Leishmania causes a disease that manifests itself. What is leishmaniasis? Forms of leishmaniasis

Very often, people encounter skin diseases: either a rash appears, or wounds, or it is not yet clear what, it seems like a bite, but it is somehow strange. Very often, a mosquito bite can develop into an infection, one of the forms of which is a disease such as leishmaniasis. It is this disease that we will talk about today. So what is leishmaniasis?

Concept

Leishmaniasis is an infection that occurs not only in humans, but also in animals. It is caused by protozoa of the genus Leishmania and is transmitted through the bites of Lutzomyia mosquitoes.

The simplest leishmania is distributed mainly in hot countries: Asia, Africa, South America.

Most often, the sources of the disease can already be infected people, canines (foxes, wolves or jackals) raised at home, and rodents.

With a difficult and long healing process, dangerous not only for humans, but also for animals, is leishmaniasis. bacteria that cause this disease takes a very long time. Mosquitoes are the first to become infected. After which the infection enters digestive system, where not yet fully mature forms of leishmaniasis mature and turn into a motile flagellated form. Accumulating in the mosquito's larynx, during a new bite they enter the wound and infect the epithelial cells of the animal.

Leishmaniasis: varieties

There are several types of this disease, and each of them is dangerous in its own way for human body:

• Cutaneous.
• Slimy.
• Visceral leishmaniasis.
• Mucocutaneous.
• Viscerotropic.

Main symptoms of leishmaniasis

The main symptoms of this disease are ulcers on the human body. They can appear several weeks or even months after he is bitten by an insect that carries the infection. Another symptom of the disease may be fever, which can also begin a few days after the bite. Enough time may pass, in some cases about a year. The disease also affects the liver and spleen, which can result in anemia.

In medicine, the first sign of leishmaniasis is an enlarged spleen: it can become larger in size than the liver. Today there are 4 forms of leishmaniasis:

1. Visceral. This is one of the most complex forms of the disease. If you don't start prompt treatment, the disease can be fatal.
2. Cutaneous leishmaniasis. It is considered one of the most common forms. Immediately after the bite, pain appears in its place. Heal this form the disease can be diagnosed only after several months have passed, and even after that a person will remember it, looking at the scar left by the disease.
3. Diffuse cutaneous leishmaniasis - this form of the disease is widespread, its appearance strongly resembles leprosy and is very difficult to treat.
4. Slimy form. It starts with which later leads to tissue damage, especially with regard to oral cavity and nose.

Concept and symptoms of visceral leishmaniasis

Visceral leishmaniasis is a form of infectious disease caused by leishmania. The disease occurs when this type of microbe spreads hematogenously from the primary source of infection to any of the human organs: liver, spleen, lymph nodes and even bone marrow. Microorganisms in the organ multiply very quickly, which leads to its damage.

Most often, children are susceptible to this disease. The incubation period is quite long, sometimes lasting up to five months. The disease begins at a slow pace, but in the category of infected people who come to endemic areas, the disease can develop rapidly.

Visceral leishmaniasis symptoms are quite common. In almost all patients they are the same: general malaise, weakness throughout the body, lethargy, complete fever begins very quickly. It passes in waves, and the body temperature can reach 40 degrees. Then there is a slight relief of the condition, which is again replaced by a high temperature, which is also very difficult to bring down.

You can also see signs of a disease such as visceral leishmaniasis on the skin. The symptoms are as follows: pale skin with a grayish tint and often with hemorrhages. It is worth paying attention to lymphatic system- lymph nodes will be enlarged.

The main signs of visceral leishmaniasis

The main sign of the disease is the initial defect, which may be isolated and therefore may not be noticed at the first examination. He looks like small size hyperemic papule, covered with scales on top. It occurs in the place where the bite was made by a carrier insect or an animal from the canine family, in whose body there is the causative agent of visceral leishmaniasis.

A constant symptom that you should first pay attention to is an enlarged spleen and liver. It is the spleen that grows at a very rapid pace and, after a couple of months after infection, can occupy the entire left side of the peritoneum. The organs become dense to the touch, but there is no pain. The liver does not enlarge so quickly, but very serious dysfunctions can be observed in it, even ascites.

If the bone marrow is affected by the disease, then symptoms manifest as thrombocytopenia and agranulocytosis, which may be accompanied by a sore throat. The first thing you can see on human body- this is the rapid appearance of colored pigment spots.

Cutaneous form of leishmaniasis

It is very common and has several forms, one of them is cutaneous leishmaniasis. The pathogen reproduces in the tissues of the human body, where Leishmania ripen at a very rapid pace and turn into flagellated larvae. This is called primary focus diseases, and a granuloma is formed. It consists of epithelial cells and plasma cells, macrophages and lymphocytes. Decomposition products can cause significant inflammatory changes, which can lead to lymphangitis or lymphadenitis.

Symptoms of the skin form

The incubation period for cutaneous leishmaniasis is about one and a half months. There are several main stages of the disease:

1. The appearance of a tubercle on the skin and its rapid increase. Its dimensions are within 2 cm.
2. The ulcer appears after a few days. At first it is covered with a thin crust, which later falls off, and a soft pink bottom with weeping appears on the surface, and subsequently an abscess forms. The edges of the ulcer are slightly raised and loose.
3. Scar. After a couple of days, the bottom of the ulcer is completely cleared and covered with granulations, which later becomes scarred.

Main signs of the skin form

There is not only a rural form, but also an urban one, and they are not much different from each other, but we must remember that there are several main features that allow us to distinguish them.

The main and very important circumstance is the correct and thorough collection of anamnesis. Long stay in an urban or rural environment will indicate in favor of one of the forms of the disease. The rural type always occurs in its primary form, but the urban type can take all of the existing forms.

Mucocutaneous form of the disease

In addition to the forms of the disease described above, there is another quite common and very dangerous one - mucocutaneous leishmaniasis (espundia). Its causative agents are mosquitoes.

It can take about 3 months from the insect bite to the first signs of the disease. At the place where a person was bitten by a mosquito, a deep ulcer forms. It involves the mucous membrane, lymphatic system and blood vessels. All this leads to very complex and severe complications, and the prognosis is not encouraging.

Human leishmaniasis in any of the existing forms is very dangerous, as it affects internal organs that are difficult to treat, such as the spleen and liver. It is for this reason that doctors recommend going to the hospital at the first discomfort; in the early stages of the disease, you can quickly recover with minimal consequences.

