Leishmaniasis: Prevention and Treatment Guide for UK Travellers

Leishmaniasis is a disease caused by Leishmania parasites. These parasites are transmitted to humans through the bites of infected female sandflies. While sandflies are much smaller than mosquitoes and often bite silently, the impact of the infection they carry can be significant for travellers. According to NICE (National Institute for Health and Care Excellence) and the NHS, leishmaniasis is not found in the UK, but it is a recognised risk for those visiting specific regions abroad.

There are three main forms of the disease: Cutaneous leishmaniasis, which affects the skin; Mucocutaneous leishmaniasis, which affects the nose, mouth, and throat; and Visceral leishmaniasis (also known as kala-azar), which affects internal organs like the spleen and liver. For most UK travellers, the cutaneous form is the most frequently encountered, often presenting as persistent skin ulcers after returning from holiday.

The symptoms of leishmaniasis depend on the type of infection. Because the incubation period can be long, you might not notice signs until weeks or even months after you have returned to the UK.

Cutaneous Leishmaniasis

This is the most common form. It typically starts as a small bump or papule at the site of a sandfly bite. Over time, this may develop into:

• Chronic skin ulcers with a raised edge and central crater.
• Sores that may be painless or slightly itchy.
• Swollen glands (lymph nodes) near the site of the sores.
• Scabs or plaques that do not heal with standard antiseptic creams.

Visceral Leishmaniasis

This is a more serious systemic form. Symptoms develop more slowly and include:

• Persistent fever and night sweats.
• Weight loss and loss of appetite.
• An enlarged spleen or liver, causing abdominal discomfort.
• Anaemia and increased susceptibility to other infections.

Sandflies thrive in warm, humid environments. British travellers should be particularly vigilant when visiting the following regions:

• Southern Europe: Including rural areas of Spain, Italy, Greece, and Turkey.
• The Middle East: Including Saudi Arabia, Iraq, and Afghanistan.
• Central and South America: Particularly Brazil, Peru, and Mexico.
• Asia and Africa: Including India, Pakistan, and parts of East Africa.

Sandflies are most active between dusk and dawn. They are often found in forested areas, gardens, or even stone walls in Mediterranean villages. Because they are so small, they can easily fly through standard mosquito nets if the mesh is not sufficiently fine.

As there is no vaccine or preventative medication for leishmaniasis available in the UK, prevention is entirely based on personal protection against bites. Public Health England recommends several layers of defence:

• Use Insect Repellent: Apply repellents containing at least 50% DEET to all exposed skin. Reapply frequently, especially in humid conditions.
• Cover Up: Wear long-sleeved shirts, long trousers, and socks when outdoors between sunset and sunrise.
• Treat Clothing: Use permethrin-based sprays on your clothing and gear for added protection.
• Fine-Mesh Bed Nets: If sleeping in high-risk areas, use a bed net treated with insecticide. Ensure the mesh is smaller than standard mosquito netting, as sandflies can fit through holes as small as 1mm.
• Stay High: Sandflies are poor fliers and generally stay close to the ground. Sleeping in upstairs rooms may slightly reduce the risk.

If you have recently returned from a country where leishmaniasis is present and notice any skin lesions that refuse to heal, you should seek medical advice. While many tropical skin conditions are harmless, leishmaniasis requires specialist identification. You can speak to a GP online for an initial assessment. An online doctor can review your travel history, look at photos of the affected area, and determine if you need a referral to a tropical medicine specialist or a dermatologist.

Speaking to a GP online is also highly beneficial for pre-travel advice. If you are planning a trip to a high-risk region, a clinician can provide tailored guidance on bite prevention and help you prepare a comprehensive travel health kit, ensuring you have the correct strength of repellents and understanding of the risks involved.

In the UK, suspected cases are usually referred to specialists, such as those at the Hospital for Tropical Diseases. Diagnosis involves taking a small sample (biopsy or scrape) from the skin lesion to look for the parasite under a microscope or through PCR testing.

Treatment depends on the severity and type of leishmaniasis. Small, localized cutaneous lesions may sometimes heal on their own, but medical intervention is often preferred to reduce scarring and prevent the disease from progressing. Treatments may include:

• Topical ointments or injections into the lesion.
• Cryotherapy (freezing the lesion).
• Oral medications or intravenous drugs for visceral or complex cutaneous cases.