In the subtropics and tropics, leishmaniasis disease is often found. The disease is transmitted to humans through mosquito bites. The causative agent of the disease is a protozoan of the genus Leishmania. This pathology has been registered in 88 countries, of which 72 are developing.
Short description
Live and develop Leishmania in the human body or various animals. Quite often they are found in foxes, jackals, dogs, and some rodents. To date, there is no information about the period of contagiousness of animals and humans. Only one is known. If there is this parasite on the skin or in the blood, then the host is the source of infection.
The leishmanias that settle in the body are very dangerous. They live in the spleen and liver. Sometimes parasites settle in the bone marrow. As noted above, such a disease is not only a human scourge. Leishmaniasis is often found in dogs, domestic rodents.
Historical background
Leishmaniasis was discovered by P. F. Borovsky in 1898. Having found the parasites in the smears of Pendin's ulcer, the doctor described them for the first time. That is why the disease is also called leishmaniasis. Borovsky's disease. Much later, the pathogen will be assigned to a specially created genus of Leishmania. And the path of transmission of pathology was established only in 1921.
Today, the disease leishmaniasis is a fairly rare disease that can only be contracted in the countries of the tropics, subtropics.
What is a parasite?
The more common disease is cutaneous leishmaniasis. The causative agent of the disease is Leishmania. It is impossible to see the parasite with the naked eye. Its dimensions are microscopically small. The length of Leishmania is about 3 microns. The parasite has a spherical or oval shape, in the middle of it is the nucleus. The front part of Leishmania contains a flagellum, the back is a blepharoplast.
The parasite feeds on the contents of animal cells, humans. Protozoa reproduce by fission. The flagellum disappears in the anterior part. This is how the process of reproduction begins, as a result of which the infection of the body occurs.
Distribution routes
The disease is easily transmitted. The scheme is quite simple. Insects, having bitten an infected person or animal, transfer parasites to a he althy body. After a while, the patient is diagnosed with leishmaniasis.
Several dozen species are known to cause diseases. About twenty of them pose a danger to human life. Most often they cause cutaneous leishmaniasis. Complicating the treatment of the disease is the fact that the parasites are completely insensitive to antibiotic therapy.
The carriers of the disease are mosquitoes. Afterthe bite of an infected person, the insects become infected. And a week later they are already the source of the disease. These blood-sucking insects infect the patient with the skin form of the disease. The human body can produce antibodies. Once ill with this form, the patient has a strong immunity to the disease.
With cutaneous leishmaniasis, the disease can be transmitted not only through the blood to the mosquito. The insect can become infected with ulcerative discharge.
Classification of pathology
There are three types of disease:
- Skin leishmaniasis. The disease is manifested by extensive foci of pronounced papules.
- Mucocutaneous leishmaniasis. This disease is characterized by ulcers on the mucous membranes of the mouth, throat, nose.
- Visceral leishmaniasis. This form is diagnosed if leishmania enters the lymphatic vessels. With a current of liquid, it spreads throughout the body. Internal organs are affected. Basically it is the spleen, lungs, heart, liver. This form does not have the ability to subsequently form immunity to pathology.
The photo below clearly demonstrates the disease leishmaniasis. It shows the skin form of the disease.
Divide pathology depending on who was the reservoir and source of infection. Thus, cutaneous and visceral leishmaniasis can be of two forms:
- anthroponotic - the source of the disease is a person;
- zoonotic - the causative agent of the disease passes from animals.
Visceral symptoms
This form is characterized by a long incubation period. From the moment of infection to the first signs of illness, it can take from 20 days to 5 months. Visceral leishmaniasis develops gradually. Symptoms in the initial stages are as follows:
- characteristic general weakness;
- pale skin;
- decrease in appetite up to its complete absence;
- spleen slightly enlarged;
- apathy is noted;
- body temperature rises (maximum is 38 C).
The progression of the disease is characterized by the addition of new signs. Unexpected treatment attempts exacerbate leishmaniasis. Symptoms in humans are added as follows:
- Significantly increased temperature (reaches 40 C). Such a sign has a wave-like character. Patient alternates between hyperthermia and normal.
- Cough. This symptom occurs when the respiratory apparatus is damaged.
- Enlarged lymph nodes. Discovered upon examination. An increase is noted near the affected organs.
- Soreness of the liver, spleen during palpation. There is a significant increase in these organs.
If you do not start the fight against pathology, leishmaniasis continues to progress. Treatment becomes much more difficult. The patient's condition continues to deteriorate:
- patient exhaustion;
- the spleen becomes huge;
- skin surface dry, extremely pale;
- frequent dizziness;
- appear puffiness inlegs;
- heart rate increases;
- the volume of the abdomen increases (fluid accumulates in the abdominal cavity);
- diarrhea occurs;
- violated potency.
