Leishmaniasis: ways of infection, complications, diagnosis, treatment and prevention. Cutaneous leishmaniasis Old world cutaneous leishmaniasis

As mentioned above, the carrier of the pathogen are female mosquitoes. During a bite, from 100 to 1000 pathogens enter the human body along with saliva. Leishmania have a specific ability - they freely penetrate macrophages without provoking an immune response. In them, they are transformed into an intracellular form and begin to actively multiply, provoking pathological reactions from the internal organs of a person.

The disease can be transmitted directly from a carrier to a person, as well as from a person to a mosquito (in this case, they speak of the progression of anthroponotic leishmaniasis). It should be noted that the disease is characterized by seasonality. Most often it is diagnosed in the period from May to November. Such time frames are due to the vital activity of mosquitoes.

Classification

Clinicians distinguish two forms of the disease, different in their course, as well as in the clinic:

The symptoms of the disease directly depend on its form, which began to progress in a person. It is important, at the first signs indicating leishmaniasis, to immediately contact a medical institution for diagnosis and treatment of the disease.

Clinic of visceral leishmaniasis

Due to the long incubation period, not many patients can relate the progression of visceral leishmaniasis to a mosquito bite. This, to some extent, complicates the diagnosis. The first signs of visceral leishmaniasis can appear only six months after the pathogen enters the body. The patient has the following symptoms:

• malaise;
• lethargy;
• fast fatiguability;
• weakness;
• loss of appetite;
• hyperthermia up to 40 degrees;
• there is a change in the color of the skin. It acquires a grayish tint, and in some cases hemorrhages appear on it;
• insignificant . At the same time, they are not painful and do not get drunk among themselves.

The first sign of the progression of visceral leishmaniasis is the appearance on the skin of a hyperemic papule, covered with scales on top (occurs at the site of the bite).

A characteristic and constant symptom of pathology is. It is the spleen that increases in size more rapidly. Already in the first month, its size can be so large that the organ will occupy the entire left side of the abdomen. As visceral leishmaniasis progresses, both organs become dense, but pain does not occur when palpated. An enlarged liver is fraught with dangerous consequences, up to and.

Clinic for cutaneous leishmaniasis

The incubation period for cutaneous leishmaniasis ranges from 10 days to 1–1.5 months. More often, the first symptoms of pathology appear in humans on the 15-20th day. Symptoms may vary somewhat depending on which form of cutaneous leishmaniasis progresses in the patient. In total there are five forms of the disease:

• primary leishmanioma;
• serial leishmanioma;
• tuberculoid leishmaniasis;
• espundia;
• diffuse leishmaniasis.

Primary leishmanioma develops in three stages:

• tubercle stage. A papule forms on the skin, which grows rapidly. Sometimes its size can reach 1.5 cm;
• ulcer stage. A few days after the appearance of a specific tubercle, the upper crust falls off from it, exposing the bottom with weeping. At first, a serous exudate is released, but then it becomes purulent. A hyperemic ring is noted along the edges of the ulcer;
• scarring stage. The bottom of the ulcer clears itself a few days after its appearance, becomes covered with granulations and scars.

As sequential leishmanioma progresses, several other secondary nodules form around the primary lesion. Tuberculoid leishmaniasis manifests itself at the site of the formed primary leishmanioma or at the site of the scar from it. With the progression of this form of cutaneous leishmaniasis, a pathological tubercle is formed, which has a light yellow color. Its dimensions are small.

Espundia is a special form of cutaneous leishmaniasis. Symptoms of pathology appear gradually. Extensive ulcers appear against the background of already existing lesions of the skin. It is most often seen in the limbs. Gradually, the pathogen penetrates into the mucous membrane of the pharynx, cheeks, larynx and nose, where it provokes purulent-necrotic changes.

Diagnostics

Leishmaniasis is diagnosed by an infectious disease specialist. Clinical diagnosis is made on the basis of a characteristic clinical picture, as well as epidemiological data. To confirm the presence of cutaneous leishmaniasis or visceral, resort to the following diagnostic methods:

• tank. examination of a scraping previously taken from a tubercle or an open ulcer;
• microscopic examination of a thick drop of blood;
• biopsy of the liver and spleen;

Treatment

Treatment of visceral and cutaneous leishmaniasis is carried out in stationary conditions. The treatment plan is developed taking into account the severity of the course of the pathology, its type, as well as the characteristics of the patient's body. Doctors resort to conservative and surgical methods of treatment.

