CUTANEOUS LEISHMANIASIS: ETIOLOGY, CLINICAL PICTURE, DIAGNOSING, TREATMENT
The etiology, pathogenesis, clinical manifestations, diagnosis and treatment of cutaneous leishmaniasis are described in the article. This unusual for Belarus disease can be imported to the country by tourists, businessmen and people working at joint ventures. The cause of cutaneous leishmaniasis of the Old World is L. majoror L. tropica, less frequentlyL. infantum, L. aethiopica. In the Mediterranean and the Caspian Seas region the cause of cutaneous leishmaniasis is L. infantumand L. chagasi. Cutaneous leishmaniasis of the New World is caused by L. mexicana, L. (L) amazonenesis, L. braziliensis, L. (V) panamensis, L (V) peruviana, and L. (V). guyanensis. The clinical spectrum of cutaneous leishmaniasis includes localized, chronic recurrent, diffuse and acute forms. The applied methods of diagnosing are dermatoscopy, microscopy of bioptic material, smears, skin scrapings; culture on NNN medium, PCR and serological testing. Four types of histological manifestations are characteristic of leishmaniasis: I - abundant amastigotes; II - macrophages, polymorphonuclear neutrophils, plasma cells, necrosis; III - early granuloma with a focal accumulation of epithelioid cells, lymphocytes and a small number of plasma cells; IV - well-formed epithelioid granuloma within the derma with giant Langerhans cells, lymphocytes and epithelioid cells. The first line medicinal treatment options for cutaneous leishmaniasis are pentavalent antimony preparations: sodium stibogluconate intravenously or intramuscularly, meglumine antimoniate, intravenously or intramuscularly; oral miltefosine. The second line of therapy includes topical paramomycin, pentamidine intravenously or intramuscularly, oral fluconazole, liposomal amphotericin B or amphotericin B deoxycholate, allopurinol. Prevention of cutaneous leishmaniasis consists in patients' informing, use of repellents, window insect screens and antimosquito bed nets.