The leishmaniases are a group of diseases caused by leishmania protozoa and is transmitted to human beings by the bite of sand fly. They are associated with malnutrition, population misplacement, poor housing, a weak immune system and lack of resources for their control and treatment.
As one of the most neglected tropical diseases that cause a variety of clinical manifestations in humans, the evolution of the leishmaniases is intrinsically associated with human activity.
In PAKISTAN, the mostly people affected are the inhabitants of the province balochistan and those living in the areas nearby.
The disease has three main forms:
- visceral leishmaniasis, also known as kala-azar, the most serious form, is fatal in more than 95% of cases if left untreated and is characterized by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia;
- cutaneous leishmaniasis, the most common form, causes skin lesions, mainly ulcers, on exposed parts of the body, leading to permanent scarring and serious disability.
- mucocutaneous leishmaniasis, which causes devastating partial or total destruction of the mucous membranes of the nose, mouth and throat.
To understand the disease, it is important to learn about the history of how it evolved. Much of modern scientific literature deals with the control, prevention and treatment of the various forms of this complex disease.
A peek into its history can provide inspiring moments.
What are the symptoms of leishmaniasis?
People can carry some species of Leishmania for long periods without becoming ill. Symptoms depend on the form of the disease.
Cutaneous leishmaniasis
The main symptom of this condition is painless skin ulcers. Cutaneous symptoms may appear a few weeks after being bitten by an infected sand fly. However, sometimes symptoms won’t appear for months or years.
Mucocutaneous leishmaniasis
In people with the mucocutaneous form of the disease, symptoms usually appear one to five years after the skin lesions. These are primarily ulcers in their mouth and nose or on their lips.
Other symptoms may include:
- runny or stuffy nose
- nosebleeds
- difficulty breathing
Visceral leishmaniasis:
symptoms often don’t appear for months after the bite with this type of leishmaniasis. Most cases are apparent two to six months after the infection occurred. Common signs and symptoms include
- weight loss
- weakness
- fever that lasts for weeks or months
- enlarged spleen
- enlarged liver
- decreased production of blood cells
- bleeding
- other infections
- swollen lymph nodes
What are the treatments for leishmaniasis?
Cutaneous leishmaniasis
Cutaneous ulcers will often heal without treatment. However, treatment can speed healing, reduce scarring, and decrease risk of further disease. Any skin ulcers that cause disfigurement may require plastic surgery.
Mucocutaneous leishmaniasis
These lesions don’t heal naturally. They always require treatment. Liposomal amphotericin B and paromomycin can treat mucocutaneous leishmaniasis.
Visceral leishmaniasis
Visceral disease always requires treatment. Several medications are available. Commonly used medicines include sodium stibogluconate (Pentostam), amphotericin B, paromomycin, and miltefosine (Impavido).
What are the potential complications of leishmaniasis?
Cutaneous leishmaniasis complications may include:
- bleeding
- other infections due to a weakened immune system, which can be life-threatening
- disfiguremet Visceral leishmaniasis is often fatal due to the effects it has on both internal organs and your immune system. If you have HIV or AIDS, you’re at higher risk of getting this disease. Having HIV or AIDS can also complicate the course of leishmaniasis, as well as the treatment.
How can I prevent leishmaniasis?
There’s no vaccine or prophylactic medication available. The only way to prevent leishmaniasis is to avoid getting bitten by a sand fly.
Follow these steps to help prevent being bitten by a sand fly:
- Wear clothing that covers as much skin as possible. Long pants, long-sleeved shirts tucked into pants, and high socks are recommended.
- Use insect repellent on any exposed skin and on the ends of your pants and sleeves. The most effective insect repellants contain DEET.
- Spray indoor sleeping areas with insecticide.
- Sleep on the higher floors of a building. The insects are poor fliers.
- Avoid the outdoors between dusk and dawn. This is when sand flies are most active.
- Use screens and air conditioning indoors when possible. Using fans might make it more difficult for the insects to fly.
- Use a bed net tucked into your mattress. Sand flies are much smaller than mosquitos, so you need a tightly woven net.
- Spray the net with insecticide containing pyrethroid if possible.
- Buy bed nets, insecticides, and repellents before traveling to high-risk areas.
What is the long-term outlook?
Sores can result in permanent scars and disfigurement. Treatment may reduce their severity.
Medication can cure the disease. However, treatment is most effective when started before extensive damage to your immune system occurs.
Mortality:
Visceral leishmaniasis is often fatal within two years if it’s not treated properly.
