What is Leishmaniasis??

3 week untreated leishmaniasis lesion on lower leg

Leishmaniasis (often called “leish” or ‘peeko de vay-hoo-co’ by the Ngabe) is a tropical skin infection found in Panama. In Panama, Leshmaniasis exists in a natural reservoir of sloths and anteaters and is then passed to humans by female sandflies (chitras).  Once infected, a small red bump will appear on the skin, turn into a blister, and later break open to form a slowly spreading skin ulcer.  The sore is usually painless and not very itchy, and slowly enlarges over weeks.  A key feature to look for when diagnosing suspected leishmaniasis lesions is that it is a slowly enlarging skin ulcer that does not respond to antibiotic cream or wound care.

The Nbobe sometimes fight the infection with topical treatments, covering it in battery acid to burn it out, which seems to be effective if somewhat scarring—patients trade a very large, shallow scar of untreated leishmaniasis for a smaller, deeper scar from battery acid treatment.  There are some botanic remedies used by the curanderos that bear further investigation, such as applying the hot amber liquid expressed by heating the meat of a raw cashew nut, which we have seen used in some of the communities with promising results.

3 Leishmaniasis ulcers on young Ngabe girl in the Bahia Azul region

As far as western medicine is concerned, there is currently NO effective topical treatment for leishmaniasis, although antibiotic cream can be helpful to prevent a secondary infection of the lesion by other bacteria.  The two existing treatments, which are 98% effective, are daily intramuscular injections with antimony (a heavy metal) for up to 21 days, or an intravenous medication called amphotericin B, which is very expensive.   Leishmaniasis responds rapidly and well to these treatments.

Because the injections need to be taken every day, early identification is vital—the smaller the lesion, the fewer days of injections will be needed and the smaller the scar will be.  If left untreated the initial skin infection can spread, spawning lesions elsewhere on the skin, and involving the mucous membranes (eyes, mouth, nose) with devastating consequences.  If you are worried you or someone you know has leishmanisis, it is very important to get checked out as soon as possible.

There is no vaccine or preventative medicine that can be taken for leish, but there is one really good defense that is 100% effective if achieved—don’t get bitten!  Easier said than done when it comes to sandflies, but the best way to minimize you risk of infection is to protect yourself:  use bug spray, cover exposed skin, and use fans with airspeeds of 5+ MPH to keep insects away.  Mosquito nets don’t usually work against sandflies because of their small size unless the net is regularly treated.  Place the net in a plastic bag and spray/pour a lot of mosquito repellent (ideally with permethrin, but at least with DEET) into the bag.  This will deter anything from even landing on the net and trying to get through.  After all, there are way worse things than leishmaniasis that are carried on tiny wings…

Until next time, fair winds and safe travels!

Leishmaniasis scar on recovered Ngabe boy

Resolving leishmaniasis lesion week 6 (week 7 treatment)