**vector**:: sand flies **epidemiology**:: Amazon region The incubation period is usually 1 to 2 weeks to 6 months, but there can be a latent period of up to 3 years. # signs and symptoms: - massive hepato-splenomegaly - pancytopaenia due to chronic macrophage infection - Leishmania infections can have **cutaneous** or **systemic manifestations** depending on parasite species and host factors, and they can remain asymptomatic. - HIV co-infection predisposes to severe or recurrent disease. ## Cutaneous leishmaniasis - manifests with skin ulcers, which are usually painless unless a secondary bacterial infection occurs. Most lesions heal spontaneously over a few months, leaving a scar. - A mucocutaneous form of the disease causes destruction of the mucous membranes of the nose, mouth, throat and surrounding tissues and can occasionally be fatal. ## Visceral leishmaniasis - (also known as kala-azar) manifests as **fever** with rigors, malaise, anorexia, lymphadenopathy and non-tender hepatosplenomegaly. - Malnutrition and anaemia occur as the disease becomes chronic. - The mortality is very high within 2 years if the disease remains untreated, although milder chronic forms also occur. # diagnosis The diagnosis can be confirmed by microscopy, culture or PCR. Treatment of leishmaniasis varies by clinical manifestation and geographic region; pentavalent antimony-containing preparations are often the most effective drugs. # treatment **prevention:** - diethyltoluamide (DEET)-containing insect repellents, covering exposed skin and insecticide spraying inside houses. - Sandflies are so small that they will pass through the mazes of bed nets that have not been treated with insecticide.