View source for Medicine:Leishmaniasis

{{Short description|Disease caused by parasites of the Leishmania type}}
{{Infobox medical condition (new)
| name            = Leishmaniasis
| synonyms        = Leishmaniosis
| image           = Skin ulcer due to leishmaniasis, hand of Central American adult 3MG0037 lores.jpg
| caption         = Cutaneous leishmaniasis in the hand of a Central American adult
| field           = [[Medicine:Infectious disease (medical specialty)|Infectious disease]]
| pronounce       = Leishmaniasis {{IPAc-en|ˌ|l|iː|ʃ|m|ə|ˈ|n|aɪ|ə|s|ɪ|s}}<br>leishmaniosis {{IPAc-en|l|iː|ʃ|ˌ|m|eɪ|n|i|ˈ|əʊ|s|ɪ|s|,_|-|ˌ|m|æ|n|i|-}}<ref>{{cite web |url=http://www.collinsdictionary.com/dictionary/english/leishmaniasis |title=Leishmaniasis definition and meaning &#124; Collins English Dictionary |access-date=2013-12-23 |url-status=dead |archive-url=https://web.archive.org/web/20131224100908/http://www.collinsdictionary.com/dictionary/english/leishmaniasis |archive-date=24 December 2013 |df=dmy-all }}</ref>
| symptoms        = Skin ulcers, [[Medicine:Fever|fever]], low red blood cells, [[Medicine:Hepatomegaly|enlarged liver]]<ref name=WHO2014/><ref name=Barrett2012/>
| onset           =
| duration        =
| causes          = ''[[Biology:Leishmania|Leishmania]]'' parasites spread by sandflies<ref name=WHO2014/>
| risks           =
| diagnosis       =
| differential    =
| prevention      = Bug nets, [[Biology:Insecticide|insecticide]]<ref name=WHO2014/>
| treatment       =
| medication      =
| frequency       = 4–12 million<ref name=Mag/><ref name=GBD2015Pre/>
| deaths          = 24,200 (2015)<ref name=GBD2015De>{{cite journal | vauthors = Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, etal | title = Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1459–1544 | date = October 2016 | pmid = 27733281 | pmc = 5388903 | doi = 10.1016/s0140-6736(16)31012-1 | collaboration = GBD 2015 Mortality Causes of Death Collaborators }}</ref>
}}

<!-- Definition and symptoms -->
'''Leishmaniasis''' is a wide array of clinical manifestations caused by [[Biology:Parasite|parasite]]s of the [[Biology:Trypanosomatida|Trypanosomatida]] genus ''[[Biology:Leishmania|Leishmania]]''.<ref>{{cite journal |last1=Roy |first1=Mrinalini |last2=Rawat |first2=Aadish |last3=Kaushik |first3=Sanket |last4=Jyoti |first4=Anupam |last5=Srivastava |first5=Vijay Kumar |date=2022-08-01 |title=Endogenous cysteine protease inhibitors in upmost pathogenic parasitic protozoa |journal=Microbiological Research |language=en |volume=261 |pages=127061 |doi=10.1016/j.micres.2022.127061 |pmid=35605309 |s2cid=248741177 |issn=0944-5013|doi-access=free }}</ref> It is generally spread through the bite of [[Biology:Phlebotominae|phlebotomine]] sandflies, ''[[Biology:Phlebotomus|Phlebotomus]]'' and ''[[Biology:Lutzomyia|Lutzomyia]]'', and occurs most frequently in the tropics and sub-tropics of Africa, Asia, the Americas, and southern Europe.<ref name="WHO2014" /><ref name=":0">{{cite journal |last1=Rawat |first1=Aadish |last2=Roy |first2=Mrinalini |last3=Jyoti |first3=Anupam |last4=Kaushik |first4=Sanket |last5=Verma |first5=Kuldeep |last6=Srivastava |first6=Vijay Kumar |date=August 2021 |title=Cysteine proteases: Battling pathogenic parasitic protozoans with omnipresent enzymes |journal=Microbiological Research |language=en |volume=249 |pages=126784 |doi=10.1016/j.micres.2021.126784 |pmid=33989978 |s2cid=234597200|doi-access=free }}</ref> The disease can present in three main ways: [[Medicine:Cutaneous leishmaniasis|cutaneous]], mucocutaneous, or [[Medicine:Visceral leishmaniasis|visceral]].<ref name=WHO2014>{{cite web|title=Leishmaniasis Fact sheet N°375|url=https://www.who.int/mediacentre/factsheets/fs375/en/|work=World Health Organization|access-date=17 February 2014|date=January 2014|url-status=live|archive-url=https://web.archive.org/web/20140221184012/http://www.who.int/mediacentre/factsheets/fs375/en/|archive-date=21 February 2014|df=dmy-all}}</ref> The cutaneous form presents with skin ulcers, while the mucocutaneous form presents with ulcers of the skin, mouth, and nose. The visceral form starts with skin ulcers and later presents with fever, low red blood cell count, and enlarged spleen and liver.<ref name=WHO2014/><ref name=Barrett2012/>

<!-- Cause and diagnosis -->
Infections in humans are caused by more than 20 species of ''Leishmania''.<ref name=":0" /><ref name="WHO2014" /> Risk factors include poverty, [[Medicine:Malnutrition|malnutrition]], deforestation, and [[Earth:Urbanization|urbanization]].<ref name="WHO2014" /> All three types can be diagnosed by seeing the parasites under microscopy.<ref name="WHO2014" /> Additionally, visceral disease can be diagnosed by blood tests.<ref name="Barrett2012" />

<!-- Prevention and treatment -->
Leishmaniasis can be partly prevented by sleeping under nets treated with [[Biology:Insecticide|insecticide]].<ref name=WHO2014/> Other measures include spraying insecticides to kill sandflies and treating people with the disease early to prevent further spread.<ref name=WHO2014/> The treatment needed is determined by where the disease is acquired, the species of ''Leishmania'', and the type of infection.<ref name=WHO2014/> Some possible medications used for visceral disease include liposomal amphotericin B,<ref name=Sun2013/> a combination of pentavalent antimonials and [[Chemistry:Paromomycin|paromomycin]],<ref name=Sun2013>{{cite journal | vauthors = Sundar S, Chakravarty J | title = Leishmaniasis: an update of current pharmacotherapy | journal = Expert Opinion on Pharmacotherapy | volume = 14 | issue = 1 | pages = 53–63 | date = January 2013 | pmid = 23256501 | doi = 10.1517/14656566.2013.755515 | s2cid = 207479873 }}</ref> and [[Chemistry:Miltefosine|miltefosine]].<ref name=Dor2012>{{cite journal | vauthors = Dorlo TP, Balasegaram M, Beijnen JH, de Vries PJ | title = Miltefosine: a review of its pharmacology and therapeutic efficacy in the treatment of leishmaniasis | journal = The Journal of Antimicrobial Chemotherapy | volume = 67 | issue = 11 | pages = 2576–97 | date = November 2012 | pmid = 22833634 | doi = 10.1093/jac/dks275 | doi-access = free }}</ref> For cutaneous disease, paromomycin, [[Chemistry:Fluconazole|fluconazole]], or [[Chemistry:Pentamidine|pentamidine]] may be effective.<ref name=Min2007>{{cite journal | vauthors = Minodier P, Parola P | title = Cutaneous leishmaniasis treatment | journal = Travel Medicine and Infectious Disease | volume = 5 | issue = 3 | pages = 150–8 | date = May 2007 | pmid = 17448941 | doi = 10.1016/j.tmaid.2006.09.004 }}</ref>

