Leishmaniasis is an infection caused by intracellular protozoan parasites belonging to the genus Leishmania (L.) (see Diagnostic Code: 6301 Visceral leishmaniasis). The infections produce a wide array of clinical findings. Four broad categories of the condition are identified, based on the severity of human host involvement. The categories are as follows: cutaneous leishmaniasis (CL), diffuse cutaneous leishmaniasis (DCL), mucocutaneous leishmaniasis (MCL), and visceral leishmaniasis (VL).

The disease is worldwide in tropical and some temperate areas. Leishmania, a parasite, is transmitted by the bite of tiny female sandflies (Phlebotomus and Lutzomyia). Vector flies are infected by biting humans or animals. The infection is rarely spread by blood transfusion, congenitally, or sexually. The cause of the disease is also related to the system infected. Mucocutaneous leishmaniasis is caused by L. viannia braziliensis. This parasite is found in Central and South America.

The signs and symptoms of the disease depend on the following factors: the parasite's invasiveness and pathogenecity and the host's genetically determined immune response. Mucocutaneous (Espundia) Leishmaniasis is characterized by a primary cutaneous ulcer that appears after 2 to 3 months and lasts 6 to 15 months. The lesion closely resembles those of simple cutaneous Leishmaniasis (see Diagnostic Code: 7808 Old World leishmaniasis (cutaneous, Oriental sores)). The lesions involve the mucocutaneous membranes and can metastasize to nasopharyngeal tissues, usually within one year. However, the metastasis may occur years or even decades after the skin lesion has healed. There may be gross mutilations of the nose and palate, requiring reconstructive surgery. Skin tests may be negative during the active infection, become positive a few weeks to 2 years after a cure, and then remain positive for life.

The different parasite species are identified by isoenzyme determinations or within specific monoclonal antibodies and DNA probes, on cultures or smears from the lesions. Skin tests and blood tests are also done.

Treatment depends on the clinical form of the disease. Cutaneous leishmaniasis [see Diagnostic Code: 7808 Old World leishmaniasis (cutaneous, Oriental sores)] is self-limited and requires no specific treatment. For extensive lesions, intralesional injections of drugs specific for the disease are administered weekly.

Treatment failures are common. The person may experience side effects from the drugs. Some anti-fungal drugs are highly toxic and renal functional impairment is the main toxic risk. Creatinine and blood urea nitrogen (BUN) levels should be monitored during treatment. There may be a change in the person's body image if the nose is destroyed by the parasite, and reconstructive surgery is required. Counseling may be necessary.

Consider service connection on a presumptive basis as a tropical disease (38 CFR §3.307; §3.308; §3.309 (b)).

Evaluate non-cutaneous (visceral) leishmaniasis under DC 6301 (visceral leishmaniasis).