Other types of leishmaniasis disease

We have already described several main forms of such a disease as leishmaniasis, but there are several more types of it, perhaps not so common, but also dangerous for humans:

1. Sequential leishmanioma - the presence of a primary form with the addition of secondary symptoms in the form of small nodules.
2. Tuberculoid leishmaniasis. Photos of patients prove that signs of the disease appear at the site of the primary form or at the site of the scar. In this case, the primary defect is caused by the presence of a small tubercle of a soft yellow color, no larger than the head of a pin.
3. Diffuse leishmaniasis. This form of the disease most often occurs in people with low level immunity and is characterized by extensive ulcerative lesions of the skin and chronicity of the process.

We have figured out what leishmaniasis is, and we will tell you further how to diagnose it correctly.

Types of diagnosis of leishmaniasis

The clinical diagnosis of a patient with leishmaniasis is made on the basis of epidemiological data and clinical picture. It will help to accurately confirm the presence of the disease laboratory diagnostics. Leishmaniasis is detected by the following methods:

• Testing for bacteria: scrapings are taken from the ulcer and tubercle.
• Microscopic examination: a smear or a thick drop is taken from the patient. This method can detect the presence of leishmania stained according to Romanovsky-Giemsa.

• A biopsy of the liver and spleen is performed; in the most severe cases, puncture is performed bone marrow.
• Serological methods such as RSK, ELISA and others.

There are a huge number of accurate determination methods, and each of them will show the most accurate data and indicate the presence of a disease such as leishmaniasis in the human body. Diagnostics in a short time will allow you to determine the severity of the disease.

Treatment

We have already described what leishmaniasis is and how to correctly diagnose it. Now let's talk a little about how its treatment is carried out.

For the visceral form, pentavalent antimony preparations are used:

1. "Pentostam." It is administered to the patient intravenously, having previously been diluted in a 5% glucose solution. The drug can also be used intramuscularly. The course of treatment lasts for a month.
2. "Glucantim". The drug is used in the same way as Pentostam. If the disease is complex, the dose can be increased and the course of treatment extended for another month, but this can only be done with the permission of the attending physician.
3. "Solyusurmin". The drug can be administered intravenously or intramuscularly; treatment should begin with 0.02 g per kg of body weight. Gradually over 20 days the dose is increased to 1.6 g/kg.

Also, in very severe forms of the disease, treatment with Amphotericin B gives excellent results. The initial dose is 0.1 mg/kg. It gradually increases, but not more than 2 g per day. The drug is administered intravenously; it is first dissolved in a glucose solution.

In the most difficult cases, when all drugs have been used and have not brought the desired results, they prescribe surgery- splenectomy. After such an operation, the patient returns to normal very quickly, but there is a risk of developing other infectious diseases.

For the skin form of the disease, you can use all the drugs we described above, and also prescribe warming and ultraviolet radiation.

Consequences of leishmaniasis

The prognosis and outcome of treatment after an infectious disease such as leishmaniasis are ambiguous. Despite the fact that the visceral form occurs with great complications, and it is very dangerous for the patient’s life, with timely treatment the disease goes away without a trace and does not cause much harm to the body.

As a result of the cutaneous form, especially its diffuse version, scars may remain on the skin. And in some, it’s enough difficult cases skeletal changes may even occur.

Possible complications

Complications after leishmaniasis are possible (photos of patients with this disease can be seen in our article). The later the disease is detected and the treatment process begins, the higher the risk of severe complications. With leishmaniasis they can take the following form:

• Liver failure, aggravated by ascites and cirrhosis.
• Severe anemia and disseminated intravascular coagulation syndrome.
• Amyloidosis of the kidneys.
• Ulcers on the mucous membrane of the digestive tract.

In the cutaneous form of the disease, complications are associated mainly with the addition of a secondary infection. It manifests itself as phlegmon and local abscesses, but in the absence of properly selected treatment it can develop into a severe septic form.

What is leishmaniasis? It's very hard infectious disease, which has different forms, each of which is quite dangerous for humans. But there are several prevention methods that will help avoid the disease or prevent its severe form.

Disease prevention

The general principle of leishmaniasis prevention is protective measures. We must try to protect ourselves from mosquito bites, which are carriers of the disease. You should carry out regular disinfection and fight against rodents, try to alienate domestic animals of the canine family that were adopted from the forest.

A drug prophylaxis It will only help in protecting against the skin form of the disease. Thus, a person who travels to endemic areas is vaccinated.

Leishmaniasis - enough serious illness, about half a million people die from it every year, so you should treat it with full responsibility and run to the doctor at the first sign. Only the early stages of the disease allow recovery without further consequences.

But it’s the way it is in our country that all “neglected diseases” are not funded, so no one will vaccinate the population until the person himself buys the vaccine and asks for it to be administered. This is how it turns out that the disease is very well known, but there is simply not enough money to properly treat it. Therefore, it is better to do everything possible on your own to prevent infection.

Rice. 1. The cutaneous form of leishmaniasis leads to significant cosmetic defects.

Forms of leishmaniasis

There are visceral leishmaniasis (defeat internal organs) and the cutaneous form of the disease (damage to the skin and mucous membranes). In different geographical areas, both forms of the disease have their own clinical and epidemiological variants.

Classification

Taking into account the variety of clinical options, the following are distinguished:

Leishmaniasis visceral

• Indian (kala-azar).
• Mediterranean-Central Asian (children's kala-azar).
• East African.

Leishmaniasis cutaneous

• Anthroponotic and zoonotic leishmaniasis of the Old and New Worlds.
• Cutaneous and mucocutaneous leishmaniasis of the New World.

Rice. 2. Type of ulcer in cutaneous leishmaniasis.

Cutaneous leishmaniasis

There are several forms of cutaneous leishmaniasis:

• Zoonotic cutaneous leishmaniasis of the Old World (Pendin ulcer, Baghdad ulcer).
• Zoonotic cutaneous leishmaniasis of the New World (Mexican, Brazilian and Peruvian).
• Anthroponotic or urban leishmaniasis (Borovsky's disease).
• Cutaneous diffuse leishmaniasis of the New World.
• Mucocutaneous leishmaniasis of the New World (American, nasopharyngeal, espundia, Breda disease).

90% of cases of cutaneous leishmaniasis are reported in Iran, Saudi Arabia, Syria, Afghanistan, Peru and Brazil.

Zoonotic cutaneous leishmaniasis of the Old World

Zoonotic cutaneous leishmaniasis of the Old World or desert (Pendian ulcer, Sart ulcer, Baghdad, Aleppo, eastern or Delhi boil, etc.) is distributed mainly in the regions of Central and Asia Minor, Northern and Western Africa, Turkmenistan and Uzbekistan.

