Leishmaniasis: Prevention and Treatment for UK Travellers

Leishmaniasis is a parasitic infection caused by Leishmania parasites. These parasites are transmitted to humans through the bite of infected female phlebotomine sandflies. While not a household name in the UK, it is a significant concern for British travellers visiting tropical, subtropical, and Mediterranean regions.

According to NHS and clinical guidelines, the disease primarily manifests in two forms: Cutaneous Leishmaniasis (CL), which causes skin sores and ulcers, and Visceral Leishmaniasis (VL), also known as kala-azar, which affects internal organs such as the spleen, liver, and bone marrow. While cutaneous cases are more common, the visceral form is life-threatening if left untreated.

For UK residents planning trips abroad, understanding where the risk is highest is the first step in prevention. Leishmaniasis is endemic in over 90 countries. In popular British holiday destinations such as Spain, Italy, Greece, and Turkey, the risk is generally low but present, particularly in rural or forested areas.

Sandflies are significantly smaller than mosquitoes and often fly silently, making them harder to detect. They are most active during twilight, dusk, and nighttime hours. They typically thrive in moist soil, animal burrows, and organic debris. Unlike mosquitoes, sandflies do not usually bite through clothing, which provides a key opportunity for prevention.

The incubation period for leishmaniasis can be lengthy, meaning symptoms may not appear until you have returned to the UK. It is vital to monitor your health for several months post-travel.

Cutaneous Leishmaniasis

• One or more skin sores or ulcers that may be painless or painful.
• Sores that start as small bumps and eventually erupt into ulcers with a 'crater-like' appearance.
• Swollen glands near the site of the sores.
• Sores that take a very long time to heal (several months).

Visceral Leishmaniasis

• Persistent, unexplained fever.
• Significant weight loss and fatigue.
• Enlargement of the spleen and liver, often causing abdominal swelling.
• Anaemia and a low white blood cell count.

As there is currently no vaccine or preventative medication (prophylaxis) available in the UK for leishmaniasis, the focus must be on bite prevention. NICE and the UK Health Security Agency (UKHSA) recommend the following measures:

• Use Insect Repellent: Apply repellents containing 50% DEET to all exposed skin. In the UK, products like Jungle Formula or Autan are commonly used.
• Cover Up: Wear long-sleeved shirts, long trousers, and socks, especially from dusk until dawn. Tucking trousers into socks is highly effective against ground-dwelling sandflies.
• Treated Clothing: Consider treating clothes with permethrin, an insecticide that kills sandflies on contact.
• Bed Nets: If sleeping in non-air-conditioned or unscreened rooms, use a fine-mesh bed net treated with insecticide. Ensure the mesh is smaller than standard mosquito netting, as sandflies are tiny.
• Avoid Ground Level: If possible, sleep on higher floors of a building, as sandflies are weak fliers and usually stay close to the ground.

If you return to the UK and notice a persistent skin lesion or develop a fever after visiting an endemic area, you must seek medical advice. Diagnosis usually involves a skin biopsy or scraping of the ulcer for cutaneous cases, or blood tests and bone marrow aspirates for the visceral form.

Treatment in the UK is specialised and often managed by infectious disease or tropical medicine units. Treatments may include topical applications, injections of antimonial compounds, or oral antifungal medications like miltefosine. The choice of treatment depends on the species of the parasite and the severity of the infection. Early intervention is key to minimising permanent scarring from skin ulcers.

You should consider a consultation with an online doctor if you are planning a trip to a region where leishmaniasis is present and need a comprehensive travel health assessment. An online GP can help you understand the risks specific to your itinerary and advise on the most effective repellent products and bite prevention techniques.

Additionally, if you have returned from travel and have a skin sore that has not healed within three to four weeks—even if it is painless—speaking to a GP online is a convenient first step. They can review your travel history, examine the lesion via video or photos, and refer you to the appropriate NHS specialist service for definitive testing if leishmaniasis is suspected.