In the visceral form, the treatment plan includes such drugs:

• Pentostam;
• Glucantim;
• Solyusurmin.

The course of treatment with these drugs is from 20 to 30 days. If resistance is observed, then the dosage of the drugs is increased and the course is extended to 60 days. Also, the treatment plan is supplemented with amphotericin B.

If conservative treatment was ineffective and the patient's condition did not stabilize, then a surgical intervention is performed - the spleen is removed. With skin forms of the disease, they also resort to physiotherapy treatment - they warm up the skin and conduct UV radiation.

Prevention

In order not to carry out the treatment of pathology, it is necessary to start its prevention as early as possible. To protect yourself from mosquito bites, you must use personal insect repellent. Also, for the purpose of prevention in areas with a high risk of infection, it is necessary to disinfect residential premises and install mosquito nets on windows.

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Diseases with similar symptoms:

Carbuncle is an inflammatory disease that affects the hair follicles, sebaceous glands, as well as the skin and subcutaneous tissue. As a rule, the inflammatory process can spread to the deep layers of the dermis. Most often, purulent formations are localized in the neck, but their appearance on the buttocks or shoulder blades is also not excluded.

Very often, people are faced with skin diseases: either a rash appears, or wounds, or it’s not yet clear what, it seems like a bite, but it’s somehow strange. Very often, a mosquito bite can develop into an infection, one of the forms of which is such a disease as leishmaniasis. It is about this disease that we will talk today. So what is leishmaniasis?

concept

Leishmaniasis is an infection that manifests itself not only in humans, but also in animals. It is caused by protozoa of the genus Leishmania and is transmitted by the bite of Lutzomyia mosquitoes.

The simplest Leishmania are distributed mainly in hot countries: Asia, Africa, South America.

Most often, already infected people, domestically raised canines (foxes, wolves or jackals), and rodents can be the most common sources of the disease.

With a difficult and long healing process, dangerous not only for humans, but also for animals, is etolishmaniasis. bacteria that cause this disease is very long. Mosquitoes are the first to infect. After that, the infection enters the digestive system, where the not yet fully mature forms of leishmaniasis mature and turn into a mobile flagellar form. Accumulating in the mosquito's larynx, during a new bite, they enter the wound and infect the epithelial cells or or the animal.

Leishmaniasis: varieties

There are several types of this disease, and each of them is dangerous in its own way for the human body:

• Cutaneous.
• Slimy.
• Visceral leishmaniasis.
• Skin-mucous.
• Viscerotropic.

The main symptoms of leishmaniasis

The main symptoms of this disease are ulcers on the human body. They can appear in a few weeks and even months after he is bitten by an insect carrier of the infection. Another symptom of the disease can be fever, which can also begin a few days after the bite. Time can pass enough, in some cases up to a year. Also, the disease affects the liver and spleen, and anemia may be a consequence.

In medicine, the first sign of leishmaniasis is an enlarged spleen: it can become larger in size than the liver. To date, there are 4 forms of leishmaniasis:

1. Visceral. This is one of the most difficult forms of the disease. If you do not start prompt treatment, the disease can lead to death.
2. Cutaneous leishmaniasis. It is considered one of the most common forms. Immediately after the bite, pain appears in its place. This form of the disease can be cured only after a few months, and even after that the person will remember it, looking at the scar left from the disease.
3. Diffuse cutaneous leishmaniasis - this form of the disease is widespread, its appearance strongly resembles leprosy and is very difficult to treat.
4. Slimy form. It begins with which further lead to tissue damage, especially in the oral cavity and nose.

The concept and symptoms of visceral leishmaniasis

Visceral leishmaniasis is a form of the infectious disease caused by leishmania. An ailment occurs when this type of microbes spreads by the hematogenous route from the primary focus of infection to any of the human organs: the liver, spleen, lymph nodes, and even to the bone marrow. Microorganisms in the body multiply very quickly, which leads to its damage.

Most often this disease affects children. The incubation period is quite long, sometimes lasting up to five months. The disease begins slowly, but in the category of infected people who come to endemic areas, the disease can develop rapidly.

Visceral leishmaniasis symptoms are quite common. In almost all patients they are the same: general malaise, weakness throughout the body, lethargy, full fever begins very quickly. It passes in a wave, while the body temperature can reach 40 degrees. Then comes a slight relief of the state, which is again replaced by a high temperature, which is also very difficult to bring down.

