leishmaniasis

Leishmaniasis - a parasitic disease caused by Leishmania. In humans, they occur in the following forms: 1) visceral leishmaniasis (kala-azar), 2) cutaneous leishmaniasis (leishmaniasis, pendinskaya ulcers), 3), mucocutaneous leishmaniasis, American (espundia). Visceral leishmaniasis is characterized by prolonged fever, enlarged liver and spleen, severe leukopenia, anemia, progressive course. Cutaneous leishmaniasis is most characteristic of the formation of long-term healing of ulcers.

Etiology, pathogenesis. The causative agents of leishmaniasis - different types of Leishmania. In the body of mosquito vectors of Leishmania are flagellar form in the human body - in leyshmanialnoy (intracellular). Infection atriums is the skin at the site of the bite of a mosquito, where the reproduction and accumulation of Leishmania. After a few days or weeks, there is a small papule or ulcer. In visceral leishmaniasis pathogen hematogenically penetrates and is fixed in the reticuloendothelial system organs (bone marrow, liver, spleen, lymph nodes), causing necrosis and degenerative changes. Cutaneous leishmaniasis changes are observed mainly in the field of infection gate.

Symptoms within. The incubation period for visceral leishmaniasis lasts from 3 weeks to 3 years (often several months). The disease begins gradually, the first manifestations of the disease usually do not notice it. There is growing weakness, there is fever, which is often wavy. Marked pallor of the skin due to anemizatsii, the skin may be darker due to destruction of the adrenal glands, it is sometimes observed purpura. In agranulocytosis may occur ulcerative necrotic lesions in the oral cavity. The condition of patients progressively worsens, they lose weight, grow anemia, leukopenia, revealed a significant increase in liver (up to the umbilical line) and spleen (up to the pelvic cavity). In the study of blood - leukopenia, anemia, agranulotsitoe, thrombocytopenia, increased erythrocyte sedimentation rate, decrease in albumin and increased globulins.

Cutaneous leishmaniasis occurs in the form anthroponotic and zoonotic type. Anthroponotic type (late ulcerating cutaneous leishmaniasis urban, ashhabadka) is characterized by a long incubation period (3-8 months). In place of the introduction of the pathogen forms a small mound (2-3 mm), slowly increasing and in 3-6 months covers the scaly crust, beneath which is found podrytymi ulcer with jagged edges. Scarring is slow and ends after 1 -2 years. Zoonotic type of false leishmaniasis (rural type pendinskaya ulcer, acute necrotizing cutaneous leishmaniasis) is characterized by a short incubation period (up to 3 weeks), bump on the site of the bite is growing rapidly, in a few days it reaches a diameter of 10-15 mm. In the center of the protuberance occurs necrosis and open ulcer with extensive infiltration and edema around. The diameter of the ulcers sometimes reaches up to 5 cm. By the 3rd month of the bottom of the ulcer cleaned, and after 5 months ends with scarring. For diagnosis are important indication for a stay in endemic areas for leishmaniasis in the last 1-2 years, the characteristic clinical symptoms, blood picture and the change of protein composition in visceral leishmaniasis. Evidence of the disease is the detection of Leishmania (material from the tubercle, bone marrow points, lymph nodes).

Treatment. Apply solyusurmin as a 10-20% solution in / in, in / m or m / to 1 times a day for 10-15 days (for the treatment of visceral leishmaniasis). The 1st day administered 1/3 dose on Day 2 - 2/3 dose, and from the 3rd day of treatment is administered a full dose, which is for children up to 7 years of 0.15 g / kg, from 7 to 16 0.12g / kg adult of 0.1 g / kg. If, after discharge from the hospital the condition deteriorates again, carry out a second round of chemotherapy. To suppress the secondary microflora prescribe antibiotics (ampicillin, oxa-tsillin). Use vitamins, Antianemic means an infusion of red cells, and plasma. Cutaneous leishmaniasis - monomitsin 250 000 IU / m 3 times a day for 10-12 days. Locally applied monomitsinovuyu ointment (70 g of petroleum jelly, lanolin and 30 g of 2 000 000 units monomycin). In cutaneous leishmaniasis zoonotic type can be used solyusurmin in the same doses as in the treatment of visceral leishmaniasis. The treatment takes 10-12 days. Sometimes designated aminoquinolyl (inside of 0.1 -0.2 g of 3 times a day for days 10-12), but it is less effective.

The prognosis of advanced therapies for life-friendly. In late started therapy in severe anemizatsii and hepatosplenomegaly for rehabilitation takes several months. Scarring in skin forms can last, depending on the type of disease from a few months to 1 -2 years.

Prevention. Early detection and treatment, the fight against mosquito vectors, the use of deterrents. In recent years, carried out vaccination against cutaneous leishmaniasis. Vaccinations do live cultures of Leishmania in closed areas of the skin.