Pathogens

The disease is caused by about 20 species of Leishmania, the main of which are Leishmania tropica major and Leishmania aethiopica.

Vectors

The carriers of Leishmania are mosquitoes of the genus Phlebotomus (P. papatasi, etc.).

Seasonality

The maximum activity of mosquitoes is observed in the autumn months - the summer period of insects. The disease is characterized by a creeping nature of spread.

Damaging contingent

People of all ages get sick. Among the local population, children are more likely to be infected, as adults have previously suffered from the disease.

Clinic of the disease

The classic form of cutaneous leishmaniasis. The incubation period of the disease is 1 - 4 weeks (on average 10 - 20 days). First, a papule appears on the skin, which quickly increases in size to the size of a hazelnut, in the center of which a necrotic area appears. The area of ​​necrosis quickly turns into a deep ulcer. Sometimes daughter lesions are formed. Ulcers can be “wet” (in case of L. tropica subspecies tropica) or “dry” (in case of L. tropica subsp. major), and are always painless. Sometimes the ulcer at the first stages of development resembles a boil. A typical ulcer in leishmaniasis with undermined edges and a thick rim of infiltration. The discharge is usually serous-purulent or bloody-purulent. Often secondary tubercles form around.

Ulcers form on open areas of the body and can be single or multiple. The disease is accompanied by the development of painless lymphangitis and lymphadenitis.

After 3 - 6 months, the ulcers epithelialize and scar. The scar is rough, pigmented (“the mark of the devil”).

When L.tropica subspecies tropica is affected, recurrent forms of the disease are sometimes recorded, which are characterized by intensive formation of granulomas and alternation of affected areas with healing areas. The disease lasts for years. Signs of cure are not observed for a long time.

Other forms of cutaneous leishmaniasis.

1. Diffuse-infiltrating form. Characterized by a large affected area and healing without a trace. It is registered mainly in older people.
2. The tuberculoid (lupoid) type is most often recorded in children. Lumps form around or on the scars, which never ulcerate and always leave scars. The process takes a long time, years and decades.

Rice. 3. Type of ulcer in cutaneous leishmaniasis.

Zoonotic cutaneous leishmaniasis of the New World

The disease is common in the southern regions of the United States, Central and South America. It is called Brazilian, Mexican and Peruvian cutaneous leishmaniasis.

Pathogens

L. mexicana subspecies amazonensis, L. mexicana subspecies venezuelensis, L. mexicana subspecies pifanoi and L. mexicana subspecies garnhami.

Pathogen reservoir

Rodents and numerous domestic and wild animals.

The peak incidence is observed during the rainy season, mainly among residents of rural areas.

Vectors of infection

Mosquitoes of the genus Lutzomyia.

Clinical picture

Similar to that of African and Asian types of cutaneous leishmaniasis, with the exception of the “rubber ulcer”. This disease is caused by L. mexicana subspecies mexicana, which is transmitted by the mosquito Lutzomyia olmeca, and has been reported in Mexico, Belize and Guatemala. Mostly rubber tappers and lumberjacks are affected. The ulcers, which occur more often on the skin of the neck and ears, are painless and last for several years. The disease leads to severe deformation ears. This is popularly called “chiclero’s ear” (chiclero is a rubber tapper). Without treatment, the ulcer heals on its own within six months.

Anthroponotic cutaneous leishmaniasis

Epidemiology

Anthroponotic or urban cutaneous leishmaniasis (Borowsky disease type 1, oriental ulcer, Ashgabat ulcer) is caused by L. tropica subspecies minor. The disease is widespread mainly in the cities of the countries of the Near and Middle East, the Mediterranean and the western part of the Hindustan Peninsula.

Clinical picture

The incubation period for the disease ranges from 2 months to 2 years. In some cases it extends to 5 years. The disease begins with the appearance on the skin of a tubercle - papules 2 - 3 mm in diameter, slightly brownish in color. In the center of the papule you can see (through a magnifying glass) a hole, closed with a plug of scales, which can be easily removed with the tip of a scalpel. The papule eventually increases to 1 cm in diameter and is completely covered with a scaly crust. When the crust is removed, a round ulcer covered with purulent plaque is exposed. The bottom of the ulcer is either smooth or wrinkled. An infiltrate forms along the edges of the ulcer, which gradually disintegrates, increasing the diameter of the damage. Without treatment, the ulcer heals within a year on average. In some cases, scarring lasts up to 1.5 - 2 years. A fresh scar has a pink color, then turns pale and an atrophic scar forms at the site of the ulcer. Depending on the number of bites, the number of ulcers ranges from 1 to 10. They are located on open areas of the body - face, hands.

Sometimes noted large area injuries (hands, feet). The skin over the bites is stagnant red. The surface is slightly flaky, smooth or slightly bumpy. There are no ulcerations. Sometimes individual ulcers appear on the surface of the infiltrate.

Rice. 4. Ulcer with cutaneous leishmaniasis on the face of an adult and a child.

Mucocutaneous leishmaniasis

Mucocutaneous leishmaniasis is also called New World, nasopharyngeal or American leishmaniasis, Breda disease or espundia. This group includes a number of diseases characterized by a variable course.

Etiology

Mucocutaneous leishmaniasis is caused by L. braziliensis subspecies braziliensis, L. braziliensis subspecies panamensis, L. braziliensis subspecies guyanensis. L. peruviana causes mucocutaneous lesions in endemic highland areas.

Epidemiology

The disease is common in moist forest regions of South and Central America. As a rule, workers involved in road and forestry work and residents of forest villages get sick. Large rodents are carriers of the infection. The carriers are mosquitoes of the genus Lutzomyia.

Clinic

The disease begins with the bite of an infected mosquito. After an incubation period of 1 to 4 weeks, the first signs of the disease appear, similar to those of the cutaneous form of leishmaniasis. In some cases, the disease ends there. But more often the disease progresses. After scarring of skin ulcers, painless ulcers appear on the tongue, nasal mucosa and cheeks, metastasizing, erosive or mushroom-shaped. The patient is worried about fever, decreases body weight, joins bacterial infections. Ulcerative lesions lead to destruction of the nasal septum, cartilage of the larynx and pharynx, soft and hard palate. When involved respiratory tract the disease may result in the death of the patient. The disease sometimes disappears spontaneously, sometimes relapses are possible after a few years.

Rice. 5. Mucocutaneous leishmaniasis.

Rice. 6. With mucocutaneous leishmaniasis, the oral mucosa is often affected. In the photo on the left is an ulcerative lesion of the hard and soft palate. The photo on the right shows damage to the mucous membrane of the gums.

