What is Leishmaniasis?
Leishmaniasis is a parasitic disease caused by protozoan parasites of the Leishmania species, transmitted through the bite of infected female sandflies. This complex infectious disease manifests in several forms, ranging from skin ulcers in cutaneous leishmaniasis to life-threatening systemic illness in visceral leishmaniasis (also known as kala-azar). While endemic in tropical and subtropical regions across 98 countries, leishmaniasis affects approximately 12 million people worldwide, with nearly one billion people living in areas at risk of transmission. The disease disproportionately impacts impoverished communities with limited access to healthcare, making it both a medical and socioeconomic challenge.
Key statistics
| Global prevalence: | 12 million people infected |
| Annual incidence: | 700,000-1 million new cases |
| Mortality: | 20,000-30,000 deaths annually |
| Case fatality rate: | 10% (visceral form, untreated) |
| Endemic countries: | 98 countries worldwide |
Symptoms
Cutaneous leishmaniasis: Skin ulcers, nodules, papules, scarring
Visceral leishmaniasis: Fever, weight loss, hepatosplenomegaly, pancytopenia, anemia, weakness
Mucocutaneous leishmaniasis: Nasal congestion, nosebleeds, facial disfigurement
The clinical presentation varies significantly depending on the Leishmania species and the patient’s immune response. Cutaneous leishmaniasis, the most common form, typically begins as a small, painless bump at the site of the sandfly bite. Over weeks to months, this develops into an open sore with raised edges and a crater-like appearance. These ulcers may be single or multiple and can persist for months before healing, often leaving permanent scars.
Visceral leishmaniasis presents as a systemic illness with prolonged fever, substantial weight loss, and enlargement of the spleen and liver. Patients develop severe anemia, low white blood cell counts, and reduced platelets, making them vulnerable to secondary infections and bleeding. Without treatment, this form is almost always fatal.
Mucocutaneous leishmaniasis affects the mucous membranes of the nose, mouth, and throat, causing progressive destruction of these tissues. This form can develop months or years after an initial cutaneous infection and may lead to severe facial disfigurement if left untreated.
Causes and risk factors
Leishmaniasis is caused by over 20 species of Leishmania parasites transmitted through the bite of infected female phlebotomine sandflies. The parasites exist as flagellated promastigotes in the sandfly vector and transform into non-flagellated amastigotes within human macrophages.
Major risk factors include living in or traveling to endemic areas, particularly rural and semi-urban regions with poor sanitation. Poverty, malnutrition, and immunosuppression significantly increase susceptibility to infection and severe disease. Environmental factors such as deforestation, urbanization, and climate change are expanding the geographic range of sandfly vectors. Occupational exposure affects agricultural workers, military personnel, and researchers working in endemic areas. HIV co-infection dramatically increases the risk of developing visceral leishmaniasis and treatment failure.
Prevention
Prevention focuses primarily on vector control and personal protective measures, as no licensed vaccine currently exists for human use. Effective strategies include using insecticide-treated bed nets, applying insect repellents containing DEET, and wearing protective clothing during peak sandfly activity (dusk to dawn). Environmental management involves eliminating sandfly breeding sites by improving sanitation, removing organic waste, and addressing moisture accumulation around homes.
Community-based interventions include indoor residual spraying with insecticides and early detection and treatment of cases to reduce transmission. For travelers to endemic areas, consultation with travel medicine specialists is essential for risk assessment and preventive counseling. Research into vaccine development continues, with several candidates in various stages of clinical testing.
Complications
Untreated visceral leishmaniasis has a case fatality rate approaching 100% within two years. Even with treatment, complications may include secondary bacterial infections due to immunosuppression, severe bleeding from low platelet counts, and liver dysfunction. Post-kala-azar dermal leishmaniasis can develop months to years after successful treatment of visceral disease, presenting as depigmented patches or nodular lesions that serve as reservoirs for continued transmission.
Cutaneous leishmaniasis complications include secondary bacterial infections, permanent scarring, and psychological distress from disfigurement. The mucocutaneous form can cause extensive tissue destruction, leading to breathing difficulties, eating problems, and severe facial deformity requiring reconstructive surgery.