You can also see signs of a disease such as visceral leishmaniasis on the skin. Symptoms are as follows: pale skin with a grayish tint and often with hemorrhages. It is worth paying attention to the lymphatic system - the lymph nodes will be enlarged.

The main signs of visceral leishmaniasis

The main symptom of the disease is the initial defect, which may be single, and therefore may not be noticed at the first examination. It looks like a small, hyperemic papule, covered with scales on top. It occurs in the place where the bite was made by an insect carrier or an animal from the canine family, in whose body there is a causative agent of visceral leishmaniasis.

A constant symptom, which is first of all worth paying attention to, is an enlargement of the spleen and liver. It is the spleen that grows very rapidly and after a couple of months after infection, it can occupy the entire left side of the peritoneum. To the touch, the organs become dense, but there is no pain. The liver does not increase so quickly, but very serious disturbances in functions can be observed in it, up to ascites.

If the bone marrow is affected by the disease, then the signs are manifested by thrombocytopenia and agranulocytosis, which may be accompanied by angina. The first thing that can be seen on the human body is the rapid appearance of colored pigment spots.

Cutaneous form of leishmaniasis

Very common and has several forms, one of them is cutaneous leishmaniasis. Reproduction of the pathogen occurs in the tissues of the human body, where Leishmania mature very quickly and turn into flagellated larvae. This is called the primary focus of the disease, and a granuloma is formed. It consists of epithelial and plasma cells, macrophages and lymphocytes. Decay products can cause significant inflammatory changes that can reach lymphangitis or lymphadenitis.

Symptoms of the skin form

The duration of the incubation period of the cutaneous form of leishmaniasis is about one and a half months. There are several main stages of the disease:

1. The appearance of a tubercle on the skin and its rapid increase. Its dimensions are within 2 cm.
2. The ulcer appears after a few days. First, it is covered with a thin crust, which later disappears, and a soft pink bottom with weeping appears on the surface, later an abscess forms. The edges of the ulcer are slightly raised and loose.
3. Scar. After a couple of days, the bottom of the ulcer is completely cleared and covered with granulations, in the future it all scars.

The main signs of the skin form

There is not only a rural form, but also an urban one, and they differ little from each other, but it must be remembered that there are several basic features that make it possible to distinguish them.

The main and very important circumstance is the correct and careful collection of anamnesis. Long stay in an urban or rural environment will indicate in favor of one of the forms of the disease. The rural type always proceeds in the primary form, but the urban type can take all of the existing types.

mucocutaneous form of the disease

In addition to the forms of the disease described above, there is another fairly common and very dangerous one - this is mucocutaneous leishmaniasis (espundia). Its pathogens are mosquitoes.

From an insect bite to the first signs of the disease, it can take about 3 months. In the place where a person was bitten by a mosquito, a deep ulcer forms. It involves the mucosa, lymphatic system and blood vessels. All this leads to very complex and severe complications, while the prognosis is not encouraging.

Human leishmaniasis in any of the existing forms is very dangerous, as it affects internal organs that are poorly treated, such as the spleen and liver. It is for this reason that doctors recommend going to the hospital at the first ailment; in the early stages of the disease, you can quickly recover with minimal consequences.

Other types of leishmaniasis disease

We have already described several main forms of such an ailment as leishmaniasis, but there are several more of its types, perhaps not so common, but also dangerous to humans:

1. Sequential leishmanioma - the presence of a primary form with the addition of secondary signs in the form of small nodules.
2. Tuberculoid leishmaniasis. Photos of patients prove that the signs of the disease appear at the site of the primary form or at the site of the scar. In this case, the primary defect causes the presence of a small tubercle of pale yellow color no larger than the head of a pin.
3. Diffuse leishmaniasis. This form of the disease most often occurs in people with a low level of immunity and is characterized by extensive ulcerative lesions of the skin and a chronic process.

What is leishmaniasis, we figured out, and how to properly diagnose it, we will tell further.

Varieties of diagnosis of leishmaniasis

The clinical diagnosis of a patient with leishmaniasis is made on the basis of epidemiological data and the clinical picture. Laboratory diagnostics will help to accurately confirm the presence of the disease. Leishmaniasis is detected by the following methods:

• Research on bacteria: they take a scraping from an ulcer and a tubercle.
• Microscopic examination: a smear or a thick drop is taken from the patient. This method can detect the presence of Leishmania stained according to Romanovsky-Giemsa.

