Cutaneous leishmaniasis in children

Cutaneous leishmaniasis in children (Pendinsky ulcer, Borovsky disease, oriental ulcer, yearling, etc.) is a localized skin disease with characteristic ulceration and scarring caused by L. tropica.

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Pathogenesis of cutaneous leishmaniasis in children

At the entry point, leishmania multiply and cause a local proliferative process with the formation of a specific granuloma (leishmanioma). Granulomas consist of plasma and lymphoid cells, fibroblasts and macrophages containing a large number of leishmania. Subsequently, granulomas-leishmaniomas become necrotic, ulcerate, and then scar. In some patients, the granulomatous process progresses, but ulceration may not occur - the so-called tuberculoid leishmaniasis is formed.

Symptoms of cutaneous leishmaniasis in children

A distinction is made between the dry form (anthroponotic urban leishmaniasis) and the wet form (zoonotic rural leishmaniasis) of cutaneous leishmaniasis.

The source of infection in the dry form is a sick person with open lesions, and in the wet form - rodents. The carrier of infection in both forms are mosquitoes.

• In the dry form of cutaneous leishmaniasis, the incubation period lasts from 2-3 months to 1 year or more. At the site of the mosquito bite, a papule or papules appear, which are small pink or brownish painless tubercles up to 3 mm in size. Later, the papules seem to mature, grow, and after 3-5 months they ulcerate and become covered with a crust. The ulcers are quite deep, crater-shaped. A dense infiltrate is determined around the ulcer, rising above the surface of the skin. Purulent plaque is found at the bottom of the ulcer. For some time, the ulcers increase in size as a result of the disintegration of the infiltrate, and by 10-12 months of the disease, they begin to cleanse and fill with granulation tissue. A scar forms at the site of the ulcer. The course of the disease is long, about a year passes from the moment the tubercle appears until the scar is formed. In some children, the process can drag on for many years, usually when so-called tuberculoid leishmaniasis develops. In such patients, multiple nodules form at the site of the infection's entry point, which grow and form nodular leprosy-like infiltrates without a tendency to ulcerate.
• In the weeping form of cutaneous leishmaniasis, the incubation period lasts from several days to a month. At the site of the infection entry point, a tubercle appears, which quickly increases in size and ulcerates (1-2 weeks after its appearance). A large ulcer is formed, up to 15-20 cm in size, with undermined edges, abundant serous-purulent discharge and painful to palpation (Pendin ulcer). Around such large ulcers, small scattered tubercles may form, which can also quickly increase in size and ulcerate. Merging, they form continuous ulcerative fields. The granulation process begins after 2-3 months, complete healing with scar formation occurs on average 6 months after the appearance of the first signs of the disease. The weeping form may also have long-term tuberculoid variants.

Diagnosis of cutaneous leishmaniasis in children

Cutaneous leishmaniasis is diagnosed based on the characteristic clinical picture, taking into account epidemiological data and detection of leishmania in the material from the ulcer bottom and marginal infiltrate. Sometimes a bioassay is performed on white mice.

Cutaneous leishmaniasis is differentiated from furuncle, syphilis, leprosy, trophic ulcers and other skin lesions.

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Treatment of cutaneous leishmaniasis in children

Antimony preparations are ineffective in cutaneous leishmaniasis. Locally, lotions of furacilin solution, gramicidin, akrikhin solution, Vishnevsky ointment are used. Monomycin ointment is effective. In case of extensive infiltrates, intramuscular administration of monomycin in an age-appropriate dose for 7 days is indicated. Antibiotics are prescribed to suppress secondary bacterial flora. General strengthening and stimulating therapy is carried out.

Prevention of cutaneous leishmaniasis in children

Rodents and mosquitoes are controlled according to existing instructions. Early detection and treatment of patients are crucial. Bandages are applied to affected areas of the body to prevent the spread of infection. Vaccinations with live cultures of Leishmania are recommended.