stibogluconate (Pentostam)
• Meglumine antimoniate (Glucantime)
• Amphotericin B

This medication is often used to treat severe or complicated cases of leishmaniasis. It is frequently administered intravenously (IV) and may be used with additional drugs. Examples include;

• Liposomal amphotericin B (Ambisome)
• Amphotericin B deoxycholate
• Miltefosine

This medication is often used to treat visceral leishmaniasis and cutaneous leishmaniasis. It is taken orally and may be used as a first-line treatment in some cases.

Paromomycin
This medication is often used to treat visceral leishmaniasis. It is frequently administered intravenously (IV) and may be used with additional drugs.

Liposomal amphotericin B

This medication is often used to treat visceral leishmaniasis. Amphotericin B is now available in a more recent version that is less toxic and produces fewer adverse effects.

It is important to note that the choice of medication and treatment regimen will depend on the specific circumstances of the individual case.

Leishmaniasis recovery times might vary based on the type and severity of the infection as well as the patient's general health. In some instances, symptoms could get better a few weeks into treatment. However, in more severe cases, it may take several months for symptoms to improve, and some individuals may experience long-term complications even after treatment.

The type and intensity of the infection, as well as the patient's general condition, can affect the outcomes of leishmaniasis treatment. In some cases, treatment may be successful in completely clearing the infection, and the individual may have no further issues with leishmaniasis. However, in other cases, the infection may recur, or the individual may experience long-term complications related to the infection.

The price of leishmaniasis treatments in India can vary depending on a number of factors, such as the specific treatment used, the severity of the infection, and the individual's overall health. In general, treatment for leishmaniasis can involve a combination of medications and other therapies, which can make the overall cost of care relatively expensive.

Factors that can impact the price of leishmaniasis treatment in India may include the cost of medications, laboratory tests, hospitalization (if required), and follow-up care. In some circumstances, people would also need to travel to get specialized care, which can add to costs.

However, it is important to note that the Indian government has implemented various programs and initiatives aimed at increasing access to affordable healthcare for all, including those with leishmaniasis. Additionally, there may be options for financial assistance or support available to help individuals cover the costs of treatment. It is important to discuss options with a healthcare professional and to explore all available resources in order to access the care needed.

Treatment for leishmaniasis can have side effects, and the type and severity of side effects can vary depending on the specific treatment used, as well as the individual's overall health. Some common side effects of leishmaniasis treatment may include;

• Nausea and vomiting
• Diarrhea
• Abdominal pain
• Headaches
• Dizziness
• Muscle or joint pain
• Skin rash or irritation
• Changes in blood pressure or heart rate

In more severe cases, treatment may also be associated with more serious side effects, such as liver or kidney damage, or neurological symptoms.

The outlook for leishmaniasis can vary depending on the type and severity of the infection, as well as the individual's overall health and response to treatment. In general, early diagnosis and prompt treatment are key to improving outcomes for individuals with leishmaniasis. However, even with treatment, some individuals may experience long-term complications related to the infection, such as scarring or chronic inflammation.

In more severe cases, leishmaniasis can be life-threatening, particularly if it affects vital organs such as the heart, liver, or spleen. Nonetheless, most people with leishmaniasis are able to fully recover and return to their regular activities with the help of competent medical care. It is important to work closely with a healthcare professional to develop an appropriate treatment plan and to receive regular follow-up care in order to ensure the best possible outcomes.