Diagnosis
Diagnosis requires a combination of clinical assessment, epidemiological history, and laboratory confirmation. Key diagnostic tests include microscopic examination of tissue samples (skin scrapings, bone marrow, or spleen aspirates) to identify amastigotes. Polymerase chain reaction (PCR) testing offers high sensitivity and can identify specific Leishmania species.
Serological tests such as the direct agglutination test (DAT) and rapid diagnostic tests (RDTs) like the rK39 test are useful for visceral leishmaniasis screening, particularly in resource-limited settings. Culture of parasites on specialized media remains the gold standard but requires specialized facilities. Histopathological examination of biopsy specimens can support diagnosis, showing characteristic inflammatory infiltrates and parasites.
Montenegro skin test (leishmanin test) indicates past exposure but cannot distinguish active from resolved infection. Complete blood count typically shows pancytopenia in visceral disease, while liver function tests may reveal elevated enzymes.
Treatment
Treatment varies by clinical form, causative species, and geographic region. For visceral leishmaniasis, liposomal amphotericin B is the preferred first-line therapy in many regions due to its high efficacy and improved safety profile compared to conventional amphotericin B. Miltefosine, the first oral treatment for leishmaniasis, is effective for both visceral and cutaneous forms but requires careful monitoring for gastrointestinal side effects and potential teratogenicity.
Other treatment options include pentavalent antimonials (sodium stibogluconate and meglumine antimoniate), though resistance is increasing in some regions. Paromomycin is used as monotherapy or in combination regimens. Combination therapies are increasingly employed to improve efficacy and reduce treatment duration.
For cutaneous leishmaniasis, treatment decisions depend on lesion characteristics, species, and risk of progression. Options include topical treatments, intralesional therapy, systemic medications, and physical therapies such as cryotherapy or thermotherapy.
Prognosis
With appropriate treatment, the prognosis for leishmaniasis is generally good. Visceral leishmaniasis cure rates exceed 95% with optimal therapy, though treatment failure and relapse can occur, particularly in immunocompromised patients. Most cutaneous lesions heal spontaneously within months to years, though treatment can accelerate healing and reduce scarring.
Long-term outcomes depend on early diagnosis and appropriate treatment. Delayed treatment of visceral leishmaniasis can result in irreversible organ damage and increased mortality risk. Post-treatment follow-up is essential to monitor for relapse and complications. Patients with HIV co-infection require long-term suppressive therapy and have higher rates of treatment failure and relapse.
Quality of life
Leishmaniasis can significantly impact quality of life through physical symptoms, social stigma, and economic burden. Patients with cutaneous lesions may experience social isolation due to visible scarring or disfigurement. Supportive care includes wound management, nutritional support, and psychological counseling.
During treatment, patients should maintain adequate nutrition and hydration, as many therapeutic agents can cause gastrointestinal side effects. Regular monitoring by healthcare providers is essential to manage drug toxicity and treatment response. Patients can generally continue normal activities as tolerated, though those with visceral disease may require hospitalization during initial treatment.
Mental health support is crucial, particularly for patients with disfiguring cutaneous or mucocutaneous disease. Support groups and counseling can help patients cope with the psychological impact of the disease and its treatment.
Pregnancy and fertility
Leishmaniasis during pregnancy poses risks to both mother and fetus. Visceral leishmaniasis can cause maternal anemia, hemorrhage, and preterm delivery. Several anti-leishmanial drugs are contraindicated in pregnancy, including miltefosine due to teratogenic risk. Liposomal amphotericin B is considered the safest option for treating pregnant women with visceral leishmaniasis.
Women of reproductive age receiving miltefosine must use effective contraception during treatment and for two months afterward. Fertility is generally not permanently affected by leishmaniasis, though severe systemic disease may temporarily impact reproductive function.
Children
Children in endemic areas are particularly vulnerable to leishmaniasis due to outdoor activities and developing immune systems. Pediatric visceral leishmaniasis often presents with failure to thrive, chronic fever, and increased susceptibility to infections. Treatment dosing is weight-based, and children generally tolerate therapy well with appropriate monitoring.