Visceral leishmaniasis

The most severe form of leishmaniasis is visceral. Every year more than 500 thousand people fall ill with it, 50 thousand of whom die. The disease is observed in 65 countries, of which more than 90% of cases are in India, Nepal, Bangladesh, Ethiopia, Sudan and Brazil.

Highlight:

• Visceral or general leishmaniasis (kala-azar, Leishman-Donovan disease, tropical splenomegaly, dum-dum fever). The disease is caused by l. donovani subspecies donovani. Anthroponosis. Found in South Asia and Africa.
• East African visceral leishmaniasis. The disease is caused by l. donovani subspecies archibaldil. Zoonosis.
• Mediterranean - Central Asian visceral leishmaniasis (“childhood”). The disease is caused by l. donovani subspecies infantum/ Zoonosis. found in South America, Mediterranean countries and Asia.

As medicinal drugs amphotericin B, pentavalent antimony drugs and miltefosine are used.

Indian visceral leishmaniasis (Kala-azar)

Kala-azar is a life-threatening disease. It occurs with prolonged fever, leading the patient to severe emaciation, loss of strength and even death. Epidemics of the disease are recorded every 20 years. Teenagers and people get sick young living mainly in rural areas.

Prevalence

Kala-azar is recorded on all continents except Australia. The disease is widely spread in South and Central Asia, Southern Europe and Latin America.

Reservoir of infection

In Latin America and Eurasia, the reservoir of infection is rodents, jackals, foxes and dogs, in Bangladesh and Eastern India - humans.

Leishmania is transmitted by mosquitoes of the genus Phlebotomus.

Clinical picture of the disease

The primary effect manifests itself in the form of a papule at the site of the bite, which often resolves without a trace. 3 to 12 months after infection, the patient develops a fever (always of the wrong type). Body temperature periodically rises. Fever attacks last 2–8 weeks and then appear irregularly. Patients develop disorders of digestion, transport of nutrients and their absorption into the small intestine, which is manifested by diarrhea (diarrhea), steatorrhea, abdominal pain, emaciation, hypovitaminosis, asthenovegetative syndrome, anemia and disturbances in electrolyte metabolism. Leishmania circulating in the blood is absorbed by the cells of the reticuloendothelial system and bone marrow cells, as a result of which the liver and spleen are affected, the lymph nodes become enlarged, anemia develops, the number of leukocytes and platelets decreases, and edema appears. With weak pigmentation, spots appear on the skin gray(“black fever” - kala-azar in Farsi).

The disease is severe. Without treatment, the patient dies.

To diagnose visceral leishmaniasis, biopathies of the liver, spleen, lymph nodes and bone marrow.

For treatment, drugs of pentavalent antimony salts, pentamidine and amphotericin B are used.

Early detection of sick people and domestic animals, shooting stray dogs, the destruction of mosquitoes, the use of personal protective equipment is the basis for the prevention of visceral leishmaniasis.

Rice. 7. Figure 12. With leishmaniasis, there is also a significant enlargement of the liver and spleen.

Mediterranean - Central Asian visceral leishmaniasis

This type of disease is caused by l. donovani subspecies infantum/chagasi. Zoonosis. Found in South America, Mediterranean countries, Africa, the Middle East, Central Asia and Transcaucasia. The disease is also called childhood visceral leishmaniasis, since 80 - 90% of all cases are children aged 1 - 5 years.

Reservoir of infection

In cities there are dogs; foxes, jackals and porcupines - in the countryside. In recent years, due to the spread of HIV infection, injection drug users have begun to play the role of carriers of the infection.

Clinic

The incubation period for the disease ranges from 10 - 20 days to 3 - 5 months, rarely - up to 1 year or more. The primary effect manifests itself in the form of a papule at the site of the bite, which often resolves without a trace. The patient gradually develops weakness, loss of appetite, the skin becomes pale, the liver and spleen enlarge, and the temperature periodically rises. Over time, the body temperature rises to 39 - 40 0 ​​C. The fever is wavy, irregular, lasts several days and even months. In some cases, the temperature in the first 2 - 3 months may increase slightly and even be normal.

The liver and spleen, peripheral, intrathoracic, mesenteric and other groups of lymph nodes increase to large sizes. Gradually, the patient's condition worsens significantly. The patient becomes exhausted (cachexia), bone marrow damage leads to anemia and agranulocytosis, often accompanied by necrosis of the oral mucosa. Hemorrhagic syndrome develops: hemorrhages appear on the mucous membranes and skin, nosebleeds and gastrointestinal tract. Liver fibrosis is complicated by portal hypertension and hypoalbuminemia, occurring with ascites and edema. Intoxication and anemia lead to malfunction of the cardiovascular system. Adults have problems menstrual cycle and impotence. Muscle tone decreases significantly, the skin becomes thinner, and protein-free edema develops. Visceral leishmaniasis occurs in acute, subacute and chronic forms.

Rice. 8. Visceral leishmaniasis in children. Cachexia, enlarged liver and spleen are the main symptoms of the disease.

Complications and prognosis

• Leishmaniasis is often a trigger for the development of secondary purulent-necrotic infections.
• The prognosis of severe visceral leishmaniasis in the absence or delay of treatment is often unfavorable.

The causative agent of cutaneous leishmaniasis, discovered by P.F. Borovsky, is morphologically similar to Leishmania donovani. At the suggestion of J. Wright, the causative agent of cutaneous leishmaniasis was named Leishmania tropica.

In 1913 - 1915 V.L. Yakimov, studying cutaneous leishmaniasis in Turkestan, identified two types of leishmania based on morphological characteristics:

P.V. Kozhevnikov and N.I. Latyshev identified 2 types of cutaneous leishmaniasis based on clinical and epidemiological data. The first type is anthroponotic, urban, caused by Leishmania tropica var. minor, the second type is zoonotic, rural, caused by Leishmania tropica var. major.

The existence of Leishmania is associated with a change in “hosts”: the keeper of the virus (“reservoir of infection”) and the blood-sucking carrier, which is the mosquito. In cities, the main “guardian of the virus” is a sick person. The role of canine leishmaniasis and other suspected reservoirs of infection remains unclear. The reservoir of the rural leishmaniasis virus is the great gerbil and the thin-toed ground squirrel. Rural cutaneous leishmaniasis is a zoonotic disease of animals. At the same time, a person who finds himself in this natural focus of a vector-borne disease becomes ill.

The incidence of zoonotic leishmaniasis in endemic areas (Central Asia and the Caucasus) begins in June and ends in November, when the mosquito season ends. There is no strictly constant seasonal incidence with anthroponotic leishmaniasis, since the main source of infection is a sick person.

