Improved understanding, diagnosis, and treatment of cutaneous and mucosal leishmaniasis in rural Ecuador

In this thesis, almost 140 years after the first sighting of the Leishmania parasite, we discover that leishmaniasis-induced changes in smell, sound, and taste cause stigma expressions in the Amazon population of Ecuador (Chapter 7). They may result in decreased health-related quality of life (Chapter 6) and prolonged health-seeking delay (Chapter 2). This is exacerbated by diagnostic (Chapter 3 and 4) and therapeutic (Chapter 5) failures, which may be dependent on parasite and host characteristics (Chapter 2). Overall, leishmaniasis causes prolonged suffering which may also exist among leishmaniasis patients in larger neighboring countries Colombia and Peru. This suffering should be alleviated through a multi-level approach involving local, national, and international communities, dedicated professionals, resources, and future research initiatives.