The final stage is characterized by a reduced tone in the muscles, the appearance of swelling of the whole body, pale code covers. As a result, the patient dies.
Sometimes a chronic pathology is diagnosed. There are practically no signs of illness. Such a clinic is observed if the contamination of internal organs with leishmania is minimal.
Symptoms of skin pathology
This form is often registered in Saudi Arabia, Afghanistan, Brazil, Syria, Iran, Peru. The incubation period can last from 10 days to 1.5 months.
At the initial stage, a formation characteristic of an insect bite appears on the surface of the skin. In this place, over time, a boil forms, visually resembling a tubercle. Palpation of this place causes painful discomfort. After one to two weeks, an area of dead tissue appears in the center of the tubercle - necrosis. This place is black. Soon it turns into an ulcer. From the center of the wound, a yellow-red liquid is oozing out - pus.
Secondary tubercles begin to appear near the primary ulcer. Taking the form of a wound, they eventually merge. One large ulcer forms on the surface of the skin.
Regional lymph nodes may increase in a patient diagnosed with Borovsky's disease. Cutaneous leishmaniasis is characterized by wound healing within 2-6 months. However, scars remain at the site of the ulcer.
Thus, the main symptoms of skin pathology are:
- appearance of tubercles - leishmaniasis;
- destruction of the skin at the site of the tubercle;
- statement;
- wound healing and scar formation.
Symptomatics of the mucocutaneous form
This type of disease leishmaniasis in its manifestations practically does not differ from skin pathology. The only difference is the spread of pathology to the adjacent mucous membranes.
This form is caused by a parasite found in the New World. The mucocutaneous pathology initially resembles an animal bite. Subsequently, the mucous membranes are involved in patients. Sometimes the disease deforms the face.
With this pathology, the following symptoms are added to the above described symptoms of cutaneous leishmaniasis:
- runny nose;
- nasal congestion;
- difficulty swallowing;
- nosebleeds;
- erosions and ulcers in the mouth (on the lips, gums, tongue);
- ulcers in the nasal cavity.
Doctors distinguish two types of complications of this form. If a secondary infection joins the disease, then the patient may develop pneumonia. If respiratory organs are involved, death is possible.
Disease diagnosis
In countries where the disease is widespread, patients with a combination of clinical symptoms and test results are suspected of having leishmaniasis.
Other patients need tissue testing to make a definitive diagnosisunder a microscope to detect parasites, or a blood test to detect antibodies. Known in medicine is a skin test called the “black skin” test. Such a study is imperfect, therefore, it is practically not used to diagnose the disease.
It should not be forgotten that many diseases can cause weight loss, fever, organ enlargement, skin lesions. Most ailments can mimic the symptoms of leishmaniasis. These are typhoid fever, malaria, Chagas disease, toxoplasmosis, tuberculosis, syphilis, histoplasmosis. Therefore, it is possible to make a final diagnosis only by excluding other pathologies.
When leishmaniasis is suspected, cutaneous diagnosis begins with a thorough epidemiological history. The fact that the patient was in an area known for outbreaks of the disease is being investigated.
Tests to confirm the diagnosis are as follows:
- examination of material taken from ulcers and tubercles;
- blood test (according to Romanovsky-Giemsa);
- bone marrow puncture;
- biopsy of the liver, lymph nodes, spleen;
- biological samples;
- serological tests (ELISA, RSK).
Treatment methods
As previously mentioned, antibiotics are ineffective in the treatment of pathology. They are prescribed only in one case - if a bacterial infection joins leishmaniasis. For different forms of the disease, their own methods of dealing with the disease are selected. If a patient is diagnosed with cutaneous leishmaniasis, treatment is based on the use of local medicines. The visceral form needs a series of injections.
Mild illnesses practically do not need special treatment. Such an ailment passes on its own after a certain period of time. At the same time, it does not leave any unpleasant consequences.
If a patient has a low level of immunity, he must be prescribed therapeutic treatment. Since the disease is quite difficult. The lack of necessary therapeutic measures is fraught with serious consequences for the patient, and sometimes even death.
A disease that is severe and involves surgery. During the operation, the patient's spleen is removed.
Treatment of skin pathology
The methods of struggle depend on the form, stage and course of such a pathology as leishmaniasis. Treatment may include the following methods:
- drug therapy;
- surgical method;
- physiotherapy treatments;
- chemotherapy.
The surgical method is used if there is one small lesion on the surface of the skin. Such an ulcer is excised surgically.
The following physiotherapy techniques can be used for therapeutic purposes:
- laser pathology elimination;
- cryolysis - the lesion is destroyed by cold;
- electric treatment - electrocoagulation.