Mosquitoes become infected with Leishmania by sucking blood on the affected skin of sick rodents or humans. In the intestine of the mosquito, Leishmania amastigotes transform into the flagellar forms of Leptomonas promastigotes.

The portal of infection is the skin at the site of the mosquito bite. This is where Leishmania reproduces and accumulates.

Anthroponotic cutaneous leishmaniasis(late ulcerating cutaneous leishmaniasis, urban type of Borovsky's disease, Ashgabat) is characterized by a long incubation period(3-8 months). At the site of pathogen penetration, a small reddish-brown tubercle (2-3 mm in diameter) is formed, which slowly increases and after 3-6 months becomes covered with a scaly crust. After about 5-10 months, with an average of 6 months, ulceration begins. The bottom of the ulcer may be pink and slightly granular. Sometimes it becomes covered with yellowish areas of necrosis. The discharge is serous, with a small admixture of pus. The shape of the ulcer is sometimes oval or round, but more often it is irregular and scalloped. The ulcer is relatively shallow. It is always located on a powerful infiltrate, which surrounds the ulcer in the form of a dark red roller. A powerful ridge-like, moderately dense, and more often doughy infiltrate around the ulcer is very characteristic of this disease. There is no tendency to penetrate into the subcutaneous tissue.

Leishmanioma and ulcer continue to grow for 8-10 or more months, reaching a size of 2-5 cm and rarely more. After holding on for 2-3 months, the ulcer begins to scar. Epithelization can occur from the periphery or from the center of the ulcer. The entire disease, from the beginning of the tubercle to the epithelization of the ulcer, usually lasts about a year, which is where the popular name “year-old” comes from. Along with sharply limited, more or less standing leishmaniomas, there are flatter diffuse infiltrates, which subsequently resolve, leaving only superficial cicatricial changes.

Zoonotic cutaneous leishmaniasis(rural type, Pendinsky ulcer, acute necrotizing cutaneous leishmaniasis) occurs in rural areas, on the outskirts of cities. The incubation period is very short, from 1 week to 2 months, and therefore this form has a pronounced seasonal nature, occurring only in the warm period - from May to October.

The disease begins with flat tubercles or boil-like infiltrates of bright red color, which grow quickly and ulcerate after 1-2 weeks, starting from the center. Ulcers with abrupt edges and a necrotic dirty yellowish bottom are formed. The ulcers are mostly irregularly scalloped in shape. Around the original leishmaniomas, additional secondary “tubercles of infestation” often appear, which in turn disintegrate and merge with the main ulcer, increasing its size and scalloped edges.

Leishmaniomas of the rural type increase in size over 2-3 months, reaching 4-6 cm, and sometimes more. After 2-4 months from the onset of the disease, the picture of the process begins to change. The bottom of the ulcer is gradually cleared of necrotic masses and becomes variegated with alternating whitish or yellowish areas of necrosis and red papillae of expanding granulations. The bottom of the ulcer becomes granular and begins to resemble fish eggs. Sometimes real vegetations and warty growths form. The appearance of such granular granulations and vegetations indicates the rapid healing of the ulcer. 2-3 weeks after this, epithelization of the ulcer occurs, often starting from the center of the ulcer. On the contrary, along the edge of the ulcer, an ulcerative strip in the form of a ditch (“edge ditch”) may remain, which epithelializes later. The entire course of rural cutaneous leishmaniasis takes from 2-3 to 5-6 months.

Number of leishmaniomas depends on the number of bites from infected mosquitoes. With urban cutaneous leishmaniasis, 1-5 leishmaniomas are usually observed and only occasionally - 20-30 or more. In the rural type, the number of leishmaniomas is 10-15, and in some patients it reaches 100-200-250.

Particularly affected are exposed parts of the body: face, upper and lower limbs. Since in hot climates the population does not take shelter at night, leishmaniomas of closed areas of the body are also possible. Unusual localization is possible: on the scalp of shaved people, on the palm of the hand in children, on the penis. A group arrangement of leishmaniomas is often noted. This is explained by the fact that mosquitoes are characterized by multiple bites: one mosquito, jumping from one area to another, can bite 10-15 times.

Along the lymphatic ducts it is often observed nodular lymphangitis. There are several possible clinical varieties of such lymphangitis: single nodes, multiple nodes, clear-shaped lymphangitis, corded, mesh, marginal (near the edge of leishmanioma), mixed. Lymphangitis nodes can ulcerate, but often they do not ulcerate and do not even produce visible inflammatory phenomena. In this case, nodes or cord-like compaction without visible redness are felt along the lymphatic vessels. Lymphangitis in the rural type develops much more often than in the urban type.

Various possible complications cutaneous leishmaniasis in the form of erysipelas, abscess, phlegmon, lymphorrhagia and other pathological processes.

Tuberculoid leishmaniasis.

In 1932 I.I. Gitelzon described a special form of cutaneous leishmaniasis, to which he first gave the name “metaleishmaniasis”, and later - tuberculoid leishmaniasis. We are talking about real leishmaniasis, only it did not end in the usual time, but turned into a protracted form as a result of a special allergic state of the body, manifested, in particular, in a sharply increased general and local reaction to the introduction of the leishmania vaccine.

This form is characterized by the fact that after the end of scarring of leishmanioma, small tubercles appear around the scar, less prone to ulceration, yellowish-brown in color, sometimes with a slight reddish tint. On diascopy they give a pronounced apple jelly phenomenon. Once formed, the tubercles for a long time change little. However, they can grow, increase in number and sometimes ulcerate.

Tuberculoid leishmaniasis is observed in 3-7% of all patients with cutaneous leishmaniasis. The disease lasts for a very long time - up to 10-20 years or more. More often it develops in childhood and adolescence.

• What is Leishmaniasis
• What causes Leishmaniasis
• Symptoms of Leishmaniasis
• Diagnosis of Leishmaniasis
• Treatment of Leishmaniasis
• Prevention of Leishmaniasis
• Which doctors should you contact if you have Leishmaniasis?

What is Leishmaniasis

Leishmaniasis(lat. Leishmaniasis) - a group of parasitic natural focal, mainly zoonotic, vector-borne diseases common in tropical and subtropical countries; caused by parasitic protozoa of the genus Leishmania, which are transmitted to humans through mosquito bites.

According to the World Health Organization, leishmaniasis occurs in 88 countries of the Old and New Worlds. Of these, 72 are developing countries, and among these, thirteen are the poorest countries in the world. Visceral leishmaniasis occurs in 65 countries.

Leishmaniasis is one of the neglected diseases.

