Topic overview

Start with the big picture

Phlebotomine sandflies transmit Leishmania, with exposure risk increased by outdoor activity from dusk to dawn. Species clusters help orient the clinical picture: the L. donovani complex is associated with visceral disease, while other species are linked to Old-World cutaneous or New-World cutaneous and mucocutaneous syndromes. Diagnosis includes demonstrating amastigotes in tissue, with PCR or rk39 antigen serology used to confirm visceral disease. Treatment varies by syndrome and context: visceral disease has several systemic regimens, selected cutaneous lesions may be treated locally, and mucocutaneous disease requires systemic therapy. Important medication risks include cardiac, renal, hepatic, pancreatic, and infusion-related effects, so treatment selection and monitoring are central themes.