Radical therapies are combined with antibacterial and anti-inflammatory drugs.
Drug treatment is based on the following drugs:
- Metronidazole. The course of treatment is usually about 10 days. The drug is taken perinatally three times a day. Single dose - 250 mg.
- Drugs of pentavalent antimony. Often these are drugs: "Solyusurmin", "Glukontim". They are prescribed for the ineffectiveness of the drug "Metronidazole", used for 2-3 days. These medications are administered locally and intramuscularly. The recommended dose is 400-600 mg per day.
- "Pentamidine". This remedy is the drug of choice. It is used twice a week at 2-4 mg/kg.
- Local antiseptic, disinfectant ointments. They lubricate the affected areas. Effective in such a pathology "Monomycin", "Gramicidin", "Rivanol" (1%), "Acrichin" (1%) ointment.
- Furacillin. Lotions from this solution are recommended.
Drug treatment is often carried out in certain courses. Between them, it is definitely recommended to take a break of about 2-3 weeks. The dosages of the drugs given above are averages. During treatment, the norms are selected for each patient individually.
In the first stages of the disease, antiprotozoal drugs ("Solyusurmin", "Glukontim") are injected directly into the affected area. It is advisable to carry out such injections for about 3-5 days.
Treatment of visceral form
With this form of pathology, 3 groups of medicines are in demand:
- Means of pentavalent antimony. Often, the therapy includes "Solyusurmin", "Pentostam", "Neostibazan", "Glucantim". The drugs are administered intramuscularly or intravenously. The dosage of these medicines depends on age. The maximum course consists of 20 injections.
- Aromatic diamidines. These are the drugs "Pentamidin", "Stilbamidin". Such funds are prescribed for ineffective treatment with the above drugs of pentavalent antimony. The patient will need to take 3 courses. Between which there is a break of 10 days.
- "Amphotericin B". We are talking about this medicine if all the above drugs do not give the necessary therapeutic effect. The duration of therapy can be about 8 weeks.
Treatment may include:
- antibacterial drugs: Metacycline, Rifampicin;
- antifungals: Ketoconazole;
- antimicrobial drugs: Furazolidone.
Traditional medicine
The methods used by healers to eliminate pathology can become effective. It should only be remembered that such methods cannot replace the therapy prescribed by the doctor for the disease "cutaneous leishmaniasis". Treatment with folk remedies should act as additional methods of dealing with pathology.
For the skin form of the disease, it is recommended:
- Using tonics. It is useful to take tinctures of aralia, magnolia vine, ginseng, eleutherococcus, leuzea. They perfectly strengthen the defenses of the whole organism, contribute to overall he alth. It is advisable to use any of the drugs twice a day drops of 30.
- Freshly squeezed juices. It is extremely useful for patients to usedrinks made from carrots, potatoes, cabbage.
- Decoctions, infusions of oats. Herbal teas from currant leaves, rose hips, honeysuckle.
- Compresses on tubercles. This method is used only if the boils have not opened. For compresses, concentrated decoctions of tansy flowers, willow bark are used.
- Coniferous resin - spruce, fir, pine. In the form of a cake, it should be applied to the affected area and secured with a bandage.
Be sure to consult your doctor when using these methods. Some remedies contain contraindications and instead of a cure, they can deliver unpleasant consequences.
Disease prevention
The main measures to prevent the disease is the destruction of sources of infection - rodents and mosquitoes - in their breeding areas.
Inoculation of places inhabited by rodents is carried out within a radius of 15 km from the settlement in which prevention is carried out. This distance corresponds to the flight distance of mosquitoes.
To prevent the spread of skin pathology, it is necessary to prevent the reproduction of homeless animals. It is recommended that pets be constantly examined for infection.
Systemic prevention measures include:
- Beautification of residential areas. Mosquito and rat breeding sites should be eliminated.
- Recommended to eliminate landfills.
- Keep basements from flooding.
- Repair all pipelines in a timely manner.
- Prophylactic disinsection of residential and basement premises should be carried out regularly.
Protect the homefrom blood-sucking insects mosquito dense nets allow. In addition, it is recommended to use repellents. Such simple methods will help prevent the occurrence of leishmaniasis.
Prophylaxis when visiting dangerous places is based on specific immune therapy. Unfortunately, no effective vaccine against the disease has been developed to date.
Conclusion
In most cases, the prognosis of the disease is favorable. If we talk about cutaneous leishmaniasis, it rarely leads to death. Although often leaves disfiguring scars. In the absence of proper therapy, the visceral form almost always leads to death as a result of severe exhaustion or organ failure. This can be avoided, but only by starting the fight against an unpleasant pathology in a timely manner under the guidance of a competent doctor.
