What is Leishmaniasis?
Leishmaniasis is a disease caused by a tiny parasite called Leishmania, which is spread to people through the bite of an infected sandfly. According to the World Health Organization, Leishmaniasis is found in more than 99 countries and affects an estimated 12 million people worldwide.
There are a few different forms of the disease. The most common is cutaneous leishmaniasis, which causes sores on the skin. A more serious form called mucosal leishmaniasis can affect the nose and mouth. The most severe form, visceral leishmaniasis, affects internal organs such as the spleen, liver, and bone marrow, causing fever, serious illness, and anaemia, and can be fatal without treatment.
The sandflies that spread leishmaniasis are small and silent, and their bites often go unnoticed. They are most active from dusk to dawn. Australians do contract leishmaniasis overseas and return home with it each year, and because the disease is so uncommon here, it can be difficult for doctors to recognise and diagnose.
FAQs
Where does leishmaniasis occur?
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In the Americas, leishmaniasis is found in North, Central and South America, from Texas to northern Argentina. It's also found in Southern Europe ans parts of Asia, the Middle East and Africa.
I'm just going on a beach holiday, do I really need to worry about leishmaniasis?
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For most short-term Australian travellers visiting popular tourist areas, the risk is low. However, even short-term travellers in leishmaniasis-endemic areas have developed the disease, particularly those spending time outdoors in rural or forested areas at night. If your destination is endemic, simple preventive measures are always worthwhile regardless of the nature of your trip, especially around dusk, dawn and through the night.
Could I have leishmaniasis and not know it?
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Yes. Skin lesions from cutaneous leishmaniasis usually develop within several weeks or months after exposure, but occasionally first appear years later. For example, following trauma or a period of immunosuppression. Because leishmaniasis is uncommon in Australia, it may not be the first condition a GP considers. Always inform your doctor of your full travel history if you develop any unexplained or slow-healing skin sores after returning from an endemic region.
Is there a vaccine or preventive medication I can take?
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No vaccines or chemoprophylaxis are currently available for leishmaniasis. Protection relies entirely on avoiding sandfly bites through personal protective measures. A travel doctor can advise on the level of risk specific to your destination and activities, and ensure you know what to look for should symptoms develop after your return
Can leishmaniasis be cured?
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Most people who are treated fully recover. However, current medications do not cure the disease in all cases, leaving some people vulnerable to relapse, and the immune system plays an important role in clearing the parasite. Treatment varies depending on the form of leishmaniasis, the species involved, and where the infection was acquired, so specialist input from an infectious disease physician is important.
What to Know
Leishmaniasis symptoms
The symptoms of leishmaniasis depend on which form of the disease you have.
Cutaneous leishmaniasis is the most common form. It causes a small painless bump on the skin that slowly grows into an open ulcer with raised edges. These sores can take a long time to heal and often leave permanent scars. They can appear anywhere on the body and are not always painful, so people sometimes delay seeking help.
Mucosal leishmaniasis affects the lining of the nose and mouth. The nose is usually affected first, causing persistent stuffiness, bleeding, and sores inside the nostrils, with the mouth and throat sometimes involved in more advanced cases. This form is particularly easy to miss because it can appear years after the original skin sore has seemed to heal.
Visceral leishmaniasis is the most severe form, affecting internal organs such as the spleen, liver, and bone marrow. Symptoms include persistent fever, significant weight loss, and a swollen spleen and liver, along with abnormal blood test results. This form can be life-threatening without prompt treatment. Anyone returning from an affected region with unexplained fever and weight loss should see a doctor and mention their travel history.
Leishmaniasis diagnosis and treatment
If your doctor suspects leishmaniasis, they will ask about your travel history in detail. Diagnosis of leishmaniasis is usually confirmed by taking a small sample of tissue (from the skin in the case of cutaneous disease or affected organs in visceral leishmaniasis), which is examined under a microscope. PCR testing and culture can also be used to identify the specific type of parasite.
Some cases of cutaneous leishmaniasis will heal without treatment. For others oral or intravenous medications may be required. Treatment for visceral leishmaniasis usually requires intravenous therapy. Because this condition is rare for Australians, it's important to let any doctor you see know that you have travelled to an area where leishmaniasis is found.
Leishmaniasis prevention
There are no vaccines or drugs to prevent leishmaniasis, making personal protection against sandfly bites the only available preventive strategy. Travellers at greatest risk include adventure tourists, humanitarian aid workers, long-term travellers, and expatriates, though any traveller spending time outdoors in endemic areas, particularly at night, should take precautions.
Apply insect repellent containing DEET, or picaridin to exposed skin, stay in well-screened or air-conditioned accommodation where possible, spray living and sleeping areas with insecticide, and use a finely woven bed net treated with permethrin. Wearing long-sleeved clothing, long trousers, and closed footwear from dusk onwards provides an additional layer of protection. Avoid sitting or sleeping directly on the ground in endemic areas.
A travel doctor can provide personalised advice on insect avoidance based on your specific destination and planned activities.