Surreal illustration of Leishmaniasis on a lip.

Unmasking Leishmaniasis: How to Spot It and What to Do When Treatment Fails

Theo Raines in Health & Wellness August 2025 • 5 min read.

"A Deep Dive into American Tegumentary Leishmaniasis: Recognizing Symptoms, Navigating Diagnostic Challenges, and Understanding Treatment Options"

Leishmaniasis, a parasitic disease transmitted by sandflies, presents a significant health challenge worldwide, particularly in endemic regions. American Tegumentary Leishmaniasis (ATL), the most common form, manifests as cutaneous and mucosal lesions, leading to serious clinical complications and psychological distress. While treatable, delayed diagnosis and ineffective treatment protocols can result in chronic conditions, disfigurement, and diminished quality of life.

The disease is caused by protozoa of the genus Leishmania sp., and transmitted through the bite of infected sandflies belonging to the genus Lutzomyia. ATL typically presents in two forms: cutaneous and mucosal leishmaniasis. The mucosal form is more severe, affecting areas such as the nose and mouth, often leading to permanent scars, disfigurement, and significant psychological distress. In rare instances, mucosal leishmaniasis can occur primarily, without a preceding cutaneous infection.

A recent case study underscores the complexities in diagnosing and treating ATL. The patient, a 25-year-old male from Paiçandu, Paraná, sought medical help for a persistent ulcer on his lower lip initially misdiagnosed and treated as herpes labialis. This case highlights the critical need for increased awareness and accurate diagnostic approaches to effectively manage leishmaniasis and prevent its devastating consequences.

Diagnostic Delays and Therapeutic Challenges

Surreal illustration of Leishmaniasis on a lip.

The initial misdiagnosis as herpes labialis underscores a common pitfall in leishmaniasis management: the importance of considering epidemiological data, lesion characteristics, and laboratory tests for accurate diagnosis. In the reported case, the patient's frequent fishing activities in the Ivaí River, an area known to be endemic for Leishmania (Viannia) sp., should have raised suspicion for leishmaniasis. Proper diagnostic procedures, including Montenegro skin test, direct parasite search, indirect immunofluorescence, and polymerase chain reaction (PCR), are essential for confirming the presence of the parasite.

The challenges extend beyond initial diagnosis, with treatment protocols often falling short due to various factors such as therapeutic failure, resistant parasite strains, and the high number of patients who discontinue treatment. The case highlights the complexities of treatment, where the patient initially received Glucantime®, a first-line drug, for an extended period (120 days) without success. This was despite the Brazilian Ministry of Health's recommendation of a shorter duration (20-30 days) for the first cycle. Such deviations from established guidelines can lead to prolonged suffering and potential complications.

Several factors contribute to the complexities of leishmaniasis treatment:

Side Effects: First-choice drugs, like pentavalent antimonial (Glucantime®), cause severe side effects.
Drug Toxicity: Second-choice drugs (amphotericin B) have high toxicity.
Treatment Failure: Therapeutic failure and emergence of resistant strains.
Compliance Issues: Many patients discontinue treatment.

When Glucantime® treatment proved ineffective, the patient was switched to amphotericin B, a second-line drug. While this ultimately led to wound healing, the delay in accurate diagnosis and appropriate treatment resulted in significant psychological distress for the patient, including episodes of depression. This underscores the broader impact of leishmaniasis, affecting not only physical health but also mental well-being and quality of life. The long treatment duration also emphasizes the need for robust patient support systems and adherence to treatment protocols.

A Call for Awareness and Improved Management

This clinical case serves as a stark reminder of the challenges in diagnosing and managing American Tegumentary Leishmaniasis. The delayed diagnosis, coupled with treatment failures and subsequent psychological distress, underscores the urgent need for increased awareness among healthcare professionals. Improved diagnostic accuracy, adherence to treatment guidelines, and comprehensive patient support are essential for mitigating the impact of this neglected disease. By recognizing the early signs and symptoms and initiating appropriate treatment promptly, we can reduce the burden of leishmaniasis and improve the lives of those affected.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1590/s1678-9946201860003, Alternate LINK

Title: American Tegumentary Leishmaniasis: Diagnostic And Treatment Challenges In A Clinical Case

Journal: Revista do Instituto de Medicina Tropical de São Paulo

Publisher: FapUNIFESP (SciELO)

Authors: Jully Oyama, Fabiana Borges Padilha Ferreira, Carolina Cella Conter, Daniele Stéfanie Sara Lopes Lera-Nonose, Áquila Carolina Fernandes Herculano Ramos-Milaré, Eneide Aparecida Sabaini Venazzi, Thaís Gomes Verzignassi Silveira, Maria Valdrinez Campana Lonardoni

Published: 2018-02-15

Everything You Need To Know

What are the primary ways American Tegumentary Leishmaniasis (ATL) manifests, and what long-term consequences can it have on those affected?

American Tegumentary Leishmaniasis (ATL) presents primarily as cutaneous and mucosal lesions, which can lead to disfigurement, psychological distress, and a diminished quality of life. The mucosal form, in particular, can affect areas like the nose and mouth, often resulting in permanent scars. Early and accurate diagnosis is critical to preventing these long-term consequences.

What are the main reasons for diagnostic delays in American Tegumentary Leishmaniasis (ATL), and what specific diagnostic procedures are essential for accurate identification?

The case study highlights that initial misdiagnosis often occurs due to a failure to consider epidemiological data, lesion characteristics, and appropriate laboratory tests. In the case cited, the patient's fishing activities in an area endemic for Leishmania (Viannia) sp. should have prompted suspicion. Diagnostic procedures such as the Montenegro skin test, direct parasite search, indirect immunofluorescence, and polymerase chain reaction (PCR) are essential for confirming the presence of the parasite.

Why is the treatment of American Tegumentary Leishmaniasis (ATL) so complex, and what factors contribute to the challenges in finding effective treatment options?

Treatment of American Tegumentary Leishmaniasis (ATL) is complex due to the side effects of first-choice drugs like Glucantime®, the toxicity of second-choice drugs like amphotericin B, therapeutic failure, emergence of resistant strains, and patient non-compliance. In the case presented, the patient's initial treatment with Glucantime® was unsuccessful, highlighting the challenges in finding effective treatment options. This underscores the need for alternative treatments and better patient support systems.

Beyond the physical symptoms, how does American Tegumentary Leishmaniasis (ATL) affect a patient's overall well-being, and what does this suggest about comprehensive patient care?

The prolonged treatment and diagnostic delays experienced by the patient in the case study led to significant psychological distress, including episodes of depression. This illustrates that American Tegumentary Leishmaniasis (ATL) affects not only physical health but also mental well-being and overall quality of life. Addressing the psychological impact of the disease is crucial for comprehensive patient care, suggesting the need for mental health support as part of treatment.

What does the case study reveal about the effectiveness of current treatments for American Tegumentary Leishmaniasis (ATL), and what are the implications for future research and innovation in this field?

The failure of Glucantime® and subsequent need for amphotericin B in the case study exemplifies the challenges of treating American Tegumentary Leishmaniasis (ATL) when first-line treatments are ineffective. This situation calls for ongoing research into new therapeutic options and a better understanding of drug resistance mechanisms in Leishmania parasites. The lack of effective treatments underscores the urgent need for innovation in this area to improve patient outcomes and reduce the burden of this neglected disease.