Leishmaniasis is a parasitic disease caused by protozoa of the genus Leishmania, transmitted by phlebotomus mosquitoes, widespread in tropical and subtropical zones, avoiding Australia and Oceania. What are the symptoms of leishmaniasis? How is her treatment going?
Leishmaniasis(Latin and Englishleishmaniasis ) is a group of diseases caused by trypanosomes, which enter the human body, causing approximately 2 million cases a year, with a high mortality rate.
Leishmaniasis has a slightly different course and range depending on geographic distribution: from cutaneous or mucocutaneous to visceral (the most dangerous) forms.
The most dangerous organ form (visceral), it is most common in India, Brazil and Sudan. The cutaneous form of this disease most often affects the inhabitants of Iran, Afghanistan, Brazil, Peru and Bolivia.
In Europe, there are cases of cutaneous and visceral leishmaniasis in the Mediterranean.
In Poland, the disease can occur only when migrants or travelers from endemic countries, usually from the Mediterranean basin, bring the disease.
Leishmaniasis: course of the infection, symptoms
The infection occurs through the sting of a vector mosquito, or its killing and rubbing the mosquito into the wound area, a possible path of infection is also blood (intravenous punctures with an infected needle, transfusions, vertical mother-fetus route).
Protozoa cause immunity disorders by attacking the host's white blood cells, and then the parenchymal organs - incl. liver, spleen and bone marrow.
The disease often develops slowly, many months undiagnosed, although it can be electrifying, sudden, after an incubation period of 3-6 months.
The first symptoms are non-specific, they occur:
- poty
- fatigue
- weight loss
- fever
Then it comes to:
- liver enlargement
- spleen enlargement
These appear:
- puffiness
- ascites
- nose bleeds
- bleeding gums
- easy bruising
Anemia and immune disorders develop. It often comes tosecondary viral or bacterial infection which was the direct cause of the patient's death.
A cutaneous form is easier to recognize, develops several weeks or months, and non-healing ulcers usually appear on the limbs or face, i.e. in exposed parts.
They usually heal on their own within a few months, leaving unsightly scars. This form is often accompanied by enlargement of the surrounding lymph nodes.
In the mucocutaneous form, initially only skin lesions appear, however, after many years, ulcerations can be observed on the mucosa of the upper respiratory tract. This can lead to the destruction of bone and cartilage structures, leading to deformation and disability.
Leishmaniasis: diagnosis
If Leishmaniasis is suspected, an urgent visit to the Infectious Diseases or Tropical Medicine Ward or Outpatient Clinic is recommended.
There, in order to confirm the infection, a sample of the lesions (skin form) is taken and the presence of protozoa in the preparation is searched for using a microscope.
In the visceral form, the presence of parasites in the bone marrow aspirate should be confirmed, in some centers they are looked for in the spleen aspirate, it is also possible to detect protozoan DNA by conducting a PCR test of biological material from the patient.
There are also two types of serological tests for the detection of anti-leishmaniasis antibodies, but they are not widely used as they are associated with a high risk of error.
Leishmaniasis: treatment
In the case of the cutaneous form, treatment is only topical (antifungal drugs), while in the case of dermal and visceral drugs, systemic drugs are administered (orally, intravenously) and symptomatic treatment is applied: intensification of nutrition, treatment of secondary bacterial and viral infections.
Antimony therapy (Amphotericin B, Paromomycin - mucocutaneous form) and treatment with sodium antimonogluconate (antimony compounds are less and less frequently used due to their toxicity).
Some countries use a combination of these two groups of drugs.
The reactivation of the infection is observed with a decrease in the body's immunity, hence the lack of certainty whether the applied treatment results in a permanent elimination of the disease. The patient should be under constant, regular medical supervision for many months.
Leishmaniasis: prophylaxis
Counteracting infections consists primarily in the use of tight protective clothing, mosquito nets in rooms and anti-mosquito sprays as well as isolation of infectedanimals.