Symptoms:

Cutaneous leishmaniasis affects the skin and sometimes the mucus membranes. Symptoms may include:

• Skin sores, which may become a skin ulcer that heals very slowly
• Ulcers and wearing away (erosion) in the mouth, tongue, gums, lips, nose, and inner nose
• Stuffy nose, runny nose, and nosebleeds
• Breathing difficulty
• Swallowing difficulty

Systemic visceral infection in children usually begins suddenly with vomiting, diarrhea, fever, and cough. Adults usually have a fever for 2 weeks to 2 months, along with symptoms such as fatigue, weakness, and appetite loss. Weakness increases as the disease gets worse.

Other symptoms of systemic visceral leishmaniasis may include:

• Belly area (abdominal) discomfort
• Cough (children)
• Diarrhea (children)
• Fever that lasts for weeks; may come and go in cycles
• Night sweats
• Scaly, gray, dark, ashen skin
• Thinning hair
• Vomiting (children)
• Weight loss

Signs and tests:

A physical exam may show signs of an enlarged spleen, liver, and lymph nodes. The patient may have been bitten by sandflies, or was in an area known for leishmaniasis.

Tests that may be done to diagnose the condition include:

• Biopsy of the spleen and culture
• Bone marrow biopsy and culture
• Direct agglutination assay
• Indirect immunofluorescent antibody test
• Lymph node biopsy and culture
• Montenegro skin test
• Skin biopsy

Other tests that may be done include:

• Complete blood count
• Serum immunoglobulin levels
• Serum protein
• Serum albumin
• Serologic testing