<!-- Epidemiology -->
About 4 to 12 million people are currently infected<ref name=Mag>{{cite web|title=Leishmaniasis Magnitude of the problem|url=https://www.who.int/leishmaniasis/burden/magnitude/burden_magnitude/en/index.html|work=World Health Organization|access-date=17 February 2014|url-status=dead|archive-url=https://web.archive.org/web/20131026230723/http://www.who.int/leishmaniasis/burden/magnitude/burden_magnitude/en/index.html|archive-date=26 October 2013|df=dmy-all}}</ref><ref name=GBD2015Pre>{{cite journal | vauthors = Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, etal | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 | collaboration = GBD 2015 Disease Injury Incidence Prevalence Collaborators }}</ref> in some 98 countries.<ref name=Barrett2012>{{cite journal | vauthors = Barrett MP, Croft SL | title = Management of trypanosomiasis and leishmaniasis | journal = British Medical Bulletin | volume = 104 | pages = 175–96 | year = 2012 | issue = 1 | pmid = 23137768 | pmc = 3530408 | doi = 10.1093/bmb/lds031 }}</ref> About 2 million new cases<ref name=Barrett2012/> and between 20 and 50 thousand deaths occur each year.<ref name=WHO2014/><ref name=Loz2012>{{cite journal | vauthors = Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, etal | title = Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010 | journal = Lancet | volume = 380 | issue = 9859 | pages = 2095–128 | date = December 2012 | pmid = 23245604 | doi = 10.1016/S0140-6736(12)61728-0 | pmc = 10790329 | url = https://zenodo.org/record/2557786 | hdl = 10536/DRO/DU:30050819 | s2cid = 1541253 | hdl-access = free }}</ref> About 200&nbsp;million people in Asia, Africa, South and Central America, and southern Europe live in areas where the disease is common.<ref name=Barrett2012/><ref>{{cite journal | vauthors = Ejazi SA, Ali N | title = Developments in diagnosis and treatment of visceral leishmaniasis during the last decade and future prospects | journal = Expert Review of Anti-Infective Therapy | volume = 11 | issue = 1 | pages = 79–98 | date = January 2013 | pmid = 23428104 | doi = 10.1586/eri.12.148 | s2cid = 20508342 }}</ref> The [[Organization:World Health Organization|World Health Organization]] has obtained discounts on some medications to treat the disease.<ref name=Barrett2012/> It is classified as a neglected tropical disease.<ref name=NTD2017>{{cite web|title=Neglected Tropical Diseases|url=https://www.cdc.gov/globalhealth/ntd/diseases/index.html|website=cdc.gov|access-date=28 November 2014|date=June 6, 2011|url-status=live|archive-url=https://web.archive.org/web/20141204084219/http://www.cdc.gov/globalhealth/ntd/diseases/index.html|archive-date=4 December 2014|df=dmy-all}}</ref> The disease may occur in a number of other animals, including [[Medicine:Canine leishmaniasis|dogs]] and [[Biology:Rodent|rodent]]s.<ref name=WHO2014/>

==Signs and symptoms==
[[File:Leishmaniasis ulcer.jpg|thumb|right|Cutaneous leishmaniasis ulcer]]
The symptoms of leishmaniasis are skin sores which erupt weeks to months after the person is bitten by infected sand flies.

Leishmaniasis may be divided into the following types:<ref name="Andrews">{{cite book| first1 = William D | last1 = James | first2 = Timothy G | last2 = Berger | first3 = Dirk M | last3 = Elston |title=Andrews' Diseases of the Skin: clinical Dermatology |publisher=Saunders Elsevier |year=2006 |pages=422–428 |isbn=978-0-7216-2921-6 }}</ref>
* [[Medicine:Cutaneous leishmaniasis|Cutaneous leishmaniasis]] is the most common form, which causes an open sore at the bite sites, which heals in a few months to a year and half, leaving an unpleasant-looking scar.<ref name=WHO2014/><ref name=Barrett2012/> Diffuse cutaneous leishmaniasis produces widespread skin lesions which resemble [[Medicine:Leprosy|leprosy]], and may not heal on its own.<ref name=Barrett2012/>
* Mucocutaneous leishmaniasis causes both skin and mucosal ulcers with damage primarily of the nose and mouth.<ref name=WHO2014/><ref name=Barrett2012/>
* [[Medicine:Visceral leishmaniasis|Visceral leishmaniasis]] or ''kala-azar'' ('black fever') is the most serious form, and is generally fatal if untreated.<ref name=WHO2014/> Other consequences, which can occur a few months to years after infection, include [[Medicine:Fever|fever]], damage to the [[Biology:Spleen|spleen]] and [[Biology:Liver|liver]], and [[Medicine:Anemia|anemia]].<ref name=WHO2014/>

Leishmaniasis is considered one of the classic causes of a markedly enlarged (and therefore palpable) spleen; the organ, which is not normally felt during examination of the abdomen, may even become larger than the liver in severe cases.{{citation needed|date=May 2021}}

==Cause==
[[File:Leishmaniasis life cycle diagram en.svg|thumb|right|500px|Lifecycle of ''Leishmania'']]
Leishmaniasis is transmitted by the bite of infected female [[Biology:Phlebotominae|phlebotomine]] sandflies<ref name=WHO2014/> which can transmit the [[Biology:Protozoa|protozoa]] ''[[Biology:Leishmania|Leishmania]]''.<ref name=WHO2014/> '''(1)'''&nbsp;The sandflies inject the infective stage, metacyclic promastigotes, during blood meals. '''(2)'''&nbsp;Metacyclic promastigotes in the puncture wound are [[Biology:Phagocytosis|phagocytized]] by [[Biology:Macrophage|macrophage]]s, and '''(3)'''&nbsp;transform into amastigotes. '''(4)'''&nbsp;Amastigotes multiply in infected cells and affect different tissues, depending in part on the host, and in part on which ''Leishmania'' species is involved. These differing tissue specificities cause the differing clinical manifestations of the various forms of leishmaniasis. '''(5,6)'''&nbsp;Sandflies become infected during blood meals on infected hosts when they ingest macrophages infected with amastigotes. '''(7)'''&nbsp;In the sandfly's midgut, the parasites differentiate into promastigotes, '''(8)'''&nbsp;which multiply, differentiate into metacyclic promastigotes, and migrate to the proboscis.

