How can I treat the parasitic disease "Leishmaniasis" caused by a sand fly bite?
May 4, 2012 10:57 AM   Subscribe

Tropical Parasitic Disease Filter: Help! What treatments are available for Leishmaniasis, caused by the Sand Fly Parasite?

Dear anyone who might have any experiences with Leishmaniasis: Please help!

I am living and working in Cambodia. Last month, I returned from a trip to the coast with a sand fly bite on my calf that, over the course of the next few days, became noticeably infected.

At the time, I wasn't concerned -- I was taking good care of the wound with alcohol and regular cleaning, and it seemed to be on its way to healing : until it turned into an infected nickel-sized crater speckled with increased infection. What's more, a scratch (acquired at the same time as the bite) on my other foot now looks very similar to the infected bite, albeit smaller.

I am afraid that it is spreading and the site of the original infection is getting larger. I cannot find any information online about the treatment. I began to panic when I read that "treatment has traditionally been unsatisfactory because of drug toxicities, poor responses, multiple disease syndromes, and other factors". I also read that the only treatment is via the ingestion of antimony, a heavy metal.

Help dear Metafilter! Tomorrow, I am going to the local hospital. But, given that I do not know the language, I do not know what kind of treatment to expect -- or if they can even provide anything else than a more generic antibiotic.
posted by Aleatoire to Health & Fitness (9 answers total) 1 user marked this as a favorite
I'm not sure about the medical treatment, but have you tried contacting your embassy for assistance? They will help you navigate the health care there. If you are a US citizen, here is the contact information .
posted by goggie at 11:06 AM on May 4, 2012

I have no idea what treatment is like for humans, sorry, but my dog had this and it was successfully treated with twice daily Glucantime injections over the course of a few months. I was also directly exposed to it via blood to blood contact during the course of his treatment and never contracted the disease, so I assume the treatment is pretty damn efficacious.
posted by elizardbits at 11:06 AM on May 4, 2012

I think you need to contact your embassy as soon as possible.
posted by KokuRyu at 11:06 AM on May 4, 2012 [2 favorites]

Should have also included this link with a list of medical facilities that can help.
posted by goggie at 11:07 AM on May 4, 2012 [1 favorite]

There is medicine that can cure this (though it may depend on the presentation of the infection). A close friend of mine actually just finished several months of a drug treatment to cure his leishmaniasis. I don't think it was a big deal at all for him except that he could not drink alcohol because it interacts with the medicine. But, I am not sure he had any visible lesions so again, it may depend on the form of the disease (I believe it can be either systemic or acute/localized)
posted by imagineerit at 11:19 AM on May 4, 2012

I'm pasting the abstract from a recent article here:

We report a 48-year-old immunocompetent male, resident of Central India, who presented with slowly progressive asymptomatic multiple red lesions on different parts of body. On enquiry, the patient gave history of travel to Middle East 6 months back. Examination showed 10 crusted erythematous indurated plaques and nodules over forearms, left leg, right index finger, left wrist and dorsa of both feet. Histopathological examination of tissue biopsy showed multiple intracellular as well as extracellular leishmania donovan bodies. Keeping in mind the higher rate of side effects to pentavalent antimony, we treated this patient with oral miltefosine 50 mg bid and the lesions showed complete resolution over 4 months of therapy.

Indian Journal of Dermatology (INDIAN J DERMATOL), 2011 Sep-Oct; 56(5): 587-90

Looks promising, see if you can get some of it. Would be happy to send more abstracts and possibly full articles if you mefimail me an email address.
posted by mareli at 11:43 AM on May 4, 2012

There are many potential treatments for leishmaniasis and not all of them include pentavalent antimony. Cambodian doctors will certainly know how to diagnose and treat it. Are you going to the best hospital/clinic you can afford? Hospitals in Cambodia vary greatly in quality, but you are in a better position than we are to determine which ones are best.
posted by atrazine at 1:26 PM on May 4, 2012

Hang on, do you even have a diagnosis? Because this could be anything. There are probably a hundred and one different infections you could get from an infected insect bite, so don't just jump to the worst one.

The hospital may have someone who speaks fluent or reasonable English. Is there anyone from your workplace, or another ex-pat you know, who might be able to help you with translation if there isn't anyone at the hospital who you can communicate with directly?

I only have personal exerience of things that weren't (and weren't likely to be) leishmaniasis, but they were bacterial infections (that responded to antibiotics) that matched your description of symptoms. So it's entirely possible that antibiotics would be an appropriate treatment. Best wishes.
posted by Lebannen at 3:28 PM on May 4, 2012 [1 favorite]

I don't see much leishmaniasis, but I checked my trusty reference guide, and the first line treatment in the United States is sodium antimony gluconate. Second line is amphotericin B. Miltefosine is not available in the United States. Hopefully it is available where you are in Cambodia, because oral drugs would be a lot easier. IANYD. You need a Cambodian doctor who probably will be much more familiar with the treatment.

Definitely get it checked out before you self-diagnose though, please.
posted by treehorn+bunny at 3:52 PM on May 5, 2012

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