37.2.3  Clinical manifestation and diagnosis of leishmaniasis

The clinical presentation of the two forms of leishmaniasis are very different. Cutaneous leishmaniasis normally produces skin ulcers on the exposed parts of the body such as the face, arms and legs (Figure 37.9). The disease can produce a large number of ulcers – sometimes up to 200 – which may result in physical disability (e.g. in using the hands). The visible ulcers are a source of social stigma, which can leave the patient suffering mental distress and rejection in their community.

Figure 37.9  Ulceration due to cutaneous leishmaniasis (a) on the face, (b) on the hand. (Photos: (a) WHO TDR Image Library, image 03061531/Crump; (b) CDC Image Library, image 352)

Visceral leishmaniasis (also known as kala azar, which means black fever in Hindu) is a life-threatening disease characterised by irregular episodes of fever, rapid and extensive weight loss, huge swelling of the spleen and liver (Figure 37.10), and anaemia. If left untreated, up to 100% of patients die within two years of infection. For this reason, visceral leishmaniasis is said to have a high case-fatality rate.

Figure 37.10  A child with severe weight loss and an enlarged abdomen with a huge liver and spleen due to visceral leishmanisis. (Photo: WHO at http://www.who.int/leishmaniasis/visceral_leishmaniasis/en/index.html)

You can identify patients with leishmaniasis by the clinical manifestations of the disease. For confirmation of the diagnosis, laboratory investigations should be done in health centres or hospitals, where the protozoan parasites can be detected in blood smears viewed with a microscope (look back at Figure 37.6).