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Members of this community have more important things to worry about than Leishmaniasis

Leishmaniasis, like malaria is a disease caused by a protozoan parasite. There are many species of Leishmania, fortunately only one species, Leishmania braziliensis is endemic to Ecuador. L. braziliensis causes only the cutaneous type of Leishmaniasis, where other species in other tropical regions of the world cause the much more severe visceral type. The parasite is transmitted by various species of sandflies (Lutzomyia sp. and Psychodopygus sp.). Humans, as well as many other types mammals can become infected.  Reservoirs for leishmaniasis include rodents, anteaters and most importantly canines, as every community we visited had scores of roaming dogs. The cutaneous lesions form at the site of the bite, beginning as small spots that can progress to much larger lesions with a characteristic crater shape.

From what I heard, even though the disease is quite prevalent throughout the Coastal and Amazonian regions, Leishmaniesis is not considered a major problem in Ecuador. I didn’t see any evidence of a prevention program, although the Ministry of Health does provide free clinics and free treatment for existing cases. The people have much higher priorities in providing for basic needs and combating more serious diseases, such as malaria and dengue fever, leaving the management Leishmaniasis to be entirely reactive.

Canines are the primary reservoir for Leishmaniasis

Nurse Eroilda giving us a tour of Tonchigue

While in Tonchigue San Antonia, a small poverty-stricken community near the coast, we visited with Eroilda who has been a nurse in the government funded free clinic for sixteen years. She told us of a number of new Leishmaniasis patients that were being treated with glucantini, an antimonial drug. Once per day for a week, the patients receive a number of injections near the site of infection; they are then retested for the parasite and continue treatment for another seven days if the wound is still infected. For people that live in remote communities traveling to the clinic everyday for an injection can be quite a burden, so most communities have a person with enough training to administer injections and other medicines.

In La Tablada, a small rural community nearby, Don Castro showed us his land where he was growing coffee, cacao and many different types of fruit. Don Mario is quite fond of guava fruit, especially spitting the seeds. Almost in passing as we were wondering along, Don Castro told us of his grandson’s bout with Leishmaniasis last year. The five year old showed us a small scar on his arm, and that was it, seemingly no big deal.

Although cutaneous leishmaniasis is usually self-limiting even without antimonial treatment, it can leave terrible scarring, but even more importantly the lesions are open wounds with can allow an easy route of entry for secondary infections. So, even though Leishmaniasis is not as high a priority as malaria, there is a mortality rate associated with the disease, most commonly due to sepsis from secondary infections.

During our journey through Ecuador I did not see any active cases of Leishmaniasis firsthand, only small scars and accounts of cases from health professionals. However, it did seem like most people knew how to identify cutaneous leishmanisasis lesions and how to obtain effective treatment.

Mmmmm.... guava!