In the subtropics and tropics, you can often meet the disease of leishmaniasis. The disease is transmitted to humans through mosquito bites. The causative agent of the disease is the simplest of the Leishmania clan. This pathology is registered in 88 countries, of which 72 are developing.
a brief description of
Leishmania live and develop in the human body or various animals. Quite often they are found in foxes, jackals, dogs, and some rodents. Until today, there is no information about the period of infectious animals and humans. Only one thing is known. If this parasite is present on the skin or blood, the host is a source of infection.
Very dangerous are those who settle in the body of Leishmania. They live in the spleen, liver. Sometimes parasites settle in the bone marrow. As noted above, such a disease is not only a human scourge. Often found leishmaniasis in dogs, domestic rodents.
History reference
Leishmaniasis was discovered by P.F. Borovsky in 1898. Finding parasites in the smears of a pendin ulcer, the doctor first described them. That is why the disease Leishmaniasis is also called "Borovsky disease." Much later, the pathogen will be assigned to a specially created genus of Leishmania. And the pathology transmission path was established only in 1921.
Today, leishmaniasis is a rare disease that can only be infected in the countries of the tropics, subtropics.
What is a parasite?
A more common disease is cutaneous leishmaniasis. The causative agent of the disease is Leishmania. It is impossible to examine the parasite with the naked eye. Its dimensions are microscopically small. Leishmania is about 3 microns long. The parasite has a spherical or oval shape, in the middle of it is the core. The front part of Leishmania contains a flagellum, the back is a blepharoplast.
The parasite feeds on the contents of animal and human cells. Protozoa reproduce by division. In front of the flagellum disappears. So the process of reproduction begins, as a result of which the organism becomes infected.
Distribution paths
The disease is easily transmitted. The scheme is quite simple. Insects, having bitten an infected person or animal, transfer parasites to a healthy body. After a while, the patient is diagnosed with leishmaniasis disease.
The causative agents of the disease are several dozen species. 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. After being bitten by an infected person, insects become infected. And a week later they already represent the source of the disease. These blood-sucking insects infect the patient with a skin form of the disease. The human body can produce antibodies. Once a patient with this form has a stable immunity to the disease.
With cutaneous leishmaniasis, the disease is not only transmitted through the blood to a mosquito. The insect can become infected with ulcerative discharge.
Pathology classification
Three types of disease are distinguished:
- Cutaneous leishmaniasis. The disease is manifested by extensive foci of expressed papules.
- Mucocutaneous leishmaniasis. For such a disease, ulcers on the mucous membranes of the mouth, throat, and nose are characteristic.
- Visceral leishmaniasis. This form is diagnosed if Leishmania enters the lymphatic vessels. With the flow of fluid, it spreads throughout the body. The internal organs are affected. This is mainly the spleen, lungs, heart, liver. This form does not have the ability to form an immunity to pathology in the future.
Clearly demonstrates the disease Leishmaniasis photo below. It presents a skin form of the disease.
Pathology is divided depending on who was the reservoir and source of infection. Thus, cutaneous and visceral leishmaniasis can be of two forms:
- anthroponous - the source of the disease is a person;
- zoonotic - the causative agent of the disease passes from animals.
Symptoms of the visceral form
This form is characterized by a long incubation period. From the moment of infection to the manifestation of the first signs of the disease, it can take from 20 days to 5 months. Visceral leishmaniasis develops gradually. Symptoms in the initial stages are as follows:
- characteristic general weakness;
- pallor of the skin;
- decreased appetite until its complete absence;
- the size of the spleen is slightly increased;
- apathy is noted;
- body temperature rises (the maximum indicator is 38 C).
The progression of the disease is characterized by the addition of new signs. Unaccounted treatment attempts exacerbate leishmaniasis. Symptoms in humans are added as follows:
- Significantly increased temperature (reaches around 40 ° C). This feature has a wavy character. The patient alternates with hyperthermia with normal values.
- Cough. Such a symptom occurs with damage to the respiratory apparatus.
- Enlarged lymph nodes. Identified during inspection. An increase is noted near the affected organs.