The [[Biology:Genome|genome]]s of three ''Leishmania'' [[Biology:Species|species]] (''L.&nbsp;major'', ''L.&nbsp;infantum'', and ''L.&nbsp;braziliensis'') have been sequenced, and this has provided much information about the biology of the [[Biology:Parasite|parasite]]. For example, in ''Leishmania'', protein-coding genes are understood to be organized as large polycistronic units in a head-to-head or tail-to-tail manner; [[Biology:RNA polymerase|RNA polymerase]]&nbsp;II transcribes long polycistronic messages in the absence of defined RNA&nbsp;pol&nbsp;II promoters, and ''Leishmania'' has unique features with respect to the regulation of gene expression in response to changes in the environment. The new knowledge from these studies may help identify new targets for urgently needed drugs and aid the development of vaccines.<ref name="Myler2008" />

===Vector===
Although most of the literature mentions only one genus transmitting ''Leishmania'' to humans (''[[Biology:Lutzomyia|Lutzomyia]]'') in the New World, a 2003 study by Galati suggested a new classification for New World sand flies, elevating several subgenera to the genus level. Elsewhere in the world, the genus ''[[Biology:Phlebotomus|Phlebotomus]]'' is considered the vector of leishmaniasis.<ref name="Myler2008">{{cite book | first1 = Peter J | last1 = Myler | first2 = Nicolas | last2 = Fasel |title=Leishmania: After The Genome |publisher=Caister Academic Press |year=2008 |url=http://www.horizonpress.com/leish |isbn=978-1-904455-28-8 |url-status=live |archive-url=https://web.archive.org/web/20080423224948/http://www.horizonpress.com/leish |archive-date=23 April 2008 |df=dmy-all }}{{Page needed|date=September 2010}}</ref>

===Possible non-human reservoirs===
Some cases of infection of non-human animals of human-infecting species of Leishmania have been observed. In one study, ''L. major'' was identified in twelve out of ninety-one wild [[Biology:Western lowland gorilla|western lowland gorilla]] fecal samples<ref>{{cite journal
|title=Wild Gorillas as a Potential Reservoir of ''Leishmania major''
|journal=J. Infect. Dis.
|volume=211
|number=2
|pages=267–273
|date=2015-01-15
|url=https://academic.oup.com/jid/article/211/2/267/860822
|doi=10.1093/infdis/jiu380
|first1=Ibrahim |last1=Hamad
|first2=Claire-Lise |last2=Forestier
|first3=Martine |last3=Peeters
|first4=Eric |last4=Delaporte
|first5=Didier |last5=Raoult
|first6=Fadi |last6=Bittar|pmid=25001460
|pmc=4342692
}}
</ref> and in a study of fifty-two captive non-human primates under zoo captivity in a leishmaniasis endemic area, eight (all three chimpanzees, three golden lion tamarins, a tufted capuchin, and an Angolan talapoin), were found to be infected with L. infantum and capable of infecting ''Lutzomyia longipalpis'' sand flies, although "parasite loads in infected sand flies observed in this study were considered low".<ref>{{cite journal
|title=Competence of non-human primates to transmit ''Leishmania infantum'' to the invertebrate vector ''Lutzomyia longipalpis''
|doi=10.1371/journal.pntd.0007313
|date=2019-04-17
|journal=PLOS Neglected Tropical Diseases
|author1=Ayisa Rodrigues de Oliveira
|author2=Guilherme Rafael Gomide Pinheiro
|author3=Herlandes P. Tinoco
|author4=Maria Elvira Loyola
|author5=Carlyle Mendes Coelho
|author6=Edelberto Santos Dias
|author7=Érika Michalsky Monteiro
|author8=Fabiana de Oliveira Lara e Silva
|author9=Angela Tinoco Pessanha
|author10=Andreza Geisiane Maia Souza
|author11=Nathália Cristina Lima Pereira
|author12=Nelder F. Gontijo
|author13=Ricardo T. Fujiwara
|author14=Tatiane Alves da Paixão
|author15=Renato Lima Santos | volume=13 | issue=4 | pages=e0007313 | pmid=30995227 | pmc=6488095 |doi-access=free
}}</ref>

===Organisms===
Visceral disease is usually caused by ''[[Biology:Leishmania donovani|Leishmania donovani]]'', ''L.&nbsp;infantum'', or ''L.&nbsp;chagasi'',<ref name=Barrett2012/> but occasionally these species may cause other forms of disease.<ref name=Barrett2012/> The cutaneous form of the disease is caused by more than 15 species of ''Leishmania''.<ref name=Barrett2012/>

===Risk factors===
Risk factors include malnutrition, deforestation, lack of sanitation, suppressed immune system and urbanization.<ref name=WHO2014/>

==Diagnosis==
[[File:Leishmania 2009-04-14 smear.JPG|thumb|right|Bone marrow aspirate smear: visceral leishmaniasis]]
Leishmaniasis is diagnosed in the hematology laboratory by direct visualization of the amastigotes (Leishman–Donovan bodies). Buffy-coat preparations of peripheral blood or aspirates from marrow, spleen, lymph nodes, or skin lesions should be spread on a slide to make a thin smear and stained with [[Chemistry:Leishman stain|Leishman stain]] or [[Giemsa stain]] ([[Chemistry:PH|pH]] 7.2) for 20 minutes. Amastigotes are seen within blood and spleen monocytes or, less commonly, in circulating neutrophils and in aspirated tissue macrophages. They are small, round bodies 2–4 μm in diameter with indistinct cytoplasm, a nucleus, and a small, rod-shaped [[Biology:Kinetoplast|kinetoplast]]. Occasionally, amastigotes may be seen lying free between cells.<ref>{{cite book| last1 = Dacie | first1 = John V. | last2 = Bain | first2 = Barbara J. | first3 = Imelda | last3 = Bates |title=Dacie and Lewis practical hematology |publisher=Churchill Livingstone/Elsevier |location=Philadelphia |year=2006 |isbn=978-0-443-06660-3 }}{{Page needed|date=September 2010}}</ref> However, the retrieval of tissue samples is often painful for the patient and identification of the infected cells can be difficult. So, other indirect immunological methods of diagnosis are developed, including enzyme-linked immunosorbent assay, antigen-coated dipsticks, and direct agglutination test. Although these tests are readily available, they are not the standard diagnostic tests due to their insufficient sensitivity and specificity{{citation needed|date=May 2021}}.

