Espuddia (Brazilian skin-mucous leishmaniasis)
Last reviewed: 23.04.2024
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Espundia (Synonym: Brazilian skin-mucous leishmaniasis).
Skin and slimy American leishmaniasis has several nosological forms, the causative agents of which belong to the complex of L. Brasiliensis.
The most severe form is Brazilian leishmaniasis (espuda), in which, in 80% of cases, in addition to ulcers on the skin at the site of the pathogen, there are also extensive lesions of the mucous membranes of the nasopharynx, larynx, and cartilage of soft tissues and even bones.
Distribution of Brazilian skin-mucous leishmaniasis
Skin-mucous leishmaniasis (espuda) occurs mainly in southern America. Cases of such a disease are known in some countries of Asia and Africa (Sudan, Somalia, Kenya, India).
Epidemiology of espuda
The spread of the disease is related to climatic conditions, the season and the nature of the terrain. High temperature and high humidity are necessary conditions, accompanying the occurrence of diseases. The espartia is often noted in autumn, rainy time. The height of the terrain is important (no more than 2000 m above sea level). The disease is more often observed in rural, wooded areas and is associated with the density of mosquitoes. Skin and mucous form of leishmaniasis often occurs in people working in forests, especially collecting resinous substances for the production of "ruminant" rubber, so the espune is also called "chewing gum" disease.
The carriers of the disease are mosquitoes, natural reservoirs-carriers - rodents and, possibly, dogs. Kiri in 1946 observed an experimental espunt after the infection of monkeys with the Sudan kala-azar. Of all the experimentally infected animals, only the monkeys managed to reproduce the oral and nasal cavity lesions.
Causes of espuda
Espuda (Brazilian skin-mucous leishmaniasis) is caused by L. Brasiliensis. Carriers are more than 12 species of mosquitoes of the genus Lutzomya, but the most common is Lu. Wilcomei.
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Pathogenesis of Brazilian skin-mucous leishmaniasis
Mucous-skin lesions begin as a perivascular infiltration, then endarteritis develops, which can lead to destruction of the surrounding tissue. The microscopic nature of skin lesions can be similar to the eastern ulcer. Parasites can penetrate through the circulating macrophages into the nose, mouth and soft palate, where they multiply in macrophages of the cartilaginous or connective tissues, causing destructive inflammation. The process can spread to the pharynx and larynx; sometimes the external genitalia are also affected. The frequency of this severe (sometimes fatal) complication depends on the strain of the parasite and ranges from 5 to 85%; The strains circulating in the southern part of Brazil and in Paraguay are characterized by a particularly frequent dissemination. Metastatic lesions may appear before the formation of the primary focus; in other cases, they can occur even 30 years after "recovery."
Symptoms of an espuda
Symptoms of classical escuda, found in Brazil, Peru, Chile, Ecuador, Bolivia, Paraguay, are the appearance of papulo-pustular skin lesions, which are noted on the face, ears and legs. Lesions of mucous membranes or accompany skin lesions, or appear after a few years. Stagnant phenomena are observed in the mucosa of the nasal cavity, and later it is ulcerated. When introducing parasites in the area of the lips, soft palate, throat, there may be destruction, which leads to severe suffering and deformities. The nose usually thickens, deforms, bends downwards, and the upper lip as a result of swelling and deformation noticeably protrudes forward and upwards ("nose of the tapir"). Duration of the disease is from 4 months to 4 years.
In addition to the espoon in South America, several endemic forms of cutaneous leishmaniasis are known, which differ in their landscape, epidemiology and clinical course. For example, in the high valleys of the Andes in Peru and Bolivia, cutaneous leishmaniasis of the uta is known, which proceeds without lesion of the mucous membrane. The infection occurs at an altitude of about 2800 m. The reservoir of the causative agent Leishmania peruana is the dogs. In most cases, the ears are affected, the disease can last for many years. Lesions begin in the form of small painful pimples (pimples - pimles).
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Treatment of Brazilian skin-mucous leishmaniasis
Espuddia (Brazilian skin-mucous leishmaniasis) can be treated poorly. A long course of therapy with preparations of 5-valent antimony is carried out. Recovery is observed only in 20%.