What causes Leishmaniasis

Reservoir and sources of invasion- humans and various animals. Among the latter, the most important are jackals, foxes, dogs and rodents (gerbils - great, red-tailed, midday, thin-toed ground squirrel, etc.). Infectiousness lasts for an indefinitely long time and is equal to the period of residence of the pathogen in the blood and ulceration of the host’s skin. The duration of cutaneous leishmaniasis in gerbils is usually about 3 months, but can reach 7 months or more.

Main epidemiological signs of leishmaniasis. Indian visceral leishmaniasis (kala-azar), caused by L. donovani, is an anthroponosis. Distributed in a number of areas of Pakistan, Bangladesh, Nepal, China, etc. It is distinguished by outbreaks of the disease that occur from time to time. Mostly teenagers and young people, mainly living in rural areas, are affected.

South American visceral leishmaniasis(New World visceral leishmaniasis), caused by L. chagasi, is close in its manifestations to Mediterranean-Central Asian leishmaniasis. The incidence is mainly sporadic in a number of countries in Central and South America.

Anthroponotic cutaneous leishmaniasis of the Old World(Borovsky's disease), caused by L. minor, is common in the Mediterranean, the countries of the Near and Middle East, in the western part of the Hindustan Peninsula, Central Asia and Transcaucasia. The disease occurs mainly in cities and towns where mosquitoes live. Among the local population, children are more likely to get sick; among visitors, people of all ages are more likely to get sick. Summer-autumn seasonality is typical, which is associated with the activity of vectors.

Zoonotic cutaneous leishmaniasis of the Old World(Pendin's ulcer) is caused by L. major. The main reservoir of invasion is rodents (great and red gerbils, etc.). Distributed in the countries of the Middle East, North and West Africa, Asia, Turkmenistan and Uzbekistan. Endemic foci are found mainly in deserts and semi-deserts, in rural areas and on the outskirts of cities. The summer seasonality of infections is determined by the period of mosquito activity. Mostly children are affected; outbreaks of diseases among people of different ages are possible among visitors.

Zoonotic cutaneous leishmaniasis of the New World(Mexican, Brazilian and Peruvian cutaneous leishmaniasis), caused by L. mexicana, L. braziliensis, L. peruviana, L. uta, L. amazoniensis, L. pifanoi, L. venezuelensis, L. garnhami, L. panamensis, are registered in Central and South America, as well as in the southern regions of the USA. Natural reservoir pathogens - rodents, numerous wild and domestic animals. The disease occurs in rural areas, mainly during the rainy season. People of all ages get sick. Usually infection occurs while working in the forest, hunting, etc.

Pathogenesis (what happens?) during Leishmaniasis

When mosquito bites, Leishmania in the form of promastigotes enters the human body. Their primary reproduction in macrophages is accompanied by the transformation of pathogens into amastigotes (flagellate-free form). In this case, productive inflammation develops, and a specific granuloma is formed at the site of penetration. It consists of macrophages containing pathogens, reticular, epithelioid and giant cells. A primary affect is formed in the form of a papule; later, with visceral leishmaniasis, it resolves without a trace or becomes scarred.

With cutaneous leishmaniasis, destruction develops skin in the place of the former tubercle, ulceration and then healing of the ulcer with the formation of a scar. Spreading by the lymphogenous route to regional lymph nodes, leishmania provokes the development of lymphangitis and lymphadenitis, the formation of limited skin lesions in the form of successive leishmaniomas. The development of tuberculoid or diffusely infiltrating cutaneous leishmaniasis is largely due to the state of reactivity of the body (hyperergy or hypoergy, respectively).

Along with cutaneous forms of the disease, so-called mucocutaneous forms can be observed with ulceration of the mucous membranes of the nasopharynx, larynx, trachea and subsequent formation of polyps or deep destruction of soft tissues and cartilage. These forms are registered in South American countries.

Convalescents develop persistent homologous immunity.

Symptoms of Leishmaniasis

In accordance with the clinical features, etiology and epidemiology, leishmaniasis is divided into the following types.

Visceral leishmaniasis (kala-azar)
1. Zoonotic: Mediterranean-Central Asian (children's kala-azar), East African (dum-dum fever), mucocutaneous leishmaniasis (New World leishmaniasis, nasopharyngeal leishmaniasis).
2. Anthroponotic (Indian kala-azar).

Cutaneous leishmaniasis
1. Zoonotic (rural type of Borovsky's disease, Pendensky ulcer).
2. Anthroponotic (urban type of Borovsky's disease, Ashgabat ulcer, Baghdad boil).
3. Cutaneous and mucocutaneous leishmaniasis of the New World (espundia, Breda disease).
4. Ethiopian cutaneous leishmaniasis.

Visceral Mediterranean-Asian leishmaniasis.
Incubation period. Varies from 20 days to 3-5 months, in rare cases up to 1 year or more. In young children and rarely in adults, long before the general manifestations of the disease, a primary affect occurs in the form of a papule.

Initial period of the disease. Characterized by the gradual development of weakness, loss of appetite, adynamia, pallor of the skin, and a slight enlargement of the spleen. Body temperature rises slightly.

High period. It usually begins with a rise in body temperature to 39-40 °C. Fever becomes wavy or irregular and lasts from several days to several months with alternating episodes high temperature and remissions. In some cases, body temperature during the first 2-3 months can be low-grade or even normal.

When examining patients, polylymphadenopathy (peripheral, peribronchial, mesenteric and other lymph nodes), enlargement and hardening of the liver, and even to a greater extent spleen, painless on palpation. In cases of development of bronhadenitis, a cough is possible, and pneumonia of a secondary bacterial nature is not uncommon.

As the disease progresses, the condition of patients progressively worsens. Weight loss (even cachexia) and hypersplenism develop. Bone marrow lesions lead to progressive anemia, granulocytopenia and agranulocytosis, sometimes with necrosis of the oral mucosa. Manifestations of hemorrhagic syndrome often occur: hemorrhages in the skin and mucous membranes, bleeding from the nose, and gastrointestinal tract. Fibrous changes in the liver lead to portal hypertension with edema and ascites, which is facilitated by progressive hypoalbuminemia.

Due to hypersplenism and the high position of the diaphragm, the heart shifts somewhat to the right, its sounds become muffled, tachycardia develops and arterial hypotension. These changes, along with anemia and intoxication, lead to the appearance and worsening of signs of heart failure. Possible diarrhea, menstrual irregularities, impotence.

Terminal period. Cachexia, a drop in muscle tone, thinning of the skin, the development of protein-free edema, and severe anemia are observed.

