Cutaneous leishmaniasis in children

Cutaneous leishmaniasis in children (Pennin's ulcer, Borovsky's disease, eastern ulcer, yearling, etc.) is a localized skin disease with characteristic ulceration and scarring caused by L. Tropica.

[1], [2], [3], [4], [5]

Pathogenesis of cutaneous leishmaniasis in children

At the entrance gate, leishmanias 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 leishmanias. Subsequently, granulomas-leishmaniomas necrotize, ulcerate, and then cicatrize. In some patients, the granulomatous process progresses, but ulceration may not occur - so-called tuberculoid leishmaniasis is formed.

Symptoms of cutaneous leishmaniasis in children

Distinguish the dry form (anthroponous city leishmaniosis) and the wet form (zoonotic rural leishmaniasis) of cutaneous leishmaniasis.

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

• With the dry form of cutaneous leishmaniasis, the incubation period lasts from 2-3 months to 1 year and more. At the site of the mosquito bite, a papule or papules appear, representing small pink or brownish, painless tubercles up to 3 mm in size. In the future, papules seem to ripen, grow and after 3-5 months. Ulcerated and crusted. Ulcers are rather deep, crater-like. Around the ulcer is determined by a dense infiltrate, towering above the surface of the skin. At the bottom of the ulcer, purulent deposits are found. Some time the ulcers increase as a result of the collapse of the infiltrate, and by 10-12 months of the disease begins their purification and filling with granulation tissue. On the site of an ulcer a scar is formed. The course of the disease is prolonged, from the moment of the appearance of the tubercle to the formation of the scar, it takes about a year. In some children, the process can be delayed for many years, usually when the so-called tuberculoid leishmaniasis is formed. In such patients, multiple nodules are formed on the site of the entry gate of the infection, which grow and form nodular leproposal infiltrates without a tendency to ulcerate.
• With a damp form of cutaneous leishmaniasis, the incubation period lasts from a few days to a month. At the entrance gate of infection there is a tubercle, which rapidly increases and ulcerates (after 1-2 weeks from the time of appearance). A large ulcer is formed up to 15-20 cm in size with ruptured margins, abundant serous-purulent discharge and painful on palpation (Pendin ulcer). Around such large ulcers it is possible to form small scattered tubercles, which can also rapidly increase and ulcerate. Fusing, they form solid ulcer fields. The process of granulation begins in 2-3 months, complete healing with scar formation occurs on average 6 months after the appearance of the first signs of the disease. Wet form can also have long-lasting tuberculoid variants.

Diagnosis of cutaneous leishmaniasis in children

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

Differentiate cutaneous leishmaniasis with furuncle, syphilis, leprosy, trophic ulcers and other skin lesions.

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Treatment of cutaneous leishmaniasis in children

Antimony preparations for cutaneous leishmaniasis are ineffective. Locally use lotions from a solution of furacilin, gramicidin, akrichin solution, Vishnevsky ointment. Effective monomycin ointment. With extensive infiltrates, intramuscular administration of monomycin in an age-related dose for 7 days is indicated. To suppress secondary bacterial flora, antibiotics are prescribed. Conduct fortifying and stimulating therapy.

Prevention of cutaneous leishmaniasis in children

The fight against rodents and mosquitoes is carried out according to existing instructions. The early detection and treatment of patients is crucial. Bandages are applied to prevent the spread of infection to the affected areas of the body. Vaccinations are recommended with live Leishmania culture.