Published on: August 5, 2024
Leishmaniasis, once seen primarily as a concern for travelers, has steadily surged in cases across the southern regions of the United States. Joining the roster of tropical threats, this new flesh-eating parasitic disease has emerged in Texas and Oklahoma and new studies suggest it might be present in other states including Florida. Leishmaniasis cases are linked to bites from female sandflies and although the number of cases in the U.S is negligible, they may soon be on the rise adding to the worries of Floridians who were once only troubled by mosquitoes borne diseases. Though not as immediately severe as malaria or Zika, untreated leishmaniasis can result in significant health complications and, in severe cases, fatal outcomes. Fortunately, the strain of Leishmaniasis currently in the U.S. causes milder symptoms and is entirely curable and treatable.
With the uptick in cases affecting the U.S, understanding leishmaniasis and the role of sandflies becomes increasingly crucial. Exploring the causes, symptoms, testing procedures, available treatments, and other essential resources is vital in staying informed and prepared for this infectious disease.
What is Leishmaniasis?
Leishmaniasis is an infectious disease that spreads through the bite of female sandflies carrying the leishmania protozoa parasite. These sandflies are about a quarter of the size of mosquitoes and inhabit tropical and subtropical regions. They are most active at night, where they can slip through mosquito nets undetected. Many people don’t even realize they have been bitten, which shows how leishmaniasis transmission often goes unnoticed. The disease manifests in two main forms:
- Cutaneous leishmaniasis: Characterized by the development of one or multiple sores on the skin, which may originate as papules or nodules before progressing into ulcers.
- Visceral leishmaniasis: Impacts internal organs such as the spleen, liver, and bone marrow. When untreated, serious cases can be fatal.
According to the CDC, cutaneous leishmaniasis remains the more common form of the disease, with reported new cases annually ranging between 700,000 to 1.2 million worldwide. Check out the CDC’s informative disease overview for further insights into leishmaniasis.
Symptoms
Symptoms of leishmaniasis vary depending on whether the contracted form is cutaneous or visceral. Between the two, visceral poses a significantly greater threat and requires immediate treatment to avoid potential fatality.
Cutaneous Leishmaniasis symptoms may include*:
- Difficulty breathing
- Skin sores (papules, nodules, or ulcers)
- Stuffy nose, runny nose, and nosebleeds
- Difficulty swallowing
Visceral Leishmaniasis symptoms may include*:
- Cough
- Diarrhea
- Fever
- Vomiting
- Swelling of the liver or spleen
- Abnormal blood tests
- Abdominal discomfort
- Weight loss
*Information sourced from the University of Florida Health
While each form of leishmaniasis will have its own set of symptoms, some people can have a silent infection without any symptoms or signs. If you experience any of these indications after visiting a region where leishmaniasis is prevalent, you should seek testing and treatment from your healthcare provider.
Testing
Prior to undergoing testing for leishmaniasis, you will have to recall if you have been potentially exposed to sandflies or if you have visited a religion where leishmaniasis is prevalent. If either circumstance applies, diagnosis typically proceeds through laboratory testing.
Doctors employ various tests based on the suspected form of the disease:
- Cutaneous Leishmaniasis: Tissue samples from skin sores are collected for microscopic examination and molecular tests.
- Visceral Leishmaniasis: Bone marrow samples may be taken for evaluation. Additional testing methods include:
- Biopsy of the spleen or liver with subsequent culture
- Direct agglutination assay
- Indirect immunofluorescent antibody test
- Leishmania-specific PCR test
- Blood tests
The selection of these tests depends on the clinical assessment to determine the accurate diagnosis and appropriate course of treatment.
Treatment
Effective treatment can yield high cure rates, especially if administered before the immune system becomes compromised. Your healthcare provider will determine the most suitable treatment and medication for your specific type of leishmaniasis. The primary medications for treatment usually include antimony-containing compounds such as meglumine antimoniate and sodium stibogluconate. Additionally, other medications like Amphotericin B, Ketoconazole, Miltefosine, Paromomycin, and Pentamidine might be prescribed.
In cases of cutaneous leishmaniasis, skin sores typically heal naturally over time. However, due to the potential for scarring, some individuals opt for plastic surgery, particularly for sores on the face, to address any resulting disfigurement.
Sandflies in Florida
Sandflies, sometimes locally known as no-see-ums, are a common nuisance in Florida’s coastal regions. These tiny pests thrive in warm summer humid conditions, like our Tampa Bay region. Since they are small, they often will go unnoticed as they leave inconspicuous bites. Fortunately, not all sandflies carry the leishmania protozoa responsible for leishmaniasis transmission.
However, there is a concerning trend of increasing leishmaniasis cases in the southern United States. While these parasites are currently endemic in Texas and Oklahoma, recent studies suggest their potential presence in other states, including Florida. Although reported U.S. cases of leishmaniasis remain relatively low, the likelihood of a rise in occurrences looms ahead. Make sure to continue wearing insect repellent with the chemical DEET, covering exposed skin, and refraining from using heavily fragranced lotions when outdoors during the sandfly season.
Stay Protected | Infectious Disease Associates of Tampa Bay
At Infectious Disease Associates of Tampa Bay (IDATB), we specialize in providing high-quality healthcare services for patients in the Tampa Bay metro area. We understand the importance of maintaining and improving the overall health of both our patients and our team.
Our comfortable, state-of-the-art clinic can provide you and your loved ones with the top care. If you or someone who lives with you would like to be evaluated for an infectious disease, then IDATB is here to help. With over 30 years of experience, IDATB has been treating Floridians with infectious diseases while providing an in-house lab for most testing. If you have any questions or concerns about infectious diseases, call IDATB at 813-251-8444.
References
- https://ufhealth.org/conditions-and-treatments/leishmaniasis
- https://www.cbsnews.com/news/flesh-eating-parasite-leishmania-sand-flies-texas-dogs-cdc-report/
- https://www.nbcnews.com/health/health-news/cdc-says-skin-disfiguring-parasite-may-endemic-texas-present-states-rcna121450
- https://www.npr.org/sections/health-shots/2021/06/25/1009885640/flesh-eating-parasites-may-be-expanding-their-range-as-climate-heats-up
- https://www.livenowfox.com/news/tropical-skin-disease-sand-flies-us
- https://www.cnn.com/2023/10/19/health/tropical-parasite-sand-fly-skin-infections/index.html