The disease can manifest itself in acute, subacute and chronic forms.
Acute form. Occasionally found in young children. It develops rapidly and without treatment quickly ends in death.
Subacute form. Seen more often. Severe clinical manifestations are characteristic, lasting 5-6 months.
Chronic form. It develops most often, often occurring subclinically and latently.

With visceral anthroponotic leishmaniasis (Indian kala-azar), in 10% of patients, several months (up to 1 year) after therapeutic remission, so-called leishmanoids appear on the skin. They are small nodules, papillomas, erythematous spots or areas of skin with reduced pigmentation, which contain Leishmania for a long time (years and decades).

Cutaneous zoonotic leishmaniasis(Pendin's ulcer, Borovsky's disease). Found in tropical and subtropical countries. The incubation period varies from 1 week to 1.5 months, on average 10-20 days. Primary leishmanioma appears at the site of the entrance gate, initially appearing as a smooth papule pink color with a diameter of 2-3 mm. The size of the tubercle quickly increases, and it sometimes resembles a boil, but is painless or slightly painful on palpation. After 1-2 weeks, necrosis begins in the center of the leishmanioma, resembling the head of an abscess, and then a painful ulcer up to 1-1.5 cm in diameter, with undermined edges, a thick rim of infiltration and abundant serous-purulent or sanguineous exudate; Small secondary tubercles often form around it, the so-called “tubercles of seeding”, which also ulcerate and, when merging, form ulcerative fields. This is how sequential leishmanioma is formed. Leishmaniomas are most often localized on open parts of the body, their number varies from a few to tens. The formation of ulcers in many cases accompanies the development of painless lymphangitis and lymphadenitis. After 2-6 months, epithelization of the ulcers and their scarring begin. Total duration the disease does not exceed 6-7 months.

Diffuse infiltrating leishmaniasis. It is characterized by pronounced infiltration and thickening of the skin with a large area of ​​distribution. Gradually the infiltrate resolves without a trace. Minor ulcerations are observed only in exceptional cases; they heal with the formation of barely noticeable scars. This variant of cutaneous leishmaniasis is very rare in older people.

Tuberculoid cutaneous leishmaniasis. Sometimes observed in children and young people. It is characterized by the formation of small tubercles around scars or on them. The latter can increase and merge with each other. As the disease progresses, they occasionally ulcerate; subsequently the ulcers heal with scarring.

Cutaneous antroponotic leishmaniasis. It is distinguished by a long incubation period of several months or even years and two main features: slow development and less severe skin lesions.

Complications and prognosis
Advanced leishmaniasis can be complicated by pneumonia, purulent-necrotic processes, nephritis, agranulocytosis, and hemorrhagic diathesis. The prognosis of severe and complicated forms of visceral leishmaniasis with untimely treatment is often unfavorable. In mild forms, spontaneous recovery is possible. In cases of cutaneous leishmaniasis, the prognosis for life is favorable, but cosmetic defects are possible.

Diagnosis of Leishmaniasis

Visceral leishmaniasis should be distinguished from malaria, typhoid-paratyphoid diseases, brucellosis, lymphogranulomatosis, leukemia, and sepsis. When establishing a diagnosis, epidemiological history data are used, indicating that the patient has been in endemic foci of the disease. When examining a patient, it is necessary to pay attention to prolonged fever, polylymphadenopathy, anemia, weight loss, hepatolienal syndrome with a significant enlargement of the spleen.

Manifestations of cutaneous zoonotic leishmaniasis are differentiated from similar local changes in leprosy, skin tuberculosis, syphilis, tropical ulcers, and epithelioma. In this case, it is necessary to take into account the phase nature of the formation of leishmanioma (painless papule - necrotic changes - ulcer with undermined edges, a rim of infiltrate and serous-purulent exudate - scar formation).

Laboratory diagnosis of leishmaniasis
The hemogram identifies the signs hypochromic anemia, leukopenia, neutropenia and relative lymphocytosis, aneosinophilia, thrombocytopenia, significant increase in ESR. Poikilocytosis, anisocytosis, anisochromia are characteristic, agranulocytosis is possible. Hypergammaglobulinemia is noted.

In cutaneous leishmaniasis, pathogens can be detected in material obtained from tubercles or ulcers; in visceral leishmaniasis, in smears and thick drops of blood stained according to Romanovsky-Giemsa, much more often (95% positive results) - in bone marrow punctate smears. A culture of the pathogen (promastigote) can be obtained by inoculating the punctate on NNN medium. Sometimes a biopsy of the lymph nodes and even the liver and spleen is performed to detect leishmania. Widely used serological reactions- RSK, ELISA, RNIF, RLA, etc., biological tests on hamsters or white mice. During the period of convalescence it becomes positive skin test with leishmanin (Montenegro reaction), used only for epidemiological studies.

Treatment of Leishmaniasis

For visceral leishmaniasis, pentavalent antimony preparations (solyusurmin, neostibosan, glucantim, etc.) are used in the form of daily intravenous infusions in increasing doses starting from 0.05 g/kg. The course of treatment is 7-10 days. In case of insufficient clinical effectiveness drugs are prescribed amphotericin B 0.25-1 mg/kg slowly intravenously in a 5% glucose solution; The drug is administered every other day for a course of up to 8 weeks. Pathogenetic therapy and prevention bacterial complications carried out according to well-known schemes.

In cases of cutaneous leishmaniasis early stage diseases, the tubercles are injected with solutions of mepacrine, monomycin, methenamine, berberine sulfate; ointments and lotions are used using these products. For formed ulcers, intramuscular injections of monomycin are prescribed at 250 thousand units (for children 4-5 thousand units/kg) 3 times a day, the course dose of the drug is 10 million units. You can treat with aminoquinol (0.2 g 3 times a day, 11-12 g of the drug per course). Apply laser irradiation ulcers Pentavalent antimony drugs and amphotericin B are prescribed only in severe cases of the disease.

Drugs of choice: sodium antimonyl gluconate 20 mg/kg IV or IM once a day for 20-30 days; meglumine antimoniate (glucantim) 20-60 mg/kg deep IM once a day for 20-30 days. If the disease relapses or treatment is insufficiently effective, a second course of injections should be administered within 40-60 days. Additional administration of allopurinol 20-30 mg/kg/day in 3 doses orally is effective.

Alternative drugs for relapses of the disease and pathogen resistance: amphotericin B 0.5-1.0 mg/kg IV every other day or pentamidine IM 3-4 mg/kg 3 times a week for 5-25 weeks. If chemotherapy has no effect, human recombinant interferon γ is additionally prescribed.