• A biopsy of the liver and spleen is performed, in the most severe cases, a bone marrow punctate is made.
• Serological methods such as RSK, ELISA and others.

There are a huge number of methods for accurately determining, and each of them will show the most accurate data and indicate the presence in the human body of a disease such as leishmaniasis. Diagnosis in a short time will determine the severity of the disease.

Treatment

What is leishmaniasis, and how to properly diagnose it, we have already described. Now let's talk a little about how his treatment is carried out.

In the visceral form, pentavalent antimony preparations are used:

1. "Pentostam". It is administered to the patient intravenously, previously diluted in a 5% glucose solution. The drug can also be used intramuscularly. The course of treatment lasts for a month.
2. "Glucantim". The drug is used in the same way as Pentostam. If the disease is of a complex form, then the dose can be increased and the course of treatment extended for another month, but this can only be done with the permission of the attending physician.
3. "Solyusurmin". The drug can be administered intravenously or intramuscularly, treatment should begin with 0.02 g per kg of body weight. Gradually, over 20 days, the dose is increased to 1.6 g / kg.

Also, with a very severe form of the disease, excellent results are obtained by treatment with the drug "Amphotericin B". The initial dose is 0.1 mg/kg. Gradually, it increases, but not more than 2 g per day. The drug is administered intravenously, previously it is dissolved in a glucose solution.

In the most difficult cases, when all the drugs have been used and have not brought the desired results, surgical intervention is prescribed - splenectomy. After such an operation, the patient returns to normal very quickly, but there is only a risk of developing other infectious diseases.

With the skin form of the disease, you can use all the drugs described by us above, and additionally prescribe warming and UVI.

Consequences of leishmaniasis

The prognosis and outcome of treatment after an infectious disease such as leishmaniasis is ambiguous. Despite the fact that the visceral form proceeds with great complications, and it is very dangerous for the patient's life, with timely treatment, the disease passes without a trace and does not cause much harm to the body.

As a result of the cutaneous form, especially its diffuse variant, scars and scars may remain on the skin. And in some, rather complex cases, changes in the bone skeleton can even occur.

Possible Complications

Possible complications after the disease leishmaniasis (photos of patients with this disease can be seen in our article). The later the disease is detected and the treatment process is started, the higher the risk of severe complications. With leishmaniasis, they can take the following form:

• Liver failure aggravated by ascites and cirrhosis.
• Severe anemia and DIC.
• Amyloidosis of the kidneys.
• Ulcers on the mucosa of the digestive tract.

In the cutaneous form of the disease, complications are mainly associated with the addition of a secondary infection. It manifests itself as phlegmon and local abscesses, but in the absence of properly selected treatment, it can develop into a severe septic form.

What is leishmaniasis? This is a very serious infectious disease that has different forms, each of which is quite dangerous for humans. But there are several methods of prevention that will help to avoid the disease or prevent its severe form.

Disease prevention

The general principle for the prevention of leishmaniasis is protective measures. We must try to protect ourselves from the bites of mosquitoes, which are carriers of the disease. Regular disinfection and rodent control should be carried out, and domestic animals of the canine family that were taken from the forest should be kept away from themselves.

And drug prophylaxis will only help in protecting against the skin form of the disease. So, a person who goes to endemic areas is vaccinated.

Leishmaniasis is a fairly serious disease, about half a million people die from it every year, so you should treat it with full responsibility and run to the doctor at the first sign. Only the early stages of the disease can be cured without further consequences.

But it’s so established in our country that all “forgotten diseases” are not funded, so no one will vaccinate the population until the person himself buys the vaccine and asks for it. This is how it turns out that the disease is very well-known, and there is simply not enough money for the correct treatment. Therefore, it is better to do everything possible on your own to prevent infection.

The causative agent of leishmaniasis is distributed mainly in tropical and subtropical countries, because there the air temperature does not fall below 200 C, and this is a good environment for the development of the disease, but there are also isolated cases in any region.

The centers of development are the countries of Africa and South America. Of these, many are considered developing - 69 countries, and 13 are the poorest in the world.

Causes and ways of infection

Having figured out what leishmaniasis is, it is worth looking at the causes of its occurrence, which lie in the simplest pathogen Leishmania tropica, it was first discovered by Leishman in 1872.

During a bite, from 100 to 1000 pathogenic bacteria enter the human body along with the saliva of a mosquito, which have one feature - they penetrate into macrophages, while not affecting the immune system. There is a transformation and active reproduction.