Several different [[Biology:Polymerase chain reaction|polymerase chain reaction]] (PCR) tests are available for the detection of ''Leishmania'' DNA.<ref name=Barrett2012/> With this assay, a specific and sensitive diagnostic procedure is finally possible. The most sensitive PCR tests use minicircle kinetoplast DNA found in the parasite. Kinetoplast DNA contains sequences for mitochondrial proteins in its maxicircles(~25–50 per parasite), and guide RNA in its minicircles(~10'000 per parasite) of the kinetoplast. With this specific method, one can still detect Leishmania even with a very low parasite load. When needing to diagnose a specific species of Leishmania, as opposed to only detection, other PCR methods have been superior.<ref>{{cite journal | vauthors = Bensoussan E, Nasereddin A, Jonas F, Schnur LF, Jaffe CL | title = Comparison of PCR assays for diagnosis of cutaneous leishmaniasis | journal = Journal of Clinical Microbiology | volume = 44 | issue = 4 | pages = 1435–9 | date = April 2006 | pmid = 16597873 | pmc = 1448629 | doi = 10.1128/JCM.44.4.1435-1439.2006 }}</ref>

Most forms of the disease are transmitted only from nonhuman animals,  but some can be spread between humans. Infections in humans are caused by about 21 of 30 species that infect mammals;<ref>{{cite web|url=https://www.cdc.gov/parasites/leishmaniasis/biology.html|title=Parasites – Leishmaniasis|date=January 2013|website=Centers for Disease Control and Prevention}}</ref> the different species look the same, but they can be differentiated by isoenzyme analysis, DNA [[Biology:Sequence analysis|sequence analysis]], or monoclonal antibodies.

==Prevention==
* Using insect repellent to exposed skin and under the ends of sleeves and pant legs. Follow the instructions on the label of the repellent. The most effective repellents generally are those that contain the chemical DEET (N,N-diethylmetatoluamide)<ref name="Prevention">{{cite web|last=Prevention|first=CDC-Centers for Disease Control and|date=2020-02-19|title=CDC – Leishmaniasis – Prevention & Control|url=https://www.cdc.gov/parasites/leishmaniasis/prevent.html|access-date=2021-06-26|website=cdc.gov|language=en-us}}</ref>
* Leishmaniasis can be partly prevented by using nets treated with [[Biology:Insecticide|insecticide]] or insect repellent while sleeping.<ref name="WHO2014" /> To provide good protection against sandflies, fine mesh sizes of 0.6&nbsp;mm or less are required, but a [[Biology:Mosquito net|mosquito net]] with 1.2mm mesh will provide a limited reduction in the number of sandfly bites.<ref name="contphle" /> Finer mesh sizes have the downside of higher cost and reduced air circulation which can cause overheating. Many [[Biology:Phlebotominae|Phlebotomine]] sandfly attacks occur at sunset rather than at night, so it may also be useful to put nets over doors and windows or to use insect repellents.<ref name="Prevention"/>
* Use of insecticide-impregnated dog collars and treatment or culling of infected dogs.{{cn|date=January 2023}}
* Spraying houses and animal shelters with insecticides.<ref name=contphle>* {{cite journal | vauthors = Alexander B, Maroli M | title = Control of phlebotomine sandflies | journal = Medical and Veterinary Entomology | volume = 17 | issue = 1 | pages = 1–18 | date = March 2003 | pmid = 12680919 | doi = 10.1046/j.1365-2915.2003.00420.x | s2cid = 31387956 | doi-access = free }}</ref>

==Treatment==
[[File:Paromomycin structure.svg|thumb|right|[[Chemistry:Paromomycin|Paromomycin]] is an inexpensive (US$10) and effective treatment for leishmaniasis.]]
The treatment is determined by where the disease is acquired, the species of ''Leishmania'', and the type of infection.<ref name=WHO2014/>
<!-- Visceral -->
For visceral leishmaniasis in India, South America, and the Mediterranean, liposomal amphotericin B is the recommended treatment and is often used as a single dose.<ref name=Barrett2012/><ref name=Sun2013/> Rates of cure with a single dose of amphotericin have been reported as 95%.<ref name=Barrett2012/> In India, almost all infections are resistant to pentavalent antimonials.<ref name=Barrett2012/> In Africa, a combination of pentavalent antimonials and paromomycin is recommended.<ref name="Sun2013"/> These, however, can have significant side effects.<ref name=Barrett2012/> [[Chemistry:Miltefosine|Miltefosine]], an oral medication, is effective against both visceral and cutaneous leishmaniasis.<ref name="Dor2012"/> Side effects are generally mild, though it can cause birth defects if taken within three months of getting pregnant.<ref name=Barrett2012/><ref name=Dor2012/> It does not appear to work for ''L. major'' or ''L. braziliensis''.<ref name=Min2007/>

<!-- Cutaneous  -->
The evidence around the treatment of cutaneous leishmaniasis is poor.<ref name=Barrett2012/> A number of topical treatments may be used for cutaneous leishmaniasis. Which treatments are effective depends on the strain, with topical paromomycin effective for ''L. major'', ''L. tropica'', ''L. mexicana'', ''L. panamensis'', and ''L. braziliensis''.<ref name="Min2007"/> Pentamidine is effective for ''L. guyanensis''.<ref name=Min2007/> Oral [[Chemistry:Fluconazole|fluconazole]] or [[Chemistry:Itraconazole|itraconazole]] appears effective in ''L. major'' and ''L. tropica''.<ref name=Barrett2012/><ref name=Min2007/> There is limited evidence to support the use of [[Medicine:Heat therapy|heat therapy]] in cutaneous leishmaniasis as of 2015.<ref>{{cite journal | vauthors = Von Stebut E | title = Leishmaniasis | journal = Journal of the German Society of Dermatology | volume = 13 | issue = 3 | pages = 191–200; quiz 201 | date = March 2015 | pmid = 25721626 | doi = 10.1111/ddg.12595 | s2cid = 221649492 }}</ref>

There are no studies determining the effect of oral nutritional supplements on visceral leishmaniasis being treated with anti-leishmanial drug therapy.<ref>{{cite journal | vauthors = Custodio E, López-Alcalde J, Herrero M, Bouza C, Jimenez C, Storcksdieck Genannt Bonsmann S, Mouratidou T, López-Cuadrado T, Benito A, Alvar J | title = Nutritional supplements for patients being treated for active visceral leishmaniasis | journal = The Cochrane Database of Systematic Reviews | volume = 2018 | pages = CD012261 | date = March 2018 | issue = 3 | pmid = 29578237 | pmc = 6494195 | doi = 10.1002/14651858.CD012261.pub2 | collaboration = Cochrane Infectious Diseases Group }}</ref>

==Epidemiology==
[[File:Parasite130072-fig1 Map of cutaneous leishmaniasis in North Africa.tif|thumb|left|Cutaneous leishmaniasis in North Africa; ''Leishmania infantum'' = green, ''Leishmania major'' = blue'', Leishmania tropica'' = red<ref name=Aoun>{{cite journal | vauthors = Aoun K, Bouratbine A | title = Cutaneous leishmaniasis in North Africa: a review | journal = Parasite | volume = 21 | pages = 14 | year = 2014 | pmid = 24626301 | pmc = 3952656 | doi = 10.1051/parasite/2014014 }}  {{open access}}</ref>]]