- Soreness of the liver, spleen during palpation. A significant increase in these organs is noted.
If you do not start the fight against pathology, leishmaniasis continues to progress. The treatment is significantly complicated. The patient's condition continues to worsen:
- exhaustion of the patient;
- the spleen becomes huge;
- the surface of the skin is dry, extremely pale;
- frequent dizziness;
- swelling in the legs;
- heart contractions become more frequent;
- the volume of the abdomen increases (fluid accumulates in the abdominal cavity);
- diarrhea occurs;
- potency is violated.
The final stage is characterized by a decreased muscle tone, the appearance of swelling of the whole body, and pale code covers. As a result, the patient dies.
Sometimes a chronic course of pathology is diagnosed. There are practically no signs of illness. Such a clinic is observed if seeding with Leishmania of internal organs 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 occurs on the surface of the skin. At this point, a boil forms over time, visually resembling a tubercle. Palpation of this place causes painful discomfort. After one or two weeks in the center of the tubercle there is a section of dead tissue - necrosis. This place has a black color. Soon it turns into an ulcer. A yellow-red liquid, pus, is released from the center of the wound.
Near the primary ulcer secondary tubercles begin to appear. Acquiring the form of a wound, they merge over time. One large ulcer forms on the surface of the skin.
Regional lymph nodes in the patient may increase with a diagnosis of Borovsky disease. Cutaneous leishmaniasis is characterized by wound healing within 2-6 months. However, scars remain in place of the ulcer.
Thus, the main symptoms of skin pathology are:
- the emergence of tubercles - Leishmaniomas;
- destruction of the skin at the site of the tubercle;
- an expression;
- wound healing and scar formation.
Symptomatology of the mucocutaneous form
This type of disease leishmaniasis in its manifestations is practically no different from skin pathology. The only difference is the spread of the pathology to the adjacent mucous membranes.
Causes this form of the parasite found in the New World. Mucocutaneous pathology initially resembles an animal bite. Subsequently, the mucous membranes are activated in patients. Sometimes an ailment deforms the face.
With this pathology, the following symptoms are added to the above symptoms of cutaneous leishmaniasis:
- runny nose;
- nasal congestion ;
- difficulty swallowing;
- nosebleeds;
- erosion and mouth ulcers (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 ailment, then the patient may develop pneumonia. If the respiratory system is involved, death is possible.
Diagnosis of the disease
In those countries where the disease is widespread, in patients who combine clinical symptoms and test results, the presence of leishmaniasis is assumed.
For other patients, it is necessary to conduct a tissue examination under a microscope in order to establish a final diagnosis in order 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 ailment.
Do not forget that many diseases can cause weight loss, fever, organ enlargement, and skin damage. Most ailments can mimic the symptoms of leishmaniasis. These are typhoid fever, malaria, Chagas disease, toxoplasmosis, tuberculosis, syphilis, histoplasmosis. Therefore, a final diagnosis can be made only by excluding other pathologies.
If leishmaniasis is suspected, skin diagnosis begins with a thorough collection of an epidemiological history. The fact of the patient's stay in an area known for outbreaks of the disease is clarified.
The tests to confirm the diagnosis are carried out 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 reactions (ELISA, RSK).
Treatment methods
As previously mentioned, antibiotics in the treatment of pathology are ineffective. They are prescribed only in one case - if a bacterial infection joins leishmaniasis. For different forms of the disease, their own methods of combating the disease are selected. If a patient is diagnosed with cutaneous leishmaniasis, the treatment is based on the use of local medicines. The visceral form needs a series of injections.
Diseases that occur in a mild form practically do not need special treatment. Such an ailment passes through a certain period of time on its own. At the same time, he does not leave unpleasant consequences.
If the patient has a low level of immunity, he is definitely 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 fatal.
An ailment that occurs in severe form implies surgical intervention. During the operation, the spleen is removed to the patient.
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;
- physiotherapeutic procedures;
- chemotherapy.
The surgical method is used if there is one small lesion on the surface of the skin. Such an ulcer is excised operatively.