A mosquito can bite anyone, regardless of age or gender. Man is a source and reservoir of infection, just like animals. Foxes, dogs, rodents, jackals are its main distributors, and mosquitoes are carriers. Considering the populated cities, we can confidently say that basements and garbage dumps are the main places where mosquitoes accumulate.

Pathogenesis

Visceral leishmaniasis develops very slowly, with an incubation period ranging from 20 days to 12 months. It all starts with mild malaise, loss of appetite, mild fever and weakness. The disease flares up on the 5th-6th day, the temperature rises sharply to 400C, a fever begins, which can last a very long time.

Visceral leishmaniasis involves temperature fluctuations, not only within a few days, but even within a day. In the early stages, the disease can not be identified immediately, it is often confused with malaria, paratyphoid, sepsis, bronchopneumonia or typhoid fever. Only by 3-4 weeks is it possible to recognize the true symptoms that are characteristic only for this disease:

• blood change;
• a sharp increase and compaction of the spleen;
• serological tests that confirm bone marrow studies;
• swollen lymph nodes;
• the appearance of a papule at the site of the bite, covered with scales.

Very often, a person's skin changes its color and becomes gray.

There are four types of visceral leishmaniasis:

1. Indian.
2. Mediterranean-Central Asian.
3. East African Old World.
4. South American New World.

Skin type and its forms

Cutaneous leishmaniasis includes two types, each with its own symptoms:

1. Rural (zoonotic) type. It is characterized by a short incubation period (1-5 weeks) and a very long treatment (3-6 months). Small tubercles appear on the skin in the form of a cone, red-blue in color, they have a yellow tint and a doughy consistency. Over time, the tubercles become larger, and after a while (about three months) they open up, forming an ulcer. Inflammation does not go away immediately, but only after three to eight months.
2. Urban (anthroponotic) type. The incubation period, on the contrary, is very long, can last up to two years, but on average lasts about three to eight months. The process takes a very long time, hence its name. The bumps that appear on the skin are pink or reddish-brown in color, superficial purulent ulcers appear over time.

mucocutaneous type

Symptoms become apparent approximately one to four weeks after the bite. First of all, the nose and mouth are affected and deformed, all this is painless. Over time, ulcers appear on the mucous cheeks and tongue. Primary foci may disappear, and resume only after a few years. Accompanying the disease is weight loss, fever and various bacterial infections.

Complications

Visceral type

Complications of leishmaniasis will depend on the timing of the start of treatment, the choice of tactics and the general depletion of the body. These include:

• various hemorrhages in organs;
• bedsores in the greatest places of influence on the skin;
• otitis;
• tropical ulcer;
• pneumonia.

Occasionally, rupture of the spleen occurs - a very serious complication, accompanied by blood loss and the development of collapse. A rupture requires urgent surgery.

Skin type

With the addition of various infections, a complication of cutaneous leishmaniasis is possible. It assumes:

• infection of ulcers with secondary flora;
• agranulocytosis;
• development of erysipelas;
• abscess development.

mucocutaneous type

Complications of mucocutaneous leishmaniasis in the later stages are:

• hyperpigmentation;
• swelling;
• cachexia.

Unfortunately, there are many deaths due to various bacterial infections in untreated patients with an advanced stage of the disease. Some patients have spots or wart-like nodules after cured leishmaniasis.

Diagnostics

When establishing the analysis, it is necessary to take into account whether the patient has been in the epidemiological foci of the disease, and first of all, pay attention to the enlargement of the spleen and fever. Cutaneous leishmaniasis can be diagnosed only after examining the material of smears from tubercles or ulcers, they also put an allergic test with killed leishmania cells and serological reactions.

There is a biopsy of the lymph nodes, in extreme cases, the spleen and liver. To diagnose visceral leishmaniasis, smears from bone marrow aspirate and blood cultures are required.

Treatment

Visceral type

At the initial stages of development of visceral leishmaniasis, apply:

1. Neostibosan in the form of injections intravenously or intramuscularly.
2. Glucantim.
3. Solustibasan.
4. Solyusurmin.
5. Stibanol.
6. Pentostan and more with pentavalent antimony.

If treatment does not give positive dynamics, and visceral leishmaniasis progresses, add Lomidin. In the case of diagnosing secondary infections, the patient is prescribed antibiotic therapy. If internal organs are damaged, respiratory and cardiovascular agents are additionally prescribed.

