Leishmaniasis - Causes, Symptoms and Treatment .MF .
Leishmaniasis - is a group of protozoan diseases of the skin and mucous membranes (incl internal organs) with the corresponding specific symptoms depending on the form of leishmaniasis (visceral or cutaneous), caused by protozoa of the genus of Leishmania, which is transmitted by mosquitoes genus Phlebotomus (Old World leishmaniasis) and lutzomyia (New World leishmaniasis).
leishmaniasis Leishmania - an intracellular parasite that is currently known about 20 species and subspecies of Leishmania.
Leishmania under a microscope
They are characterized by a complex life cycle that takes place in the body of the two hosts, one of which is a vertebrate (incl and people), and the second - the mosquitoes that live in Europe, Africa, Asiaand America.Develops intracellularly in free macrophages and cells of the MPS (the system of mononuclear phagocytes: histiocytes connective tissue, Kupffer cells of the liver (stellate retikuloendoteliotsity), alveolar macrophages lung macrophages of the lymph
Stability: The pathogen is killed by the action of disinfectants, extreme high and low temperatures.
susceptibility and prevalence: a general susceptibility, but pinpoint the geographic distribution and frequency of detection - it is difficult, because in many countries the disease is not subject to registration.It is known that leishmaniasis each year get sick of not less than 400 thousand people in 80 countries.There are projects for the development of new areas of the Old World and the New World - this is due to the migration of people and as a result, emerging epidemics in Iran, Iraq, Israel, Sudan and other countries.The probability of importation of infections in our region is quite large, given that the leishmaniasis occur in the ways of the most active trade and tourist population migration.
widespread Leishmaniasis, a long incubation period (reaching up to 2 years), severity and high frequency of adverse outcomes in untreated cases, a weak awareness of practitioners - all this complicates the diagnosis and treatment of Leishmaniasis.
Source - a sick man, a dog, wild mammals of the detachments of predators and rodents.Transduction - transmissive (bites), transfusion.Contact (if any microtrauma) path remains open to question, with the exception of infection with visceral forms.The reservoir of infection - the female mosquitoes.
Symptoms of visceral leishmaniasis
The incubation period varies from a few days up to 15 months, counted from the moment of penetration of the pathogen before the first clinical symptoms.The period of clinical manifestations begins gradually (but possibly acute onset), in the form of unwarranted fatigue, weakness, a feeling of heaviness and discomfort in the abdomen, the disappearance of appetite, weight loss, the patient pays attention mainly to the fact that he had "reason"belly begins to grow.Periodically, the temperature rises initially to subfebrile, and then higher.At the initial examination the doctor may notice:
• pale skin with a further occurrence of hemorrhages in the skin and mucous membranes, as well as the appearance of the skin and mucous icteric.Sometimes identify primary affect - small size of a lentil, a tight pale pink nodule or ulcers in the scrapings of which found a large number of Leishmania.
• Increase in regional lymph nodes can be detected rarely, because they are slightly raised, painless and the skin over them is not changed.
• Auscultation - muffled heart sounds, systolic murmur over the top, a moderate tachycardia.
• Discover hepatosplenomegaly (enlargement of the liver and spleen), but tenderness to palpation is not marked.In the long term this could lead to inhibition of the functional activity of these bodies, and the impact it is in violation of the immune response, disruption of coagulation and protivosvertyvayuschiey systems, enzymatic deficiency and others - all of these have arisen factors produce visible symptoms of leishmaniasis (ikterichnost, hemorrhage, pallor due to anemia).
• Fever reaches high numbers, but it is impossible to predict the dynamics.
• At the height of the disease the skin becomes dry, flaky and dull brittle hair is easy to fall, forming small nests baldness.
