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Anthroponous cutaneous leishmaniasis
Last reviewed: 23.04.2024
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[What causes anthroponous cutaneous leishmaniasis?
Anthroponous cutaneous leishmaniasis is caused by Leishmania tropica minor.
Symptoms of anthroponous cutaneous leishmaniasis
The incubation period of anthroponous cutaneous leishmaniasis varies from 2-4 months to 1-2 years (the lengthening of the term up to 4-5 years is possible). After its expiration, the main symptoms of anthroponous cutaneous leishmaniasis appear on the site of the bite by infected mosquitoes (more often the face, upper limbs) - unobtrusive single, less often multiple tubercles - leishmaniomas. They go through three stages: red or brown tubercle (proliferation stage), dry ulcer (stage of destruction) and scar (repair stage). They slowly increase and after 3-4 months reach 5-15 mm in diameter. Their color becomes reddish-brownish with a cyanotic shade. After a few months the tubercles can gradually resolve and almost completely disappear. However, this abortive course is rare. More often on the surface of the tubercle, a barely noticeable occlusion appears and a scaly is formed, which then turns into a yellowish-brownish crust tightly attached to the hillock.
After falling off or forcibly removing the crust, bleeding erosion or a shallow, often crater-like ulcer with a smooth or fine-grained bottom covered with a purulent coating is found. The edges of the ulcers are uneven, eaten, sometimes dug. For a long time, the ulcer is covered with a dense crust. In 2-4 months after the formation of ulcers, the process of scarring begins gradually, which ends an average of one year after the appearance of the tubercle. Hence the local alternative names of the disease - "godovik", "solk", "yl-yarasy". In some cases, the disease anthroponous cutaneous leishmaniasis is delayed by 2 years or more.
Sometimes after this or that time after the first leishmanioma new tubercles appear, which often dissolve without being subjected to ulcerous decay, especially late ones. Since immunity to superinvasia develops only 6 months after the disease, the clinical course of successive leishmanias almost does not differ from the development of primary.
In some patients, more often in the elderly, unlimited, and diffusively infiltrating leishmaniomas develop. They are characterized by larger, rather sharply limited foci of lesions, formed as a result of the fusion of closely located bumps. The skin in these areas is sharply infiltrated and thickened (3-10 times thicker than normal). The surface of it is cyanotic red, slightly flaky, smooth or tuberous. On the common infiltrate, individual small ulcers covered with crusts can be scattered.
After anthroponous cutaneous leishmaniasis, approximately 10% of cases develop sluggish chronic tuberculoid skin leishmaniasis (recurrent cutaneous leishmaniasis), clinically reminiscent of tuberculous lupus, which can last for decades. People who have suffered anthroponous cutaneous leishmaniasis acquire immunity to this form of leishmaniasis, but may develop zoonotic cutaneous leishmaniasis.
Diagnosis of anthroponous cutaneous leishmaniasis
Leishmania can be detected in Romanov-Giemsa stained smears prepared from the contents of an ulcer, or obtained by culturing at room temperature on a NNN-arape medium or in a tissue culture.
Differential diagnosis of anthroponous 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 an ordinary eel, a papule-pustule of the folliculitis, a persistent blister formed at the site of a mosquito or mosquito bite. To establish the correct diagnosis requires a comprehensive examination of the patient, including histological, bacteriological and immunological methods of investigation.
Differential diagnosis between anthroponotic and zoonotic forms of cutaneous leishmaniasis based on the clinical picture is difficult to conduct.
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Treatment of anthroponous cutaneous leishmaniasis
Treatment of anthroponous cutaneous leishmaniasis, first of all, consists in purifying the ulcer and treating it with antibiotics to prevent pyogenic infection.
Treatment of anthroponous cutaneous leishmaniasis depends on the number and spread of lesions. Local treatment is successful in the presence of a small number of ulcers. With multiple lesions treatment is shown, as in visceral leishmaniasis, solusurmin. Some lesions are relatively resistant and require long-term treatment. An effective type of treatment, according to foreign authors, is the use of dehydro-methine inside. In the presence of pyogenic infections, antibiotics are used. Good results are obtained from the administration of monomycin.
In the early stages, it is possible to chop and apply ointments containing chloromarazine (2%), paromolycin (15%) and clotrimazole (1%).
How to prevent anthroponous cutaneous leishmaniasis?
Anthroponous cutaneous leishmaniasis can be prevented if, along with general preventive measures, including vector control (mosquitoes and rodents), vaccination with L-tropine is carried out. Vaccination leads to the formation of ulcers, which is accompanied by the development of long-term immunity. Such vaccination does not protect against visceral leishmaniasis, against which an effective vaccine is not yet available.