[[File:Leishmaniasis world map - DALY - WHO2002.svg|thumb|upright=1.15|[[Disability-adjusted life year]] for leishmaniasis per 100,000&nbsp;inhabitants.{{Div col|small=yes|colwidth=10em}}
{{legend|#b3b3b3|no data}}
{{legend|#ffff65|less than 20}}
{{legend|#fff200|20–30}}
{{legend|#ffdc00|30–40}}
{{legend|#ffc600|40–50}}
{{legend|#ffb000|50–60}}
{{legend|#ff9a00|60–70}}
{{legend|#ff8400|70–80}}
{{legend|#ff6e00|80–100}}
{{legend|#ff5800|100–120}}
{{legend|#ff4200|120–150}}
{{legend|#ff2c00|150–200}}
{{legend|#cb0000|more than 200}}
{{div col end}}]]
Out of 200 countries and territories reporting to WHO, 97 countries and territories are endemic for leishmaniasis.<ref>{{cite web |title=Leishmaniasis: Situation and trends |url=https://www.who.int/gho/neglected_diseases/leishmaniasis/en/ |website=WHO Global Health Observatory |access-date=30 May 2018}}</ref> The settings in which leishmaniasis is found range from rainforests in Central and South America to deserts in western Asia and the Middle East. It affects as many as 12 million people worldwide, with 1.5–2.0 million new cases each year.<ref>{{cite web | url = https://www.who.int/leishmaniasis/burden/magnitude/burden_magnitude/en/index.html | title = Leishmaniasis: Magnitude of the problem | archive-url = https://web.archive.org/web/20131026230723/http://www.who.int/leishmaniasis/burden/magnitude/burden_magnitude/en/index.html | archive-date=26 October 2013 | publisher = World Health Organization }}</ref> The visceral form of leishmaniasis has an estimated incidence of 500,000 new
cases.<ref name="BBC_2006-04-23">{{cite news |url=http://news.bbc.co.uk/1/hi/health/4930528.stm |title=Hope for tropical disease vaccine |work=BBC News |date=April 23, 2006 |url-status=live |archive-url=https://web.archive.org/web/20060427154147/http://news.bbc.co.uk/1/hi/health/4930528.stm |archive-date=27 April 2006 |df=dmy-all }}</ref> In 2014, more than 90% of new cases reported to WHO occurred in six countries: Brazil, Ethiopia, India, Somalia, South Sudan and Sudan.<ref>{{cite web |title=Epidemiological situation: Epidemiology |url=https://www.who.int/leishmaniasis/burden/en/ |archive-url=https://web.archive.org/web/20040630170300/http://www.who.int/leishmaniasis/burden/en/ |url-status=dead |archive-date=30 June 2004 |website=World Health Organization |access-date=30 May 2018}}</ref> {{As of|2010|post=,}} it caused about 52,000 deaths, down from 87,000 in 1990.<ref name=Loz2012/> Different types of the disease occur in different regions of the world.<ref name=WHO2014/> Cutaneous disease is most common in Afghanistan, Algeria, Brazil, Colombia, and Iran, while mucocutaneous disease is most common in Bolivia, Brazil, and Peru, and visceral disease is most common in Bangladesh, Brazil, Ethiopia, India, and Sudan.<ref name=WHO2014/>

Leishmaniasis is found through much of the [[Earth:Americas|Americas]] from northern {{wipe|Argentina}} to South Texas, though not in Uruguay or {{wipe|Chile}}, and has recently been shown to be spreading to North Texas and Oklahoma,<ref name="Dallas News">{{cite web|url=http://www.dallasnews.com/sharedcontent/dws/dn/latestnews/stories/091507dnmetskin.d3fcc2e2.html |title=Dallas News: Rare, non-fatal skin disease found in N. Texans |access-date=2015-06-02 |url-status=dead |archive-url=https://web.archive.org/web/20091227070142/http://www.dallasnews.com/sharedcontent/dws/dn/latestnews/stories/091507dnmetskin.d3fcc2e2.html |archive-date=December 27, 2009 }}</ref><ref>{{cite journal | vauthors = Clarke CF, Bradley KK, Wright JH, Glowicz J | title = Case report: Emergence of autochthonous cutaneous leishmaniasis in northeastern Texas and southeastern Oklahoma | journal = The American Journal of Tropical Medicine and Hygiene | volume = 88 | issue = 1 | pages = 157–61 | date = January 2013 | pmid = 23185078 | pmc = 3541728 | doi = 10.4269/ajtmh.2012.11-0717 }}</ref> and further expansion to the north may be [[Earth:Climate change and infectious diseases|facilitated by climate change]] as more habitat becomes suitable for vector and reservoir species for leishmaniasis.<ref>{{cite journal | vauthors = González C, Wang O, Strutz SE, González-Salazar C, Sánchez-Cordero V, Sarkar S | title = Climate change and risk of leishmaniasis in north america: predictions from ecological niche models of vector and reservoir species | journal = PLOS Neglected Tropical Diseases | volume = 4 | issue = 1 | pages = e585 | date = January 2010 | pmid = 20098495 | pmc = 2799657 | doi = 10.1371/journal.pntd.0000585  | veditors = Galvani AP | doi-access = free }}</ref> Leishmaniasis is also known as ''papalomoyo'', ''papa lo moyo,'' ''úlcera de los chicleros'', and ''chiclera'' in Latin America.<ref name="http://almanaqueept.net/">{{cite web |url= http://www.almanaqueept.net/Publicaciones/1985/198525.pdf |title=Papalomoyo |access-date=2010-08-16 |url-status=dead |archive-url=https://web.archive.org/web/20110723012227/http://www.almanaqueept.net/Publicaciones/1985/198525.pdf |archive-date=2011-07-23 }}</ref> During 2004, an estimated 3,400 troops from the Colombian army, operating in the jungles near the south of the country (in particular around the Meta and Guaviare departments), were infected with leishmaniasis. Allegedly, a contributing factor was that many of the affected soldiers did not use the officially provided [[Chemistry:Insect repellent|insect repellent]] because of its disturbing odor. Nearly 13,000 cases of the disease were recorded in all of Colombia throughout 2004, and about 360 new instances of the disease among soldiers had been reported in February 2005.<ref>{{cite web|url=http://www.serviciojesuitaarefugiados-vzla.org/informes/infront-feb2005.html |url-status=dead |archive-url=https://web.archive.org/web/20051110025422/http://www.serviciojesuitaarefugiados-vzla.org/informes/infront-feb2005.html |archive-date=10 November 2005 |title=Informes – Informe de Fronteras Febrero 2005 |publisher=Servicio Jesuita a Refugiados}}</ref>

