Prof. Amir Horev

Dermatology and Venereology Specialist and Pediatric Dermatologist

Cutaneous Leishmaniasis

It is an endemic disease in Israel, meaning a disease that occurs in fixed areas of the country. In the south of the country, it is mainly caused by a parasite of the Leishmania major species, and in the Jerusalem area and in the north of the country - mainly by a parasite of the Leishmania tropica species.

The parasite spends part of its life in the blood of host animals (for example, pheasants in the south and rock rabbits in the north) and is introduced into the human skin by the bite of the sand fly, which bites mainly in exposed areas of the skin - the face and limbs.

The disease is characterized by exuding and ulcerating wounds on the skin, which appear at the site of the bite. The wounds on the skin will only heal after several months to years, and will leave a scar, which will sometimes be large and significant in the area of the bite. A large number of those bitten are children who sometimes spend more time outdoors and are therefore exposed to sand fly bites.

Prof. Horev is a guest on Prof. Carasso's show
and talks about the disease Rose of Jericho (Leishmania)

Prof. Horev - Rose of Jericho - Yedioth Ahronoth Supplement

Prof. Horev - Rose of Jericho - Interview with Radio Darom

Diagnosis of the disease

A clinical diagnosis of the disease can be made by a doctor who is familiar with the disease, and a high suspicion of the disease will be in patients who have been in an endemic area with a constant presence of the sand fly, but this diagnosis is uncertain, and does not provide a clear answer regarding the identity of the parasite (which is most important for adjusting the correct treatment).

An accurate, innovative and highly effective laboratory diagnosis for diagnosing leishmania is called PCR. This method is based on identifying DNA particles of the parasite in the wound and is therefore particularly accurate and allows for rapid identification of the parasite species. Another advantage of this method is the fact that the patient is not required to come to the laboratory in person, since it is possible to send a simple sample from the wound taken by the attending physician at the place of residence and receive a quick answer from the attending physician.

Treatment

The goal of treatment is to speed up recovery and reduce the degree of scarring that will remain for life and may cause severe aesthetic damage. Treatments for leishmania are very diverse and include, among others: treatments by injection or application, treatments with oral medications and intravenous medications. The choice of the appropriate treatment depends on the severity of the injury, the area of the body involved, the location of the wounds and the type of parasite.

The usual treatment for the disease in southern Israel is with paromomycin ointment, but nearly 20% of patients treated with this ointment may develop a severe skin reaction and treatment failure.

Additional treatment for both adults and children is with a drug called amphotericin B, which is given in the form of a gel to apply to the wounds, or in more resistant and severe cases intravenously. Intravenous treatment is considered effective, but requires 6 days of day hospital treatment. Other effective treatments include injecting a substance called gluconate directly into the lesions, as well as an oral pill called Impavido (miltefosine).