Looking for a new way to “get rid” of some characters? Maybe a slow, painful way to go? Perhaps a way to torture someone from far away? Look no further. Leishmaniasis is a parasitic disease that is gruesome and can result in death.

Leishmaniasis is generally found in the Tropics, Subtropics, and Southern Europe. Research shows that rural areas are more likely to be affected than urban areas, though diseases know no physical boundaries and can show up anywhere.

It is spread by phlebotomine sand flies, which may not sound terrifying but is one-fourth the size of a mosquito or smaller. This means you will likely never see this flying death-bug coming for you.

Once bitten, leishmaniasis appears in different forms – cutaneous, visceral, and mucosal. Each has varying symptoms, infection rates, and severity. Additionally, some people can develop leishmaniasis but have a silent infection with no signs or symptoms.

Cutaneous leishmaniasis results in oozing skin sores and there are over half-a-million new cases of this form every year. The skin sores can take weeks to months to develop after a bite. They can change in size and appearance over time, often starting as papules (small bumps) and increasing to skin ulcers. Luckily, the cutaneous form can heal on its own but it may leave the individual with lasting scars.

Visceral leishmaniasis affects the internal organs, specifically the spleen, liver, and bone marrow. Some research suggests there are just under 100,000 new cases a year, while others suggest there may be approximately 400,000 a year. Either rate is astonishing as visceral leishmaniasis can be life-threatening. It usually takes months to develop but can remain dormant for years, meaning the bearer may have no idea until they are hospitalized. Symptoms include fever, weight loss, spleen and liver swelling, low red and white blood counts, and low platelets. If left untreated, visceral leishmaniasis is typically fatal.

Mucosal leishmaniasis is the least common of the three and is generally a consequence of infection from one of the above. For instance, an individual can have cutaneous leishmaniasis and skin sores. This can spread from the skin into the mucous membranes, such as the mouth. I’m not saying someone licked their sore (which is a nauseating thought) but it can be transferred in similar ways to other infections and diseases. Often, mucosal leishmaniasis is not noticed for years. Cutaneous sores can heal and an individual can still have leishmaniasis that developed into the mucosal form. Of course, this lasting infection is not good for the individual and can result in delayed treatment and additional pain.

Treatment is a bit difficult though. Because diseases can evolve, there are different strains of leishmaniasis and, consequently, different rates of effectiveness. Liposomal amphotericin B can be used for most strains of visceral leishmaniasis with about 93% effectiveness. Miltefosine is generally effective for visceral and cutaneous forms but is not effective on certain strains. A topical cream can also be used for cutaneous leishmaniasis but, again, it depends on the strain. Pentavalent antimonials are often used for treatment for mucosal leishmaniasis with about an 88% rate of effectiveness. Of course, treatment is on a case by case basis and there are more than just the above-mentioned treatments.

It is important to mention again that people have different exposure rates and immunity toward leishmania parasites, as well as different strains and reactions to treatment. Given all of this, leishmaniasis is considered one of the top ten neglected tropical diseases by the World Health Organization with thousands of deaths each year, even in the twenty-first century.