The disease is found across much of Asia, and in the Middle East. Within Afghanistan, leishmaniasis occurs commonly in [[Place:Kabul|Kabul]], partly due to bad sanitation and waste left uncollected in streets, allowing parasite-spreading sand flies an environment they find favorable.<ref>{{cite web | url = http://english.aljazeera.net/NR/exeres/8A2BB5AC-A330-4AF3-8ABA-7177872EC80F.htm | work = Al Jazeera English | title = CENTRAL/S. ASIA – Kabul: A city in intensive care | archive-url = https://web.archive.org/web/20070618183239/http://english.aljazeera.net/NR/exeres/8A2BB5AC-A330-4AF3-8ABA-7177872EC80F.htm | archive-date = June 18, 2007 }}</ref><ref>{{cite web| first = Robert | last = Birsel | date=May 7, 2007 |title=Disfiguring skin disease plagues Afghanistan |url=http://www.e-ariana.com/ariana/eariana.nsf/allDocs/3D54699903FBCF92872572D4004E8BA7?OpenDocument |agency=Reuters |work=e-Ariana |access-date=8 December 2015 |url-status=dead |archive-url=https://web.archive.org/web/20151210183201/http://www.e-ariana.com/ariana/eariana.nsf/allDocs/3D54699903FBCF92872572D4004E8BA7?OpenDocument |archive-date=10 December 2015 }}</ref> In Kabul, the number of people infected was estimated to be at least 200,000, and in three other towns ([[Place:Herat|Herat]], [[Place:Kandahar|Kandahar]], and [[Place:Mazar-i-Sharif|Mazar-i-Sharif]]) about 70,000 more occurred, according to WHO figures from 2002.<ref>{{cite web| first = Robert | last = Birsel |date=June 28, 2002 |title=Disfiguring epidemic hits 270,000 Afghans |url=http://www.e-ariana.com/ariana/eariana.nsf/7eca40d3d348841987256b79007d1cb8/70a208df652a4ced87256c04004f922a?OpenDocument |agency=Reuters |work=e-Ariana |access-date=December 8, 2015 |url-status=dead |archive-url=https://web.archive.org/web/20151210213154/http://www.e-ariana.com/ariana/eariana.nsf/7eca40d3d348841987256b79007d1cb8/70a208df652a4ced87256c04004f922a?OpenDocument |archive-date=December 10, 2015 }}</ref><ref>{{cite web|url=https://www.voanews.com/a/a-13-a-2002-06-28-2-who/392333.html|title=WHO Seeking Funds to Prevent Leishmaniasis Outbreak in Afghanistan|date=October 2009|website=voanews}}</ref> Kabul is estimated as the largest center of cutaneous leishmaniasis in the world, with around 67,500 cases as of 2004.<ref>{{cite web | url = https://www.who.int/mediacentre/news/releases/2004/pr55/en/index.html | title = World Health Organization action in Afghanistan aims to control debilitating leishmaniasis | archive-url = https://web.archive.org/web/20101026134647/http://www.who.int/mediacentre/news/releases/2004/pr55/en/index.html | archive-date = 26 October 2010 }}</ref> Africa, in particular the [[Place:East Africa|East]] and [[Place:North Africa|North]],<ref name=Aoun/> is also home to cases of leishmaniasis. Leishmaniasis is considered endemic also in some parts of southern parts of western Europe and spreading towards north in recent years.<ref>{{cite journal | vauthors = Medlock JM, Hansford KM, Van Bortel W, Zeller H, Alten B | title = A summary of the evidence for the change in European distribution of phlebotomine sand flies (Diptera: Psychodidae) of public health importance | journal = Journal of Vector Ecology | volume = 39 | issue = 1 | pages = 72–7 | date = June 2014 | pmid = 24820558 | doi = 10.1111/j.1948-7134.2014.12072.x | s2cid = 20645170 | doi-access = free }}</ref> For example, an outbreak of cutaneous and visceral leishmaniasis was reported from Madrid, Spain, between 2010 and 2012.<ref>{{cite journal | vauthors = Aguado M, Espinosa P, Romero-Maté A, Tardío JC, Córdoba S, Borbujo J | title = Outbreak of cutaneous leishmaniasis in Fuenlabrada, Madrid | journal = Actas Dermo-Sifiliograficas | volume = 104 | issue = 4 | pages = 334–42 | date = May 2013 | pmid = 23567452 | doi = 10.1016/j.adengl.2013.03.005 | doi-access = free }}</ref>

Leishmaniasis is mostly a disease of the developing world, and is rarely known in the developed world outside a small number of cases, mostly in instances where troops are stationed away from their home countries. Leishmaniasis has been reported by U.S. troops stationed in Saudi Arabia and Iraq since the Gulf War of 1990, including visceral leishmaniasis.<ref>{{cite web|url=http://www.veteransforcommonsense.org/index.php/veterans-category-articles/1649-kelly-kennedy |publisher=Veterans for Common Sense |first=Kelly |last=Kennedy |date=30 March 2010 |title=VCS Advocacy in the News: VA May Designate 9 Infectious Diseases as Related to Gulf War |access-date=10 February 2011 |url-status=dead |archive-url=https://web.archive.org/web/20110213124549/http://www.veteransforcommonsense.org/index.php/veterans-category-articles/1649-kelly-kennedy |archive-date=13 February 2011 }}</ref><ref>{{cite web | url = http://www.sptimes.com/2004/06/09/Business/Company_s_mesh_will_h.shtml | title = Business: Company's mesh will help troops beat 'Baghdad boils' | archive-url = https://web.archive.org/web/20050316065427/http://www.sptimes.com/2004/06/09/Business/Company_s_mesh_will_h.shtml | archive-date = 16 March 2005 }}</ref><ref>{{cite web |url=http://www.pdhealth.mil/downloads/Leishmaniasis_exsu_16Mar042.pdf |title=Archived copy |access-date=2007-09-17 |url-status=dead |archive-url=https://web.archive.org/web/20071012192134/http://www.pdhealth.mil/downloads/Leishmaniasis_exsu_16Mar042.pdf |archive-date=12 October 2007 |df=dmy-all }}</ref>
In September 2005, the disease was contracted by at least four Dutch marines who were stationed in Mazar-i-Sharif, Afghanistan, and subsequently repatriated for treatment.<ref>{{cite book|title=Leishmaniasis: Biology, Control and New Approaches for Its Treatment| first1 = Saurabh | last1 = Bhatia | first2 = Divakar | last2 = Goli |publisher=CRC Press|year=2016|isbn=9781315341897}}</ref><ref>{{cite journal | vauthors = van Thiel PP, Leenstra T, de Vries HJ, van der Sluis A, van Gool T, Krull AC, van Vugt M, de Vries PJ, Zeegelaar JE, Bart A, van der Meide WF, Schallig HD, Faber WR, Kager PA | title = Cutaneous leishmaniasis (Leishmania major infection) in Dutch troops deployed in northern Afghanistan: epidemiology, clinical aspects, and treatment | journal = The American Journal of Tropical Medicine and Hygiene | volume = 83 | issue = 6 | pages = 1295–300 | date = December 2010 | pmid = 21118937 | pmc = 2990047 | doi = 10.4269/ajtmh.2010.10-0143 }}</ref>