For therapeutic purposes, the following physiotherapeutic methods can be used:
- laser pathology elimination;
- cryodestruction - the site of damage is destroyed by cold;
- current treatment - electrocoagulation.
Radical methods of therapy are combined with antibacterial and anti-inflammatory drugs.
Medication 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. A single dose is 250 mg.
- Pentavalent antimony drugs. Often these are drugs: Solusurmin, Glukontim. They are prescribed for the ineffectiveness of the drug "Metronidazole", used for 2-3 days. These medicines are administered topically 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, disinfecting ointments. They lubricate the affected areas. Effective with such a pathology, "Monomycin", "Gramitsidinovaya", "Rivanol" (1%), "Akrikhinovaya" (1%) ointment.
- "Furacilin." 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 lasting about 2-3 weeks. The dosage given above is averaged. During treatment, the norms are selected for each patient individually.
At the first stages of the disease, antiprotozoal agents (Solusurmin, Glukontim) are injected directly into the affected focus. It is advisable to carry out such injections for about 3-5 days.
Visceral treatment
With this form of pathology, 3 groups of medicines are in demand:
- Pentavalent antimony. Often, Solusurmin, Pentostam, Neostibazan, Glucantim are included in therapy. 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 "Pentamidine", "Stilbamidine." Such drugs are prescribed for the ineffective treatment of the above antimony pentavalent drugs. The patient will need to undergo 3 courses. Between which there is a break of 10 days.
- "Amphotericin B". We are talking about this medicine if all of the above drugs do not give the necessary therapeutic effect. The duration of therapy may be about 8 weeks.
The treatment may include:
- antibacterial drugs: "Metacyclin", "Rifampicin";
- antifungal agents: "Ketoconazole";
- antimicrobial medicines: "Furazolidone."
ethnoscience
The methods used by the healers to eliminate the 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 combating pathology.
With a skin form of the disease, it is recommended:
- The use of tonic agents. It is useful to take tinctures of Aralia, Schisandra chinensis, ginseng, eleutherococcus, and leuzea. They perfectly strengthen the defenses of the whole body, contribute to overall recovery. It is advisable to take any of the drugs twice a day in drops of 30.
- Freshly squeezed juices. It is extremely useful for patients to drink drinks from carrots, potatoes, cabbage.
- Decoctions, infusions of oats. Herbal teas from currant leaves, rosehip berries, honeysuckle.
- Compresses on the tubercles. This method is used only if the boils are not opened. For compresses, concentrated decoctions of tansy flowers, willow bark are used.
- Coniferous resin - spruce, fir, pine. In the form of cakes, it should be applied to the affected area and secured with a bandage.
Using such methods, be sure to consult a doctor. Some remedies contain contraindications and can deliver unpleasant consequences instead of cure.
Prevention of ailment
The main measures to prevent the disease is the destruction of the sources of infection - rodents and mosquitoes - in the areas of their reproduction.
Seeding of places inhabited by rodents is carried out within a radius of 15 km from the locality where the prevention is carried out. This distance corresponds to the range of mosquitoes.
To prevent the spread of skin pathology, it is necessary to prevent the reproduction of stray animals. Homework is recommended to constantly be screened for infection.
Systemic preventive measures include:
- Improvement of residential areas. The breeding sites of mosquitoes and rats should be eliminated.
- It is recommended that landfills be disposed of.
- Avoid flooding basements.
- Repair all pipelines in a timely manner.
- Preventive disinsection of residential and basement should be carried out regularly.
To protect the home from bloodsucking insects allow mosquito dense nets. In addition, repellents are recommended. Such simple methods will prevent the occurrence of Leishmaniasis disease.
Prevention when visiting places that are dangerous is based on specific immune therapy. Unfortunately, to date, a valid vaccine against the disease has not been developed.
Conclusion
In most cases, the prognosis of the disease is favorable. If we talk about cutaneous leishmaniasis, then it is extremely rarely fatal. Although often leaves behind ugly scars. In the absence of proper therapy, the visceral form almost always leads to death as a result of severe depletion or organ failure. This can be avoided, but only in a timely manner, starting the fight against unpleasant pathology under the guidance of a competent doctor.