Whenever someone starts bragging about their imminent tropical vacation, I always stop and think to myself, "I'm glad I'm not going there!" The tropics might be filled with natural splendor and cultural beauty, but they are also filled with dismal diseases and pestilent parasites. Foremost in my mind is the horrid parasitic disease known as Leishmaniasis. Leishmaniasis is a parasitic disease acquired in tropical and subtropical areas of the world. Persons become infected through the bite of some species of sand flies. The infection usually is acquired in rural areas but may be acquired in some urban areas as well. The disease most commonly manifests either in a cutaneous (skin) form or in a visceral (internal organ) form. Cutaneous leishmaniasis is characterized by one or more skin sores (either open or closed) that develop weeks to months after a person is bitten by infected sand flies.

Leishmania can also cause systemic disease (visceral leishmaniasis) with fatal complications. When introduced into the body by the bite of a sandfly the parasite migrates to the bone marrow, spleen, and lymph nodes. Systemic infection in children usually of begins suddenly with vomiting, diarrhea, fever, and cough. In adults, fever for 2 weeks to 2 months is accompanied by nonspecific symptoms such as fatigue, weakness, and loss of appetite. Weakness increases as the disease progresses. The skin may become grayish, dark, dry and flaky. The parasites damage the immune system by decreasing the numbers of disease fighting cells so death usually results from complications of the disease such as infection rather than from the disease itself. Death often occurs within two years.

Vaccines and drugs for preventing infection are not currently available. Doesn't that suck? So - what must you do to prevent infection? Avoid the sand flies!! Outdoor activities should be avoided when sand flies are most active (dusk to dawn). Although sand flies are primarily night-time biters, infection may be acquired during the daytime if resting sand flies are disturbed. Sand fly activity in an area may easily be underestimated because sand flies are noiseless fliers, and rare bites may go unnoticed.

Infection by Leishmania have been reported on all the continents except Australia. In the Americas, Leishmania can be found from Mexico south into the South American continent. Leishmaniasis has been reported among some military personnel returning from the Persian Gulf.

The photos shown above were gleaned from the magnificent website of appalling photos collected by Tom Comegys. The information was mercilessly swiped from the Excite Health Home and The Yellow Book: Health Information For International Travel.

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