==History==
[[File:JerichoButtons.jpg|thumb|A 1917 case of [[Medicine:Cutaneous leishmaniasis|cutaneous leishmaniasis]] in the Middle East, known then locally as "Jericho buttons" for the frequency of cases near the ancient city of Jericho]]

Descriptions of conspicuous lesions similar to cutaneous leishmaniasis appear on tablets from King Ashurbanipal from the seventh century BCE, some of which may have derived from even earlier texts from 1500 to 2500 BCE. Persian physicians, including [[Biography:Avicenna|Avicenna]] in the 10th century CE, gave detailed descriptions of what was called ''balkh'' sore.<ref>
{{cite journal | vauthors = Cox FE | title = History of human parasitology | journal = Clinical Microbiology Reviews | volume = 15 | issue = 4 | pages = 595–612 | date = October 2002 | pmid = 12364371 | pmc = 126866 | doi = 10.1128/CMR.15.4.595-612.2002 | publisher = The Wellcome Trust | isbn = 978-1-869835-86-6 | df = dmy-all | oclc = 35161690 }}</ref>  In 1756, Alexander Russell, after examining a Turkish patient, gave one of the most detailed clinical descriptions of the disease. Physicians in the [[Earth:Indian subcontinent|Indian subcontinent]] would describe it as ''kala-azar'' (pronounced ''kālā āzār'', the [[Social:Urdu|Urdu]], [[Social:Hindi|Hindi]], and [[Social:Hindustani language|Hindustani]] phrase for "black fever", ''kālā'' meaning black and ''āzār'' meaning fever or disease). In the [[Earth:Americas|Americas]], evidence of the cutaneous form of the disease in Ecuador and Peru appears in pre-Inca pottery depicting skin lesions and deformed faces dating back to the first century CE. Some 15th- and 16th-century texts from the Inca period and from Spanish colonials mention "valley sickness", "Andean sickness", or "white leprosy", which are likely to be the cutaneous form.<ref>{{cite web | title = WHO: Leishmaniasis background information – a brief history of the disease | url =https://www.who.int/leishmaniasis/en/ | url-status = live | archive-url = https://web.archive.org/web/20140315040939/http://www.who.int/leishmaniasis/en/ | archive-date = 15 March 2014 | df = dmy-all }}
</ref>

It remains unclear who first discovered the organism. David Douglas Cunningham, Surgeon Major of the British Indian army, may have seen it in 1885 without being able to relate it to the disease.<ref>
{{cite book| vauthors = Cunningham DD | title = On the presence of peculiar parasitic organisms in the tissue of a specimen of Delhi boil  | publisher = Printed by the superintendent of government printing, India  | series = Scientific memoirs officers Medical Sanitary Departments Government India  | location =Calcutta | pages = 21–31| year = 1885  | oclc = 11826455  }}</ref><ref>{{cite journal | vauthors = Cox FE | title = History of human parasitology | journal = Clinical Microbiology Reviews | volume = 15 | issue = 4 | pages = 595–612 | date = October 2002 | pmid = 12364371 | pmc = 126866 | doi = 10.1128/CMR.15.4.595-612.2002 }}</ref> Peter Borovsky, a Russian military surgeon working in [[Place:Tashkent|Tashkent]], conducted research into the etiology of "oriental sore", locally known as ''sart'' sore, and in 1898 published the first accurate description of the causative agent, correctly described the parasite's relation to host tissues and correctly referred it to the [[Biology:Protozoa|protozoa]]. However, because his results were published in Russian in a journal with low circulation, his results were not internationally acknowledged during his lifetime.<ref name="Hoare1938">{{cite journal| vauthors = Hoare CA | year = 1938 | title = Early discoveries regarding the parasite of oriental sore | journal = Transactions of the Royal Society of Tropical Medicine and Hygiene | volume = 32 | issue = 1 | pages = 67–92 | doi = 10.1016/S0035-9203(38)90097-5 }}</ref> In 1901, William Boog Leishman identified certain organisms in smears taken from the [[Biology:Spleen|spleen]] of a patient who had died from "dum-dum fever" (Dum Dum is an area close to Calcutta) and proposed them to be trypanosomes, found for the first time in {{wipe|India}}.<ref name="Leishman">{{cite journal| vauthors = Leishman WB | year = 1903 | title = On the possibility of the occurrence of trypanomiasis in India | journal = The British Medical Journal| volume = 1 | issue = 2213 | pages = 1252–1254 | doi = 10.1136/bmj.1.2213.1252 | pmc = 2514706 }}</ref> A few months later, Captain Charles Donovan (1863–1951) confirmed the finding of what became known as Leishman-Donovan bodies in smears taken from people in Madras in southern India.<ref name="Donovan">{{cite journal| vauthors = Donovan C | year = 1903| title = Memoranda: On the possibility of the occurrence of trypanomiasis in India | journal = The British Medical Journal}}</ref>  But it was [[Biography:Ronald Ross|Ronald Ross]] who proposed that Leishman-Donovan bodies were the intracellular stages of a new parasite, which he named ''Leishmania donovani''.<ref name="Ross">{{cite journal | vauthors = Ross R | title = Further Notes on Leishman's Bodies | journal = British Medical Journal | volume = 2 | issue = 2239 | pages = 1401 | date = November 1903 | pmid = 20761210 | pmc = 2514909 | doi = 10.1136/bmj.2.2239.1401 }}</ref> The link with the disease ''kala-azar'' was first suggested by Charles Donovan, and was conclusively demonstrated by Charles Bentley's discovery of ''L. donovani'' in patients with ''kala-azar''.<ref name="Bentley">{{cite journal| vauthors = Bentley CA | title =Telegram to R. Ross | date = 24 December 1903 | journal = Ross Archives | page = 47/157}}</ref> Transmission by the sandfly was hypothesized by Lionel Napier and Ernest Struthers at the School of Tropical Medicine at Calcutta and later proven by his colleagues.<ref name="IMG">{{cite journal | title = Dr. L. Everard Napier | journal = The Indian Medical Gazette | volume = 78 | issue = 5 | pages = 252 | date = May 1943 | pmid = 29012190 | pmc = 5158438 }}</ref><ref name=":7">{{cite journal|last=Gewurtz|first=Margo S. |date=2017-01-01|title=Transnationalism in Missionary Medicine: The Case of Kala-azar in China and India, 1909–1946|journal=Social Sciences and Missions|language=en|volume=30|issue=1–2|pages=30–43|doi=10.1163/18748945-03001001|issn=1874-8945}}</ref> The disease became a major problem for Allied troops fighting in Sicily during the Second World War; research by Leonard Goodwin then showed pentostam was an effective treatment.<ref name="tel">{{cite news|url=https://www.telegraph.co.uk/news/obituaries/4241645/Leonard-Goodwin.html|title=Leonard Goodwin – Telegraph|date=14 January 2009|publisher=The Daily Telegraph|access-date=2009-01-18|url-status=live|archive-url=https://web.archive.org/web/20090420055410/http://www.telegraph.co.uk/news/obituaries/4241645/Leonard-Goodwin.html|archive-date=20 April 2009|df=dmy-all}}</ref>

