Synopsis
Recognise leishmaniasis forms, distinguish African sleeping sickness from Chagas disease, secure reference confirmation and start stage-specific specialist care.
- Leishmania is transmitted by infected sandflies and presents as cutaneous ulcers, destructive mucosal disease or visceral infection affecting spleen, liver and marrow.
- Visceral leishmaniasis causes prolonged irregular fever, weight loss, massive splenomegaly, cytopenias and hypergammaglobulinaemia; prompt complete treatment is essential.
- First-line confirmation of cutaneous or mucosal disease uses lesion scraping, aspirate or biopsy for microscopy, culture and PCR; serology is usually unhelpful for isolated skin disease.
Key red flags
Prolonged fever, weight loss, marked splenomegaly and pancytopenia after endemic residence can be untreated visceral leishmaniasis, which is usually fatal without therapy.
Progressive nasal blockage, epistaxis, septal destruction, oral ulceration or voice change can follow a remote New World skin lesion.
Investigation priorities
Define epidemiological plausibility, competing emergencies and organ injury before rare-pathogen confirmation.
Management branches
A compatible skin, mucosal or visceral syndrome follows sandfly exposure in an endemic region.
- Classify cutaneous, mucosal or visceral disease and record lesion number, size, site, duration, mucosal symptoms, immune status and complete geography.
- Send appropriate lesion or tissue material for microscopy, culture and PCR through a tropical laboratory; add serology for visceral but not as a skin-disease rule-out.
Key medicines
Liposomal amphotericin B for visceral leishmaniasisUse a specialist intravenous course to a total 21 to 30 mg/kg over 10 to 21 days, with exact daily or intermittent schedule selected for species, geography, immunity and product.
Fexinidazole for human African trypanosomiasisFor an eligible patient weighing at least 35 kg, WHO dosing is 1,800 mg orally once daily on days 1 to 4, then 1,200 mg once daily on days 5 to 10 with a substantial meal.