2
Key Points
Î The clinical manifestations of infection caused by protozoa of the
genus Leishmania are variable and reflect a complex interplay between
the human host's cell-mediated immune responses and the virulence
and tropism of the infecting Leishmania species.
Î Each leishmaniasis-endemic region has particular combinations of
parasite species/strains, sand fly species, mammalian reservoir hosts
(in zoonotic transmission cycles), and human hosts with different
genetic backgrounds.
Î Although Leishmania infection can be subclinical, the three main
clinical syndromes are cutaneous leishmaniasis (CL), mucosal
leishmaniasis (ML), and visceral leishmaniasis (VL). Less common
presentations include diffuse cutaneous leishmaniasis, disseminated
cutaneous leishmaniasis, leishmaniasis recidivans, bubonic
leishmaniasis, uveitis, and post kala-azar dermal leishmaniasis (PKDL).
Î VL, and less commonly CL or ML, may be opportunistic infections in
persons who are immunocompromised because of HIV/AIDS or other
reasons.
Î The only FDA-approved medications for leishmaniasis are intravenous
liposomal amphotericin B (L-AmB) for VL, and oral miltefosine for CL,
ML, and VL caused by particular species.
Î For prevention of leishmaniasis, no prophylactic medications or
vaccines are currently available.
Î Travelers should use personal protective measures (PPM) that
minimize vector exposure whenever they are in leishmaniasis-endemic
areas. These measures include protective clothing, insect repellents
such as DEET applied to exposed skin, permethrin applied to clothing,
window coverings, and insecticide-impregnated bed nets.
Î Persons with a history of leishmaniasis (particularly, but not only, VL)
should refrain from donating blood.
Figure 1. Sand Flies that Transmit the Leishmania Parasites
Image courtesy of CDC. Available at: http://www.cdc.gov/parasites/leishmaniasis/
