Likely due to massive civil unrest in war torn Libya, scores of people in the capital city of Tripoli have sought medical attention for leishmaniasis, a parasitic infection transmitted to people via the bite of a sandfly vector, according to a Libya Herald report.
The chaotic situation in Libya likely has resulted in a breakdown in vector control and public health measures; however, Libya has experienced leishmaniasis outbreaks in previous years when thousands were infected.
Leishmaniasis is not a single disease, but a group of syndromes due to a variety of species of this parasite. The affect different populations and are related to a characteristic vector, the sandfly.
The disease can range from asymptomatic infections to those causing significant illness and death. Disease can appear on a spectrum from a single skin ulcer to destructive lesions of the face to terminal organ disease.
Leishmaniasis is found in 88 countries worldwide and is broken down between Old World and New World. Old World leishmaniasis is primarily found in parts of Asia, East and North Africa, Soouthern Europe and the Middle East.
New World leishmaniasis occurs from northern Mexico to northern Argentina, with rare cases reported in parts of Texas and Oklahoma. In South America it is not found in Chile or Uruguay.
Leishmaniasis in the US is typically indicative of immigration and travel.
The vector for this parasite is a phlebotomine sandfly. There are a few different species implicated depending on the part of the world.
Sandflies are very small (about 1/3 the size of a mosquito) and make no noise when flying. There bites can sometimes be painless; because of these reasons, many people have no idea they were bitten.
Even one bite of a sandfly can transmit disease, so travelers on short trips can still get infected.
When the female sandfly takes a blood meal it injects the parasite into the wound. Macrophages pick up the parasite and here they multiply until the cell bursts from overcrowding. The parasite goes on to infect more macrophages.
Some of these cells get carried to organs of the body including the liver, spleen and the bone marrow.
There are several species of Leishmania that cause disease in humans. The most common are Leishmania donovani (kala-azar), L. tropica (Baghdad boil), and L. braziliensis (espundia).
After getting bitten by a sandfly, disease may manifest itself from a week to many months later.
It starts out as a papule that enlarges to an ulcer. The ulcer can give the appearance of a volcano crater. Lesions may appear singly or multiple; many heal spontaneously within weeks to months to years.
Certain species (L. braziliensis) can disseminate to the mucosal areas of the face and mouth and cause very destructive and disfiguring disease (espundia) that appears similar to leprosy.
Kala-azar, an Indian name given to systemic type of the disease due to the grayish appearance of the body, can result in enlarged spleen and liver, diarrhea, emaciation, weakness and death.
There is not a vaccine available to prevent leishmaniasis. The best way is to avoid sandfly bites.
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