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Anthroponotic cutaneous leishmaniasis
Last reviewed: 05.07.2025
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[ What causes anthropozoonotic cutaneous leishmaniasis?
Anthroponotic cutaneous leishmaniasis is caused by Leishmania tropica minor.
Symptoms of anthroponotic cutaneous leishmaniasis
The incubation period of anthroponous cutaneous leishmaniasis ranges from 2-4 months to 1-2 years (it may be extended to 4-5 years). After this period, the main symptoms of anthroponous cutaneous leishmaniasis appear at the site of the bite of infected mosquitoes (usually the face, upper limbs) - barely noticeable single, less often multiple tubercles - leishmaniomas. They go through three stages: a red or brown tubercle (proliferation stage), a dry ulcer (destruction stage) and a scar (reparation stage). They slowly increase in size and after 3-4 months reach 5-15 mm in diameter. Their color becomes reddish-brownish with a bluish tint. After several months, the tubercles can gradually resolve and disappear almost without a trace. However, such an abortive course is rare. More often, a barely noticeable depression appears on the surface of the tubercle and a scale forms, which then turns into a yellowish-brownish crust tightly attached to the tubercle.
After the crust falls off or is forcibly removed, a bleeding erosion or shallow, often crater-shaped ulcer with a smooth or fine-grained bottom covered with purulent plaque is found. The edges of the ulcer are uneven, corroded, sometimes undermined. For a long time, the ulcer is covered with a dense crust. After 2-4 months from the formation of the ulcers, the process of their scarring gradually begins, which ends on average a year after the appearance of the tubercle. This is where the local folk names for the disease come from - "godovik", "solek", "yil-yarasy". In some cases, the disease anthroponous cutaneous leishmaniasis drags on for 2 years or more.
Sometimes, after a certain period of time after the first leishmanioma, new tubercles appear, which often resolve without undergoing ulcerative decay, especially late ones. Since resistance to superinvasion develops only 6 months after the disease, the clinical course of successive leishmaniomas is almost no different from the development of primary ones.
Some patients, more often elderly people, develop diffusely infiltrating rather than limited leishmaniomas. They are characterized by larger, rather sharply limited lesions formed by the fusion of closely located tubercles. The skin in these areas is sharply infiltrated and thickened (3-10 times thicker than normal). Its surface is bluish-red, slightly flaky, smooth or bumpy. Individual small ulcers covered with crusts may be scattered on the general infiltrate.
After anthroponotic cutaneous leishmaniasis, in about 10% of cases a sluggish chronic tuberculoid cutaneous leishmaniasis (relapsing cutaneous leishmaniasis) develops, clinically resembling tuberculous lupus, which can last for decades. People who have had anthroponotic cutaneous leishmaniasis acquire immunity to this form of leishmaniasis, but can develop zoonotic cutaneous leishmaniasis.
Diagnosis of anthroponotic cutaneous leishmaniasis
Leishmania can be detected in Romanovsky-Giemsa-stained smears prepared from the ulcer contents or obtained by room temperature cultivation on NNN-arape or in tissue culture.
Differential diagnostics of anthroponotic cutaneous leishmaniasis is carried out with other skin lesions: yaws, leprosy, primary syphilis, lupus, various forms of skin cancer, leprosy, tropical ulcer.
The initial tubercle in Borovsky's disease must be differentiated from a common acne, papulopustule of folliculitis, persistent blister formed at the site of a mosquito or midge bite. A comprehensive examination of the patient, including histological, bacteriological and immunological research methods, is required to establish the correct diagnosis.
Differential diagnosis between anthroponotic and zoonotic forms of cutaneous leishmaniasis based on the clinical picture is quite difficult to carry out.
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Treatment of anthropozoonotic cutaneous leishmaniasis
Treatment of anthropozoonotic cutaneous leishmaniasis primarily involves cleaning the ulcer and treating it with antibiotics to prevent pyogenic infection.
Treatment of anthroponotic cutaneous leishmaniasis depends on the number and extent of lesions. Local treatment is successful if there are a small number of ulcers. In case of multiple lesions, treatment is indicated, as in case of visceral leishmaniasis, with solusurmin. Some lesions are relatively resistant and require long-term treatment. An effective type of treatment, according to foreign authors, is the oral administration of dehydroemetine. In case of pyogenic infections, antibiotics are used. Good results were obtained from the introduction of monomycin.
In the early stages, injections and the use of ointments containing chloriromasine (2%), paromolycin (15%) and clotrimazole (1%) are possible.
How to prevent anthropozoonotic cutaneous leishmaniasis?
Anthroponotic cutaneous leishmaniasis can be prevented by vaccination with L-tropin, along with general preventive measures including control of vectors (mosquitoes and rodents). Vaccination causes ulceration, which is accompanied by the development of long-term immunity. Such vaccination does not protect against visceral leishmaniasis, for which there is no effective vaccine yet.