Skin type

If cutaneous leishmaniasis is detected, then the treatment, first of all, depends on the stage of its development. At an early stage, the patient is injected with various drugs intradermally:

1. Monomycin.
2. Urotropin.
3. Solution Mepakrin (akrikhin).
4. Berberine sulfate.

And also apply various ointments that contain all of the above funds.

At the stage of the ulcer, Monomycin and Aminoquinol are prescribed. In order to avoid scarring, laser therapy is very effective at the stage of the appearance of tubercles. Severe cases suggest the inclusion of pentavalent antimony preparations.

mucocutaneous type

Treatment, as in any case of illness, should be prescribed only by a doctor. Preference is given to:

1. Monosodium antimoniate glutamate.
2. Meglumine antimoniate.

If this is not effective enough, the injections are repeated and Allopurinol is additionally prescribed. Alternative drugs are Amphotericin or Pentamid. If the disease is diagnosed early, and the treatment is timely, then more than 90% of patients recover. Unfortunately, in the absence of treatment, about 95% of dead adults, and 85% of children, died.

Surgical intervention

Surgical intervention is possible if there is only one ulcer on the human body and it is small.

Prevention

As has been said more than once, it is better to prevent a disease than to suffer and be treated later. Prevention methods include:

• local residents living in endemic areas need to use protective equipment and repellents;
• carriers of pathogens must be destroyed soon by any means;
• people living in "dangerous" areas need to undergo regular examinations;
• if the risk of the disease is very high, then it is better to give the necessary vaccinations.

Cutaneous leishmaniasis is a rare skin disease in dermatology. At the same time, the development of international tourism, commercial trips abroad, including to countries with a tropical climate, do not exclude the importation of this disease into our country. Experience shows that cases of cutaneous leishmaniasis occur among diplomats and foreign students who came to study in Russia.

In most cases, this disease is misdiagnosed. The disease is diagnosed as pyoderma ulcer, basalioma, skin tuberculosis, etc. In accordance with the requirements of the international nomenclature, the disease is called "cutaneous leishmaniasis". Leishmania amostigotes in the cells of the reticuloendothelial system are oval, 2-6 µm long and 2-3 µm wide. When stained with hematoxylin with eosin: the nucleus is red, the protoplasm is blue. Transversely divide, multiply, destroy cells. Leishmania promostigotes are spindle-shaped. One end is rounded, the other is blunt. Length 10-25 microns. At the head end there is a kinetoplast from which a long flagellum originates. It stains like an amostigote. The development of Leishmania - promastigotes from amostigotes - is carried out in 20 hours. There are two varieties of Leishmania: 1. Leishmania tropica var. major (round) 2. Leishmania tropica var. minor (oval).

There are currently two types of leishmaniasis:

* anthroponotic (source - man);

* zoonotic (source - rodents-gerbils).

Leishmaniasis classification

1. Late ulcerative type.

2. Acute necrotizing type.

3. Intertype clinical forms.

They differ in symptoms, source of infection, confinement to the landscape and pathogen. The clinical classification of leishmaniasis is determined by the type of leishmaniasis, the type of pathogen, its virulence, the reactivity of the organism, the presence of complications, etc.

Leishmaniasis symptoms

A person has a regular change in clinical manifestations, which indicates the cyclicity of cutaneous leishmaniasis. Zoonotic acutely necrotizing cutaneous leishmaniasis is characterized by necrotic ulcers, granulations, infiltrate - incubation period - 5-15 days (up to 2 months) - primary morphological element tubercle or leishmanioma (diameter up to 4 mm, acutely inflammatory, painful) - peripheral growth up to 1 cm by the end 3 days - necrosis - ulcer (small - up to 4 mm; "drilled"). An extensive zone of infiltration is revealed, the element is similar to a furuncle, but there is no severe pain and necrotic rod - the ulcerative stage lasts up to 4 months. Subsequent necrotization of the infiltrate with increased pain. The ulcer can be up to 5 cm in diameter.

Diagnosis of leishmaniasis

Diagnostics is carried out according to the following points.

1. Clinic of the disease.

2. Epidemiological history (active epidemiological period from May to October).

3. Microscopy of detachable leishmanioma - detection of "Borovsky's bodies".

Leishmaniasis treatment

1. Monomycin - 5 thousand units per kg of body weight (300-500 thousand units) for each injection. It is administered 3 times a day, the course is 8-12 days. Complications: nephritis and deafness.

