Leishmaniasis

Leishmaniasis is a disease caused by protozoan parasites called Leishmania. Specific carrying agents of leishmaniasis are small blood-sucking insects – sand flies. The focus of infection in the city are diseased people and dogs, and in rural areas – various gnawing animals (chickweed, hamsters). The disease is found in Asia and America. Outbreaks of the disease usually occur from May to November that is connected with biology of sand flies. High risk to disease have those who arrived in endemic region.

There are two main clinical forms of leishmaniasis: visceral leishmaniasis and cutaneous leishmaniasis.

Visceral leishmaniasis
Symptoms. Typical sign is sharp increase of spleen along with increase of liver and lymphatic glands. Remittent fever rises about two times a day. Incubation period lasts from 10-20 days to several months.  The disease starts gradually with rising weakness and intestinal upset (diarrhea). Spleen gradually increases and at height of disease achieves great size (it goes down into small pelvis). Liver is increased too.  Different rashes appear, most of them are papulous. Skin is dry and has sallow color. Distinctive is tendency to bleeding, gradually is developing weight loss, anemia, edema.

Recognition
The exact diagnosis can be made only after puncture of spleen or bone marrow and after finding leishmania in them.

Dry sore (urban type of cutaneous leishmaniasis)
Incubation period lasts 3-8 months. First, on spots where agent was penetrated appears papilla of 2-3mm. Gradually it increases in its size, skin above it becomes red, and in 3-6 months it is crusted. When removing it, on its spot appears sore in form of a round with smooth or wrinkled bottom covered with white matter.  Around sore appears infiltrate - after its breaking size of sore increases gradually.  Sore scaring finishes in about one year from the beginning of disease. The number of sores on the body usually varies from 1-3 to 10, they are located on opened skin areas available for sand flies (hands, legs).

Moist Sore (rural type of cutaneous leishmaniasis)
Incubation period is shorter. On spot of agent penetration appears pineal papilla of 2-4mm which increases quickly and achieves in several days 1-1.5cm having in its center necrosis. After rejection of sphacelus opens a sore which extends quickly.  Singular sores can be very big, achieving size of 5cm and even more. In case of multiple sores the number of them can be tens and hundreds small size each.  They have ragged edges, their bottom is covered with necrotic mass and abundant white matter. By third month the bottom of sore is cleaned and granulation is growing. The process ends in 5 months. Often is observed lymphangitis. Both types of  cutaneous leishmaniasis can be resulted in chronic tubercular form, resembling with lupus.

The diagnosis of cutaneous leishmaniasis is made on specific clinical image and is confirmed by detecting of agent in sample taken from infiltrate.

Treatment
To treat this disease is recommended to take 3 times a day intramuscularly a medicine called monomycin during 10-12 days. Monomycin ointment is used topically.

Preventive Measures
Fighting with sand flies who are carrier agents, extermination of dogs and gnawing animals. Recently doctors started to make preventive injections.