Mucocutaneous Leishmaniasis: An Overview

Introduction

Mucocutaneous leishmaniasis is a parasitic disease that is caused by the Leishmania parasite. Leishmania parasites live in infected sand flies. Therefore, an infected sandfly bite causes leishmaniasis. The sand flies carrying the parasite are found in tropical and subtropical environments. However, fatal epidemics have occurred in certain parts of Asia, East Africa, and South America. Affected regions are remote and unstable, with few resources for treating leishmaniasis. Doctors without orders have referred to leishmaniasis as one of the most dangerous and neglected tropical diseases, and this disease is second after malaria in parasitic infection-related death.

What Are the Types of Leishmaniasis?

Leishmaniasis occurs in three types:

• Cutaneous.

• Visceral.

• Mucocutaneous.

Different species of Leishmania parasite are associated with each of the forms mentioned above. There are around 20 Leishmania species that transmit this disease to humans.

Cutaneous Leishmaniasis:

Cutaneous leishmaniasis leads to ulcers on the skin. It is the most common type of leishmaniasis. Treatment is not always required, but the treatment depends on the individual and the healing rate to prevent complications.

Mucocutaneous Leishmaniasis:

A rare form of the disease, mucocutaneous leishmaniasis, is caused by the cutaneous parasite and occurs several months after the healing of the skin ulcers. With this leishmaniasis, the parasites spread to the nose, throat, and mouth. This causes either partial or complete destruction of the mucous membranes in the nose, throat, and mouth. Mucocutaneous leishmaniasis is considered a type of cutaneous leishmaniasis and is more serious. It does not heal on its own and compulsorily needs treatment.

Visceral Leishmaniasis:

Visceral leishmaniasis is also called systemic leishmaniasis or kala-azar. It generally occurs two to eight months after a sandfly bite. It damages the internal organs, like the spleen and liver. It also affects the bone marrow and immune system by damaging these organs. The condition is fatal if not treated well.

What Causes Leishmaniasis?

• Leishmaniasis is caused due to protozoan parasites belonging to Leishmania species. Leishmaniasis occurs by an infected sandfly bite.

• The parasite lives and multiplies in the female sand fly.

• Sandflies are active in humid environments during the warm months and the night.

• Domestic animals, like dogs, serve as reservoirs for the parasite.

• Transmission occurs from animal to sand fly followed by a human.

• Humans can also transmit the parasite to one another through blood transfusions or shared needles.

• The transmission can also occur from human to sand fly and back to human.

Who Is at Risk for Leishmaniasis?

• The disease is found all around the world except Australia and Antarctica. In addition, 95 % of leishmaniasis cases are also found in Brazil, Ethiopia, India, Kenya, Somalia, South Sudan, and Sudan.

• Traveling to the countries mentioned above and tropical or subtropical areas are at a higher risk of contracting this disease. Environmental and climate factors also influence the spread of the disease.

• Socioeconomic conditions

According to the World Health Organization, poverty increases disease. Leishmaniasis occurs in areas where the below-mentioned conditions are prevalent:

• Malnutrition.

• Famine conditions.

• Less financial resources

• Migrations of people by urbanization, emergency, war, environmental, and climate changes.

• Low immunity increases the risk of leishmaniasis.

• HIV influences the transmission of the leishmaniasis parasite and increases the risk of a visceral type of leishmaniasis. HIV and leishmaniasis affect all kinds of immune cells. People infected with HIV are infected with leishmaniasis. In Ethiopia, around 35 percent of people with leishmaniasis are infected with HIV.

What Are the Symptoms of Leishmaniasis?

People carry certain species of Leishmania for the long term without showing any symptoms. Symptoms seen depend on the type of the disease.

Cutaneous Leishmaniasis:

The main symptom of cutaneous leishmaniasis is the presence of a painless skin ulcer. Cutaneous symptoms are seen weeks after the infected sandfly bite. However, symptoms occur after months or years.

Mucocutaneous Leishmaniasis:

In the mucocutaneous form of the disease, symptoms appear one to five years post the appearance of skin lesions. There are ulcers present on the mouth, nose, or lips.

Other symptoms include the following:

• Runny or stuffy nose.

• Bleeding nose.

• Difficulty breathing.

• Visceral leishmaniasis.

• Symptoms are not seen for months after the bite and are apparent two to six months after the infection.

Common signs and symptoms include the following:

• Weight loss.

• Weakness.

• Fever for weeks or months.

• Enlarged spleen.

• Enlarged liver.

• Decreased production of blood cells.

• Bleeding.

• Swollen lymph nodes.

How Is Leishmaniasis Diagnosed?

The doctor must know about living in or visiting a place with a common leishmaniasis occurrence. Then, tests can be conducted to detect parasites and species of Leishmania.

Diagnosing cutaneous leishmaniasis,

• A biopsy is done by scraping the ulcers. First, they evaluate the DNA and genetic material of the parasite. Then, they use various methods to identify the species of the parasite that causes the infection.

• A history of living or traveling to an area of leishmaniasis helps. A physical exam can be performed to look for an enlarged spleen or liver, followed by a bone marrow biopsy and blood examination.

• Special chemical stains of bone marrow can identify immune cells infected with the parasite.

What Are the Treatments for Leishmaniasis?

Antiparasitic drugs, Amphotericin B, help treat leishmaniasis.

Cutaneous leishmaniasis:

Cutaneous ulcers will generally heal without treatment. However, the treatment can help speed up the healing process and reduce scarring.

Mucocutaneous Leishmaniasis:

The lesions do not heal naturally. They require treatment. Liposomal amphotericin B and paromomycin can help treat mucocutaneous leishmaniasis.

Visceral Leishmaniasis:

The visceral disease needs treatment. Several medications are available. Commonly used medicines are Sodium stibogluconate, Amphotericin B, Paromomycin, and Miltefosine.

What Are the Potential Complications of Leishmaniasis?

Cutaneous leishmaniasis complications include the following:

• Bleeding.

• Secondary infections.

• Disfigurement.

• HIV or AIDS complicate leishmaniasis.

How to Prevent Leishmaniasis?

There is no vaccine or prophylactic medicine available for leishmaniasis. To prevent leishmaniasis, avoid getting bitten by a sandfly.

Follow these steps to help prevent sandfly bites:

• Wear clothing that covers the skin, like long pants, long-sleeved shirts, and high socks.

• Use insect repellent on exposed skin; effective insect repellants contain N, N-Diethyl-meta-toluamide.

• Spray indoor sleeping areas with insecticide.

• Sleep on the higher floors as insects are poor fliers.

• Avoid the outdoors between dusk and dawn.

• Use screens and air conditioning indoors.

• Use a bed net tucked into the mattress. Sand flies are smaller than mosquitos; a tightly woven net helps.

• Spray the net with an insecticide containing pyrethroid.

Conclusion

Sores can cause permanent scars and disfigurement. However, treatment can reduce the severity, and medication can cure the disease. In addition, the treatment is effective when started before causing damage to the immune system.