Leishmaniasis

Leishmaniasis is a clinically heterogeneous group of diseases, caused by infection with protozoa of the genus Leishmania. The aggressiveness of the individual species, their organ preference and the host immune status determine disease course. This can range from a solitary, spontaneous healing ulcer (cutaneous leishmaniasis), to often destructive mucocutaneous disease to generalized involvement with visceral leishmaniasis which may be lethal if not treated. The protozoa are transmitted by small (2-4 mm) phlebotomine sand flies. Protection with non-impregnated mosquito nets is almost impossible. An estimated 12 million people are affected; 60,000 die annually. Every non-healing ulcer associated with travel to between the 40th parallels should be suspected as possible leishmaniasis. The diagnostic approach should be standardized; one should attempt to directly demonstrate the organism in the edge of the ulcer and then subspeciate it. Both are basis requirements for initiating appropriate therapy. Pentavalent antimony preparations, amphotericin B and miltefosine are licensed in Germany. A number of other off-label approaches are also commonly employed. Insect repellents, eradication of vectors and control of the animal reservoir are useful to prevent infection.