• Kidney damage is immune complex character, with the further development of glomerulonephritis.
also have atypical forms of visceral leishmaniasis : lymphatic leishmaniasis with generalized lymphadenopathy, leishmaniasis with a predominance of hemorrhagic lesions, with lesions of Leishmania predominantly mucous membranes.Visceral leishmaniasis is a form of some differences in the various regions of the globe, so on this principle distinguish children's kala azar, Indian kala azar, an African American.
Antropanozny cutaneous leishmaniasis Old World (later ulcerated form, "yearling", "ashhabadka")
possible contamination Places: Africa, southern Europe, the Middle East, Central Asia, India, Pakestan.Infection occurs transmissivynm way - through the bite of mosquitoes to bite formed the primary element - papule, which increases in size, and then covered with a crust, ulcerate and then through the time covered by granulation (it is the primary signs of healing).From the moment of the bite until the first manifestations may take 3-15 months and at every stage of the formation of the inflammatory process (from papule to granulation) takes an average of 3-6 months, but 12 months the ulcer to heal.Localization ulcers mainly on the face and extremities, and may be 1-10.After suffering a disease generated proof lifelong immunity.
Zooantraponozny cutaneous leishmaniasis Old World (early willing leishmaniasis)
places of possible infection: South and Central Asia, and sometimes Africa.The entire route of infection occurs almost 3 times faster: the incubation period - 7-45 days, inflammatory infiltrate appears in 1-2 weeks, around it there are children rashes, but it goes through 6 months, and ends by scarring.Immunity is lifelong.
mucocutaneous leishmaniasis of the New World (espundia): Mexican, Brazilian, Peruvian
This natural form of alopecia.Carriers are Maskit.From the first bite to the clinical manifestations, held from 2 weeks - 3 months.On the site of the bite are formed deep ulcers, with the involvement of mucous membranes, lymph nodes and blood vessels - this is followed by heavy cosmetic complications and serious prognosis.
mucocutaneous form of leishmaniasis (espundia)
diagnostic errors may occur when setting serological tests, because of Leishmania antigens are shared with and mycobacterium triponasomami.
the diagnosis of fence material depends on the form of the disease: for example, in skin scrapings examined forms, with the visceral form - blood, bone marrow puncture, biopsy of the liver, lymph nodes, scrapings from the nasal mucosa.The test material was stained with Romanovsky-Giemsa exhibit intracellularly located amostigoty.In an epidemiological study used skin allergological test, a positive result which speaks the presence of the past in contact with Leishmania - Trial Montenegro.
treatment of leishmaniasis
Antibiotics: monomitsin, solyusurmin, quinacrine, aminoquinolyl, pentamidine isethionate.Symptomatic therapy of dominant states.Also, effective local treatment, ie obkalyvanie foregoing the use of drugs or lotions.Tk for our latitude is not characteristic of this disease, we have to rely on more than the experience of foreign authors with expertise in the treatment of leishmaniasis, and it is not a small part of them refers to the choice and monomycin aminoquinolyl as the most effective drugs against the pathogen.With the ineffectiveness of these drugs are used 5-valent antimony, and if does not help the drug, then resorted to pentamidine isethionate - but this step scheme is more suitable for the visceral form.Effective laser therapy, especially at the stage of tubercle.Treatment time 2 weeks on average.As you can see, the specific drugs and about any self-treatment and self-diagnosis can be no question.
complications Leishmaniasis and forecast
Depending on the form and a choice of tactics of treatment, namely how early it started.So, for example, in the form of skin at the site of Leishmania remains hyper / depigmentation, small scars, or in the early diagnosis and treatment of all may pass unnoticed.The most dangerous in terms of prognostic mucocutaneous form, because it leaves a disabling in terms of cosmetic scars in place of ulcerations and increases the risk of secondary bacterial and septic complications.
prognosis for timely treatment early enough favorable, mortality is very low and often are the cause of secondary complications.
specific prophylaxis - the introduction of a living cultural vaccine, not later than 3 months prior to departure in the epidemic area.Non-specific prevention - the fight against mosquitoes.
therapists Shabanova IE