Prevention strategies for children include protective clothing, bed nets, and limiting outdoor activities during peak sandfly hours. School-based education programs can help communities recognize early symptoms and seek prompt medical care.
When to see a doctor
Seek immediate medical attention for persistent fever with weight loss and abdominal swelling, particularly in individuals with travel history to endemic areas. Urgent evaluation is needed for signs of severe anemia (weakness, pallor, shortness of breath) or bleeding tendencies.
For cutaneous lesions, consult a healthcare provider if skin ulcers fail to heal within several weeks, show signs of secondary infection, or occur after travel to leishmaniasis-endemic regions. Early diagnosis and treatment improve outcomes and reduce transmission risk.
Regional context
In the Caucasus region, leishmaniasis occurs primarily in Armenia and Azerbaijan, with cutaneous leishmaniasis being more common than visceral forms. The disease is less prevalent in Georgia but sporadic cases have been reported. Regional climate change and population movements may influence future transmission patterns. Healthcare providers in this region should maintain awareness of leishmaniasis, particularly in patients with travel history to known endemic areas. We welcome contributions from regional medical experts to enhance our understanding of leishmaniasis epidemiology in the Caucasus and Eastern Mediterranean regions.
Research and clinical trials
Current research focuses on developing new therapeutic agents, improved diagnostic tools, and effective vaccines. Several drug candidates are in clinical development, including oral formulations that could simplify treatment in resource-limited settings. Combination therapy trials aim to shorten treatment duration and prevent resistance development.
Vaccine research is progressing with multiple candidates in various trial phases, including live attenuated vaccines and subunit vaccines. Diagnostic research emphasizes point-of-care tests and molecular techniques for species identification. Vector control innovations include genetically modified sandflies and novel insecticides.
Patients and healthcare providers can find current clinical trials at ClinicalTrials.gov using search terms “leishmaniasis” and specific treatment modalities.
Frequently asked questions
Is leishmaniasis contagious between people?
No, leishmaniasis is not directly contagious between humans. Transmission requires the sandfly vector, though rare cases of transmission through blood transfusion, needle sharing, or from mother to child have been reported.
Can leishmaniasis be completely cured?
Yes, with appropriate treatment, leishmaniasis can be completely cured in most cases. However, some patients may experience relapse, particularly those with compromised immune systems.
How long does treatment take?
Treatment duration varies by form and severity. Visceral leishmaniasis typically requires 10-28 days of treatment, while cutaneous forms may need several weeks to months depending on the chosen therapy.
Will the scars from cutaneous leishmaniasis fade?
Scars from cutaneous leishmaniasis are usually permanent, though they may fade somewhat over time. Early treatment can minimize scarring, and cosmetic procedures may help improve appearance.
Can I travel to endemic areas after having leishmaniasis?
Yes, but take precautions against sandfly bites. Previous infection may provide some immunity against the same species, but you can still be infected with different Leishmania species.
Support and resources
- World Health Organization (WHO): www.who.int/health-topics/leishmaniasis
- Centers for Disease Control and Prevention: www.cdc.gov/parasites/leishmaniasis/
- Drugs for Neglected Diseases initiative (DNDi): dndi.org
- Leishmaniasis East Africa Platform (LEAP): Regional research consortium
- Pan-American Health Organization: www.paho.org
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Sources: Orphanet (orpha.net), OMIM, GeneReviews (NCBI), WHO ICD-11, relevant guidelines. Informational only; not medical advice. CC BY 4.0.
Cite this page
GMJ News Desk. “Leishmaniasis.” GMJ News — Georgian Medical Journal, 2 June 2026. https://news.gmj.ge/condition/leishmaniasis/
Licensed under CC BY 4.0. Free to share with attribution to GMJ News.Sources: Orphanet (orpha.net), OMIM, GeneReviews (NCBI), WHO ICD-11, EULAR/ACR guidelines. Schema.org MedicalCondition structured data included.
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