Leyshmanioza (Latin Leishmaniasis) - group of the parasitic natural and focal, generally zoonotic, transmissible diseases widespread in the tropical and subtropical countries; is caused by the parasitizing protozoa of the sort Leishmania who are transmitted to the person through stings of mosquitoes.
According to World Health Organization, leyshmanioza meet in 88 countries of the Old and New World. From them 72 treat developing countries, and among these thirteen are the poorest countries of the world. The visceral leushmaniosis meets in 65 countries.
Leyshmanioza treat the forgotten diseases.
Types of leyshmanioz
According to features of clinic, an etiology and epidemiology of a leyshmanioza divide into the subsequent types:
- Visceral leushmaniosis;
- Zoonotic: Mediterranean and Central Asian, east, skin and mucous leushmaniosis;
- Skin leushmaniosis;
- Skin and skin and mucous leushmaniosis of the New World;
- Ethiopian skin leushmaniosis;
- Visceral Mediterranean and Asian leushmaniosis.
- Epidanamnez – stay in the endemic area, stings of mosquitoes.
- Long incubation interval, beginning of a disease sharp or gradual.
- It is shown by a visceral or skin form, a sharp or chronic course.
- Refer intoxication with long fever to characteristic signs of a visceral form of a disease, a splenomegaly, anemia in combination with a pancytopenia and a neutropenia, a relative monocytosis.
- The skin leushmaniosis begins with emergence in the place of a sting of a mosquito of an erythematic makulo-papule with the subsequent formation of a superficial ulcer.
- Leyshmaniozny ulcers – single or multiple, painless, have well limited, rising edges inclined to long not healing have favourite localization on a face or extremities.
- Acute onset of a disease from temperature rise to 39 ° –40 °C, symptoms of the general intoxication, quickly progressing increase in a liver and spleen, increase of anemia, development of dystrophy, development of bacterial complications is characteristic of children of the first year of life.
Diagnosis of a leushmaniosis
The general blood test in a leushmaniosis shows symptoms of hypochromia anemia, a neutropenia and an aneosinophilia in a relative lymphocytosis and also the lowered concentration of thrombocytes. SOE is raised. Biochemical analysis of blood can show a hypergammaglobulinemia.
Discharge of the causative agent of a skin leushmaniosis is possible from hillocks and ulcers, at visceral - leishmanias are found in crops of blood on sterility. If necessary make for discharge of the activator a biopsy of lymph nodes, spleens, a liver. As specific diagnostics an osushchestvlyayutmikroskopichesky research, bakposev on NNN nutrient medium, biological tests on laboratory animals.
Serological diagnosis of a leushmaniosis is carried out using RSK, IFA, RNIF, RLA.
In the period of a convalescence the positive reaction of Montenegro is noted (skin test with leyshmaniny). It is made at epidemiological researches.
Causes of the Leushmaniosis
The causative agent of a skin leushmaniosis - Leishmania tropica, a leushmaniosis zoonotic - L. tropica major, a skin and mucous leushmaniosis - L. brasiliensis, visceral - L. donovani. The contagium gets at a sting of a mosquito through skin; in the place of inoculation of a parasite the inflammatory skin process develops and there is a small papule or a sore where parasites breed. There is a skin defeat - a histiocytoma. In infection of L. tro-. pica major the histiocytoma remains local, limited and further undergoes involution (the self-recovering form of a skin leushmaniosis).
In a visceral leushmaniosis of leishmanias in the hematogenic way extend on all organism and are fixed in marrow, lymph nodes, a liver, a spleen. Defeat of the haematogenic fabric leads to the progressing anemia and a leukopenia, spleno- and hepatomegalias; is followed by a hypergammaglobulinemia.
Treatment of a leushmaniosis
The obkalyvaniye of hillocks of 5% is shown by quinacrine solution. Recommend to apply locally diathermocoagulation, freezing by carbonic acid, roentgenotherapy. 3 — 4 times a day repeated courses for 5 days with intervals of 5 days apply also Monomycinum in a dose of 250,000 PIECES.
In a visceral leushmaniosis appoint subcutaneously or intravenously Solusurminum in the form of 5, 10 and 20% of aqueous solutions on twice distilled water at the rate of 0.05 — 0.15 g to 1 kg of weight once a day. The course of treatment consists of 15 — 30 injections. In the first injection appoint 1/3 doses, in the second — 2/3 and in the third injection — a full dose. At the complications connected with secondary flora appoint antibiotics and sulfanamide drugs. For the purpose of elimination of anemia transfuse blood, a packed red cells, apply vitamins.
Treatment of a leushmaniosis folk remedies
Phytotherapy in a skin leushmaniosis is shown as additional resources for reduction of by-effects from chemotherapy, especially in cases of the multiple centers, presence of diseases of kidneys, a liver or dysbacteriosis.
Recommend the herbs having anti-inflammatory, antimicrobial effect (a plantain, a sage, an eucalyptus, a train, a yarrow, a three-colored violet, a camomile, a calendula, etc.). To accept herbal mixes on 50 ml on reception within 10-12 days.
Prevention of leyshmanioz
The efficiency of prevention of leyshmanioz among visitors in many respects depends on knowledge them the centers of these diseases and features of activity (attack) of mosquitoes. On the basis of such data limit visit of unsuccessful areas and take necessary protective measures (repellents, overalls, processing by insecticides of possible places of breeding of mosquitoes near housing). The experts occupied at works in the areas which are strongly infected with a skin leushmaniosis are recommended to do precautionary specific intracutaneous vaccination.
- At late stages of a disease hypostases, a cachexia, a hyperpegmentation are possible
- Bacterial superinfections and bleedings from a GIT can become a cause of death of the uncured diseased with a visceral leushmaniosis
- At 3 — 10% of treated patients changes of integuments in the form of the depigmented spots and borodavkoobrazny small knots on a face and the extensive plane of extremities develop
- At patients with a mucous and skin leushmaniosis metastatic destructive damages of a mucous nasopharynx are possible.