==Society and culture==
The Institute for OneWorld Health has reintroduced the drug [[Chemistry:Paromomycin|paromomycin]] for treatment of leishmaniasis, results with which led to its approval as an [[Chemistry:Orphan drug|orphan drug]]. The [[Medicine:Drugs for Neglected Diseases Initiative|Drugs for Neglected Diseases Initiative]] is also actively facilitating the search for novel therapeutics. A treatment with paromomycin will cost about US$10. The drug had originally been identified in the 1950s, but had been abandoned because it would not be profitable, as the disease mostly affects poor people.<ref>{{cite web |url = https://www.nytimes.com/2006/07/31/health/31charity.html |title = A Small Charity Takes the Reins in Fighting a Neglected Disease |archive-url = https://web.archive.org/web/20161220101801/http://www.nytimes.com/2006/07/31/health/31charity.html |archive-date = 20 December 2016 |work = {{wipe|New York Times}} |date = 31 July 2006 }}</ref> The Indian government approved paromomycin for sale in August 2006.<ref>{{cite web |url=http://www.oneworldhealth.org/drug_program |title=Drug Program – Clinical Trial of Paromomycin |publisher=Institute for OneWorld Health |access-date=10 February 2011 |url-status=dead |archive-url=https://web.archive.org/web/20100606042359/http://www.oneworldhealth.org/drug_program |archive-date= 6 June 2010 }}</ref>

By 2012 the World Health Organization had successfully negotiated with the manufacturers to achieve a reduced cost for liposomal amphotericin B, to US$18 a vial, but a number of vials are needed for treatment and it must be kept at a stable, cool temperature.<ref name=Barrett2012/>

==Research==
{{Main|Medicine:Leishmaniasis vaccine}}
[[File:Leishmania culture in hood 2.jpg|thumb|right|A parasitologist working on ''L. major'' in a biocontainment hood]]

As of 2017, no [[Medicine:Leishmaniasis vaccine|leishmaniasis vaccine]] for humans was available.<ref name="Srivastava 2016">{{cite journal | vauthors = Srivastava S, Shankar P, Mishra J, Singh S | title = Possibilities and challenges for developing a successful vaccine for leishmaniasis | journal = Parasites & Vectors | volume = 9 | issue = 1 | pages = 277 | date = May 2016 | pmid = 27175732 | pmc = 4866332 | doi = 10.1186/s13071-016-1553-y | doi-access = free }}</ref><ref name="Ghorbani_2018" /> Research to produce a human vaccine is ongoing.<ref name="Ghorbani_2018">{{cite journal | vauthors = Ghorbani M, Farhoudi R | title = Leishmaniasis in humans: drug or vaccine therapy? | journal = Drug Design, Development and Therapy | volume = 12 | pages = 25–40 | date = 2018 | pmid = 29317800 | doi = 10.2147/DDDT.S146521 | doi-access = free | pmc = 5743117 }}</ref>

Currently some effective leishmaniasis vaccines for dogs exist.<ref name="Moafi 2019">{{cite journal | vauthors = Moafi M, Rezvan H, Sherkat R, Taleban R | title = Leishmania Vaccines Entered in Clinical Trials: A Review of Literature | journal = International Journal of Preventive Medicine | volume = 10 | pages = 95 | date = 2019 | pmid = 31360342 | pmc = 6592111 | doi = 10.4103/ijpvm.IJPVM_116_18 | doi-access = free }}</ref> There is also consideration that public health practices can control or eliminate leishmaniasis without a vaccine.<ref name="Ghorbani_2018"/> [[Chemistry:Pyrimidine|Pyrimidine]]–based drugs are being explored as anti-leishmanial compounds.<ref>{{cite journal |last1=Ramesh |first1=Deepthi |last2=Sarkar |first2=Deblina |last3=Joji |first3=Annu |last4=Singh |first4=Monica |last5=Mohanty |first5=Amaresh K. |last6=G. Vijayakumar |first6=Balaji |last7=Chatterjee |first7=Mitali |last8=Sriram |first8=Dharmarajan |last9=Muthuvel |first9=Suresh K. |last10=Kannan |first10=Tharanikkarasu |date=April 2022 |title=First-in-class pyrido[2,3- d ]pyrimidine-2,4(1 H ,3 H )-diones against leishmaniasis and tuberculosis: Rationale, in vitro, ex vivo studies and mechanistic insights |url=https://onlinelibrary.wiley.com/doi/10.1002/ardp.202100440 |journal=Archiv der Pharmazie |language=en |volume=355 |issue=4 |pages=2100440 |doi=10.1002/ardp.202100440 |pmid=35106845 |s2cid=246474821 |issn=0365-6233}}</ref>

== See also ==
* Canine vector-borne disease
* [[Medicine:Tropical disease|Tropical disease]]
* [https://www.youtube.com/watch?v=gYpw_KoFAvw How a Youtuber got treatment]
{{clear}}

== References ==
{{Reflist}}

== External links ==
{{offline|med}}
* {{curlie|Health/Conditions_and_Diseases/Infectious_Diseases/Parasitic/Leishmaniasis}}
* [http://www.doctorswithoutborders.org/our-work/medical-issues/kala-azar-leishmaniasis Doctors Without Borders' Leishmaniasis Information Page]
* [https://www.cdc.gov/parasites/leishmaniasis/ CDC Leishmaniasis Page]

{{Medical condition classification and resources
| ICD10           = {{ICD10|B|55||b|50}}
| ICD9            = {{ICD9|085}}
| DiseasesDB      = 3266
| DiseasesDB_mult = {{DiseasesDB2|29171}}<!--  {{DiseasesDB2|3266}} {{DiseasesDB2|7070}} -->
| MedlinePlus     = 001386
| eMedicineSubj   = emerg
| eMedicineTopic  = 296
| MeshID          = D007896
}}
{{Protozoal diseases}}

[[Category:Tropical diseases]]
[[Category:Wikipedia medicine articles ready to translate]]
[[Category:Zoonoses]]

{{Sourceattribution|Leishmaniasis}}