2. Solyusurmin - sodium salt of a complex compound of pentavalent antimony and gluconic acid.

3. Metacycline (Rondomycin).

4. Aminoquinol - has a weaker effect. It is prescribed for adults and children over 12 years of age, 0.4 g per day. The duration of the course is up to 20 days.

5. Furazolidone - 0.15-0.2 x 4 times a day for 20-25 days. With prolonged use, neuritis may develop.

6. Chingamine (delagil, chloroquine) - has a specific anti-leishmania effect. Assign 0.25 X 2 times a day for 10 days; 0.25 x 3 times a day for 7 days.

No 2,4,6 do not affect the bacterial flora that often complicates leishmaniasis, so sulfalene is a good addition (1 day 1 g, then 0.2 for 10-12 days).

7. Massive vitamin therapy.

8. Topical treatment:

Surgical removal;

cryodestruction;

Diathermocoagulation;

Impregnation with 4-5% Akrikhin's growth solution according to the Dobrotvorskaya method (all this is in the presence of a single tubercle without signs of inflammation);

Ointment therapy:

5-10% protargolova ointment;

1% acrichin ointment;

1% rivanol ointment;

2% yellow mercury ointment;

5% boric ointment;

aniline dyes;

Powders:

10% dermatol;

3-5% monomycin;

1-2% furatsilin;

Collagen regeneration sponges:

algipore;

algimaph;

kombutek;

collagenomonomycin complex.

The dressing is changed as the sponge dissolves.

Use of a carbon dioxide or helium-neon laser.

• What is Cutaneous Leishmaniasis
• Symptoms of cutaneous leishmaniasis
• Treatment of cutaneous leishmaniasis

What is Cutaneous Leishmaniasis

What Causes Cutaneous Leishmaniasis?

The rural type is characterized by seasonality associated with the presence of mosquitoes in the warm season. The incidence begins in spring, increases in summer and decreases in winter. The urban type is characterized by the absence of seasonality and a long course. It can show up at any time of the year. It turned out (P.V. Kozhevnikov, N.F. Rodyakin) that often in animals and humans it is possible to carry an infection without pronounced clinical manifestations, which complicates the epidemiological and preventive aspects of recreational activities.

Symptoms of cutaneous leishmaniasis

For rural (zoonotic) type a relatively short incubation period (from 1-2 to 3-5 weeks) and a not very long (3-6 months) course are characteristic. Usually, conical tubercles with a wide base, red-bluish color with a brownish or yellowish tint, and a doughy consistency appear on open areas of the skin. In the future, the tubercles increase in size and after 1-3 months. open with the formation of a rounded or irregularly shaped ulcer with an uneven bottom and abundant serous-purulent exudate, shrinking into layered dense crusts. The edges of the ulcer are, as it were, corroded. In the circumference, a test-like infiltrate of a pinkish-cyanotic color is formed, behind which strands of inflamed lymphatic vessels and the so-called rosary of secondary leishmania are palpated. In children, there is a more acute course with a furuncle-like, fluctuating pustular formation of the focus, quickly abscessing and necrotic. Often in adults and children, the process is complicated by a purulent infection with the development of phlegmon, erysipelas. The inflammatory process ends in - 3-8 months. with the formation of a scar and persistent immunity to this ooze of the pathogen.

Urban (anthroponotic) type found in cities and large towns. It is characterized by a lengthening of the incubation period (an average of 5-8 months, and sometimes 1-2 years) and a slow process, hence the name - yearling. The disease is transmitted from a sick person or carrier through the mosquito vector. Small bumps of a pinkish or reddish-brown color with a yellowish tint appear on open areas of the skin. Elements of rounded outlines, doughy consistency. The infiltrate is unsharply expressed, disintegrates late. The ulcers are superficial with uneven roller-like edges and a granulating bottom covered with a grayish-yellow serous-purulent discharge. In the circle of ulcers, a border of inflammatory infiltrate is usually formed. As with the zoonotic form, nodular lymphangitis (“rosary”) can form along the periphery. They sometimes ulcerate, turning into small, secondary (daughter) leishmaniomas.