Surgical treatment. Splenectomy is performed according to indications.

Prevention of Leishmaniasis

Control of animal carriers of leishmania is carried out in an organized manner and on a large scale only for zoonotic cutaneous and visceral leishmaniasis. They carry out deratization measures, improvement of populated areas, elimination of vacant lots and landfills, drainage of basements, treatment of residential, household and livestock premises with insecticides. The use of repellents and mechanical means of protection against mosquito bites is recommended.

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Cutaneous leishmaniasis is a disease characteristic of those areas where the temperature can remain above 20 degrees for 50 days. However, isolated cases of infection can occur in any region. The causative agent of leishmaniasis is tropical leishmania.

Pathology is divided into 3 types according to the symptoms it manifests:

1. Cutaneous leishmaniasis is characterized by a profuse rash on the epidermis in the form of ulcerated papules.
2. Mucocutaneous leishmaniasis is characterized by the appearance of ulcers on the oral and nasal mucosa, in the pharynx.
3. Visceral leishmaniasis is characterized by the pathogen entering the lymph vessels. The pathology spreads throughout the body along with the flow of fluid, affecting the internal organs. This form of leishmaniasis mainly affects the heart muscle, spleen, liver, and lungs.

Cutaneous and visceral leishmaniasis can be transmitted from humans (anthroponotic form of pathology) or from animals (zoonotic).

Pathogen carriers

Cutaneous leishmaniasis is divided into 2 types depending on the pathogen.

• acute necrotizing;
• late-expressing.

Acute necrotizing pathology manifests itself depending on the season and has a close relationship with the presence of mosquitoes in the warm season. Basically, the disease begins to spread in the spring, its peak is observed in the summer, and a decrease in activity is observed in the beginning of winter.

Late-onset cutaneous leishmaniasis is characterized by a lack of attachment to any season. The disease can be diagnosed at any time of the year. The difficulty of diagnosis lies in the fact that animals and people often carry an infection that does not manifest any symptoms.

The causative agent of visceral leishmaniasis is Donovan's leishmania. The carrier of this pathology is the phlebotomus mosquito.

Leishmania: life cycle

Next life cycle different forms pathologies differ from each other. If a person is affected by cutaneous leishmaniasis, the pathogen begins to multiply at the site of the mosquito bite, resulting in the formation of leishmaniomas.

These pathogenic nodules contain:

• macrophages;
• fibroblasts;
• endothelial cells;
• lymphoid tissue.

Later, these nodules begin to gradually die off, and ulcers form in their place.

Symptoms

Various forms of leishmaniasis are characterized by individual symptoms, which can be used to identify the pathogen infecting the body.

Visceral pathology

This form of invasion has a long incubation period. From the moment of infection until the appearance of the primary symptoms of leishmaniasis, 20–150 days usually pass.

Visceral leishmaniasis on initial stage development manifests itself with the following symptoms:

• the appearance of general weakness;
• apathy;
• decreased appetite;
• blanching of the epidermis;
• slight enlargement of the spleen;
• temperature rise to 38 degrees.

In the absence of treatment for leishmaniasis, the primary symptoms include:

• temperature rise up to 40 degrees;
• cough;
• enlarged lymph nodes;
• pain in the liver area;
• significant enlargement of the liver and spleen.

Advanced pathology makes itself felt:

• severe deterioration in general health;
• exhaustion;
• severe enlargement of the spleen;
• diarrhea;
• dryness of the epidermis;
• pallor of the epidermis;
• swelling of the lower extremities;
• dizziness;
• frequent heartbeat;
• enlargement of the abdominal area;
• violation of potency.

The last stage of pathology is characterized by:

• swelling of the whole body;
• decreased muscle tone;
• pale epidermis;
• death of the patient.

With minimal damage to internal organs by visceral leishmania, it is often diagnosed chronic form pathology that does not manifest itself with any symptoms.

Skin pathology

The incubation period of the disease of this form lasts 10–45 days. Initial stage development is characterized by the following course:

1. The appearance of neoplasms on the epidermis, similar to mosquito bites.
2. Later, these bites form into boils that look like a simple bump.
3. After 7–14 days, a dead area of ​​black skin appears in the center of the boil, signaling the onset of necrosis.
4. The boil forms into an ulcer, from the center of which pus begins to ooze, colored yellow-red.
5. Secondary bumps begin to appear near the ulcer.
6. After some time, they grow and merge together, forming a large wound.

The resulting wounds heal within 2–6 months if the patient has been treated for leishmaniasis.

Mucocutaneous pathology

The symptoms of this form are similar to skin pathology. The only difference is the distribution of boils throughout the mucous membranes. In some cases, this disease can deform the face, which manifests itself:

• runny nose;
• nasal congestion;
• difficulty swallowing;
• nosebleeds;
• development of erosions and ulcers in the mouth and nose.

This form can cause 2 types of complications:

• when a secondary infection occurs, pneumonia may appear;
• in case of defeat respiratory organs death is often recorded.

Treatment of skin pathology

Treatment of leishmaniasis mainly occurs with drug therapy:

1. "Monomycin" is prescribed in the form intramuscular injections three times a day every 8 hours at a dosage of 250,000 units.
2. Glucantim injections are carried out in a dosage of 60 milligrams per kilogram of body weight.
3. Secnidazole is used 500 milligrams four times a day for 3 weeks. After this period, the frequency of doses is reduced to 2 times a day for 3 weeks.
4. To treat boils, Solyusurmin, Metacycline, Doxycycline are used; other antimalarial medications can also be used.

In some cases, cryodestruction or laser therapy may be prescribed.

Treatment of visceral pathology

Visceral leishmaniasis is effectively treated with 5-valent antimony and pentamidine isothionate. Medicines based on antimony are used intravenously for 7–16 days. The dosage during treatment gradually increases.

If the medications were not effective, doctors prescribe Pentamidine at a dosage of 0.004 grams per 1 kilogram of body weight per day. The course of treatment consists of 10–15 injections given every day or every other day.

In addition to specific drug treatment, pathogenetic therapy and prevention of bacterial deposits are prescribed.

To avoid the development of leishmaniasis of any form in humans, it is necessary to observe individual safety measures in places where there are large concentrations of insects. This kind of prevention is especially necessary in the spring and autumn.

In winter it is necessary to do preventive vaccinations, which consist in the introduction of 0.1–0.2 milliliters of liquid sulfur with a live weakened culture of the causative agent of tropical leishmania (major).

Such vaccinations provoke the development lung pathology form, which occurs in the form of the formation of 1 boil and ensures the formation of immunity to all types of disease.