Leishmaniasis

In leishmaniasis (thesaurus synonyms: Aleppo bump; American leishmaniasis; Asian desert leishmaniasis; Assam fever; eyelid infestation in leishmaniasis; eyelid leishmaniasis; Baghdad bump; Baghdad ulcer; Bahia ulcer; Brazilian leishmaniasis; Burdwan fever; Chiclero ulcer; Chiclero ulcer; Cochinchina ulcer; Delhi ulcer; Delhi ulcer; Delhipustel; Dumdum fever; Dum-Dum fever; Dysenteric leishmaniasis; Espundia; Skin infection post Kala-azar; Skin leishmaniasis; Skin leishmaniasis post Kala-azar; Skin leishmanoid; Skin leishmanoid post Kala-azar; Infection by Leishmania; Infection by Leishmania aethiopica; Infection by Leishmania brasiliensis; Infection by Leishmania chagasi; Infection by Leishmania donovani; Infection by Leishmania infantum; Infection by Leishmania major; Infection by Leishmania mexicana; Infection by Leishmania tropica; kala-azar; cutaneous American leishmaniasis; cutaneous Asian leishmaniasis; cutaneous Ethiopian leishmaniasis; cutaneous leishmaniasis; cutaneous leishmaniasis of the eyelid; cutaneous urban leishmaniasis; leishmaniasis-s. a. Leishmaniasis; leishmaniasis; leishmaniasis cutis; leishmaniasis interna; leishmaniasis tegumentaria diffusa; leishmaniasis tropica; leishmaniasis tropica major; leishmaniasis; Mediterranean leishmaniasis; leishmaniasis of the oral and nasal mucosa; leishmanoid according to Kala-Azar; Mediterranean leishmaniasis; Mexican leishmaniasis; mucocutaneous leishmaniasis; nasooral leishmaniasis; nasopharyngeal leishmaniasis; natal bump; Nile bump; Oriental bump; Oriental fistula; Oriental ulcer; pian bois; mucosal leishmaniasis; black disease; black fever; South American cutaneous mucosal leishmaniasis; tropical leishmaniasis; ulcus tropicum due to leishmaniasis; uta; uta ulcer; visceral leishmaniasis; desert leishmaniasis; ICD-10-GM B55. -: Leishmaniasis) is an infectious disease caused by parasites of the genus Leishmania. Leishmania belong to the genus of flagellate-bearing protozoa (protozoa), which are members of the Trypanosomatida family. They multiply in the blood in macrophages (phagocytes) (hemoflagellates). The disease belongs to the parasitic zoonoses (animal diseases). Pathogen reservoirs are humans and animals (various rodents and dogs, but also foxes). In Spain, the majority of urban dogs are infected with Leishmania. Occurrence: The infection occurs mainly in tropical and subtropical regions. These include especially Peru, Colombia, Brazil, eastern Africa (including Ethiopia, Somalia, (South) Sudan), Mediterranean region (Spain, Portugal, Balkans, Italy) and Asia (China, India, Pakistan). Seasonal accumulation of the disease: The main transmission period by mosquitoes is the summer. The transmission of the pathogen (infection route) occurs through the female sand or butterfly mosquitoes, which are active at dusk and at night, the so-called phlebotomes. Rarely, transmission occurs through organ or blood donations. Diaplacental transmission from mother to unborn child is equally rare. The pathogen enters the body parenterally (the pathogen does not penetrate through the intestine), i.e. it enters the body through the skin (percutaneous infection). There, uptake occurs in the macrophages, where the leishmania transforms into the amastigote form with residual flagellum. Human-to-human transmission: Yes, but rare. The incubation period (time from infection to onset of disease) depends on the form of the disease:

• Visceral leishmaniasis (synonyms: kala-azar; also known as dum-dum fever or black fever) – highly variable incubation period; 2 to 6 months (with a range of 10 days to 2 years).
• Cutaneous leishmaniasis (synonym: Oriental bump) – a few days to several months, sometimes a year.
• Mucocutaneous leishmaniasis – can take up to 30 years before symptoms appear.

Depending on the pathogen species and the immune status of the affected person, the following forms of leishmaniasis are distinguished:

• Visceral (internal) leishmaniasis (VL; synonyms: Dum-Dum fever; black fever; kala-azar (“black skin“); ICD-10-GM B55.0: visceral leishmaniasis).
  • Pathogen:
    • Leishmania donovani – mainly in Asia and in Bangladesh and Nepal.
    • Leishmania infantum – mainly in the Mediterranean region.
    • Leishmania chagasi – mainly in South America.
  • In this form, the internal organs are affected (especially liver and spleen), but also lymph nodes and bone marrow.
• Cutaneous leishmaniasis (CV; synonyms: Cutaneous leishmaniasis; Baghdad, Aleppo, Nile, Oriental bubonic; ICD-10-GM B55.1: Cutaneous leishmaniasis).
  • Pathogen:
    • Leishmania tropica (L. tropica major, L. tropica minor).
    • Leishmania peruviana
    • Leishmania mexicana
    • Leishmania aethiopica
  • Only the skin is affected
• Mucocutaneous leishmaniasis (MCL; synonyms: mucocutaneous leishmaniasis; American leishmaniasis; uta; espundia; chiclero ulcer; pian bois; ICD-10-GM B55.2: mucocutaneous leishmaniasis).
  • Pathogen:
    • Leishmania brasiliensis – predominantly found in the Americas.
  • Chronic progressive necrotizing disease (local tissue death) of the nasopharynx; can lead to complete destruction (destruction) of the mucous membranes of the nasopharynx.

Up to 2 million people are infected per year (worldwide) – about 1.5 million are the cutaneous form of leishmaniasis and about 0.5 million are the visceral form. In Germany, about 20 cases (mostly cutaneous leishmaniasis) are recorded annually. Most of these cases are imported diseases, for example from infected dogs or travelers from endemic areas. In the meantime, sandflies have also been discovered in Germany. Course and prognosis: Of the three forms of the disease, visceral leishmaniasis is the most severe. If detected and treated in time, the prognosis is good. If left untreated, lethality (mortality relative to the total number of people with the disease) is 90%. Cutaneous and mucocutaneous leishmaniasis are significantly milder. Cutaneous leishmaniasis usually does not require therapy. The developing bump heals spontaneously (by itself) after six months to a year with scarring. The course of mucocutaneous leishmaniasis is more severe and is manifested, among other things, by destructive skin lesions that do not heal spontaneously. If the infection is latent (hidden), reactivation is possible throughout life in the case of immunosuppression (immunodeficiency). Vaccination: A vaccination against leishmaniasis is not yet available. In Germany, visceral leishmaniasis must be reported to the Institute for Tropical Medicine in Berlin.