The anthroponotic form includes a rare clinical form of skin leishmaniasis - lupoid, or tuberculoid cutaneous leishmaniasis(metalishmaniasis). This form is difficult to distinguish from ordinary lupus due to the appearance of tubercles on the scars formed after the regression of leishmania or along the periphery. The tubercles are flat, barely rising above the level of the skin, brownish in color, soft in texture, giving a distinct brownish color during diascopy (symptom of apple jelly). The number of tubercles can gradually increase, persist for a long time, and are difficult to treat. Tuberculoid leishmaniasis is most often localized on the skin of the face and is observed in childhood and adolescence. The development of this form of leishmaniasis is associated with inferiority of immunity due to the presence of a focus of chronic infection, hypothermia, trauma, or possible natural superinfection.

The atypical form of the anthroponotic type includes mucocutaneous and diffuse cutaneous leishmaniasis. Characteristic of these varieties is the slow formation of the process. Ulceration develops late or absent. Healing occurs within 1-3 years or even longer. The primary elements of mucocutaneous leishmaniasis are similar to the usual type in the form of a tubercle with subsequent ulceration. Metastatic spread of the process to the mucous membrane of the mouth, nose and pharynx occurs at an early stage of the disease, but can sometimes occur after several years. Erosion and ulceration of the tubercles is accompanied by the destruction of soft tissues, cartilage of the oral cavity and nasopharynx. At the same time, swelling of the nasal mucosa, the red border of the lips develops. A secondary infection often accompanies. The process ends with pronounced mutations.

Diffuse cutaneous leishmaniasis is manifested by widespread elements of multiple tubercles on the face and on open areas of the extremities. Merging, rashes resemble lesions in leprosy. Characterized by the absence of ulceration and lesions of the mucous membranes. The disease does not go away spontaneously and is characterized by a tendency to relapse after treatment.

Diagnosis of cutaneous leishmaniasis

Diagnosis of cutaneous leishmaniasis is based on peculiar efflorescences of a nodular or tubercular type with the presence of distinct nodular lymphangitis along the periphery of the primary foci. Anamnestic data on the stay of patients in endemic areas help the diagnosis. Differential diagnosis is carried out with lupus erythematosus, syphilides of the secondary and tertiary period, chronic ulcerative pyoderma, malignant neoplasms, sarcoidosis. The main justification for the diagnosis is the patient's stay in the endemic zone and the detection in the scraping from the edges of the ulcers of the pathogen - L. Tropica (Borovsky's body), which is localized in large numbers, mainly in macrophages. For diagnosis, a skin test with leishmanin (Montenefo test) is used.

Treatment of cutaneous leishmaniasis

Monomycin, solyusurmin, glucantim, metacycline, doxycycline, antimalarial drugs are shown.

Monomycin - 250,000 IU intramuscularly 3 times a day every 8 hours, for a course of 7,000,000 9,000,000 IU, glucantim (60 mg / kg intramuscularly No. 15), secnidazole (500 mg 4 times a day in for 3 weeks, then 2 times a day for another 3 weeks), as well as solyusurmin, metacycline, doxycycline, antimalarial drugs (including for the treatment of unopened leishmaniasis); cryodestruction, laser therapy. 2 3% monomycin ointment.

Prevention of cutaneous leishmaniasis

Carrying out a complex of deratization works in places of natural foci. Of great importance is the timely detection and treatment of patients, the use of personal protective equipment against mosquitoes. In the autumn-winter period, prophylactic vaccinations are carried out by intradermal injection of 0.1-0.2 ml of a liquid medium containing a live culture of the causative agent of rural type leishmaniasis (L. Tropica major), which causes the rapid development of leishmanioma, providing immunity to both types of leishmaniasis. The resulting grafting leishmanioma proceeds without ulceration with rapid disappearance, leaving a barely noticeable atrophic scar.

To exterminate rodents, their burrows are seeded in a zone up to 15 km wide from the settlement. The seeding zone is dictated by the flight range of the mosquitoes. Mosquito breeding sites (in particular, accumulations of garbage) are treated with bleach, residential and utility rooms are sprayed with insecticide preparations (thiophos, hexachloran). Disinfection of residential buildings and utility rooms is shown.

Considering that mosquitoes attack people mostly at night, in endemic places of leishmaniasis, netting or gauze canopies are arranged over the beds, which are smeared with Lysol or turpentine, which repel mosquitoes. During the day, the skin (mainly exposed parts of the body) is smeared with Geologist or Taiga cream, clove oil; you can also use a strong-smelling cologne, or dimethyl phthalate, which protects against mosquito bites for several hours.

Which Doctors Should You See If You Have Cutaneous Leishmaniasis

Infectionist
Dermatologist

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