Leishmaniasis

Leishmaniasis is a vector-borne protozoan diseases affecting the skin and mucous membranes (cutaneous leishmaniasis) or internal organs (visceral leishmaniasis).
Etiology. The causative agents are Leishmania. Human parasites three types: L. tropica - the cause of cutaneous leishmaniasis, L. braziliensis - exciter Muco-cutaneous leishmaniasis, L. donovani is the causative agent of visceral leishmaniasis. In humans and other mammals Leishmania parasites inside the cells of the skin, mucous membranes, liver, spleen, bone marrow, and in the body of the mosquito vector of infection in the gut. In blood of patients Leishmania are rare. Pathogens grow well on artificial environment containing sterile defibrilatorun blood rabbit, and in tissue culture. Painted by the method Romanovsky - Himsi.
Epidemiology of leishmaniasis.
The source of infection in skin leishmaniasis urban type is a person and, apparently, the dog; when cutaneous leishmaniasis village is big and midday geebil, tonkopaly gopher, and others In visceral leishmaniasis source of infection is a sick man, a dog, wild carnivores. Carriers of the infection mosquitoes (see)that are infected with sucking the blood of the sick person or animal.
Disease disseminated leishmaniasis in the Mediterranean countries, South Asia and South America, in the USSR - in Transcaucasia and Central Asia.
Pathogenesis. The pathogen enters the body of a person by the bite of the mosquito. When cutaneous leishmaniasis in the skin at the site of the bite of the mosquito is the reproduction of the parasite and the formation of nodules - Leishmania representing infiltrates, consisting of macrophages, endothelial, lymphoid cells and fibroblasts. Then nodules nekrotizirutee and forms an ulcer with intercellular edema and keratinization, after cleansing, which formed a scar. In visceral leishmaniasis at the bite site develops a knot. Further Leishmania the blood spread to internal organs, settling primarily in the spleen, lymph nodes, liver, bone marrow, where are formed secondary foci breeding and growing parasitic reticuloendotheliosis, which is characterized by the proliferation of endothelial, hyperplasia of the affected organs, their increase with further development of dystrophic and necrobiotic processes.
Laboratory diagnostics. For detection of the pathogen in cutaneous leishmaniasis prepare smears from the contents of tubercles, with visceral leishmaniasis - from bone marrow punctate; in addition, make the blood cultures. Put allergic skin diagnostic test with killed cultures Leishmania (cutaneous leishmaniasis) and serological reactions: formalumu, Sormovo and distilled water (visceral leishmaniasis).
The forecast. If timely treatment of leishmaniasis ends recovery. Fatal possible due to the accession of secondary infection or the development of cachexia.
Treatment. Shown around the bumps 5% solution of Akrikhin. Recommend local apply the diathermocoagulation, freezing carbonic acid, x-ray treatments. Applied also monomitsin dose of 250,000 U 3-4 times a day repeated courses of 5 days with the interval of 5 days.
In visceral leishmaniasis appoint subcutaneously or intravenously , saucermen in the form of 5, 10 and 20% water solutions with double-distilled water at the rate of 0.05-0.15 g per 1 kg of body weight once a day. The course of treatment consists of 15-30 injection. In the first injection is prescribed 1/3 dose, the second - 2/3 and the third injection - full dose. When complications associated with secondary flora, prescribe antibiotics and sulfa drugs. With the eradication of anemia, blood transfusions, erythrocyte mass use vitamins.
Prevention. The destruction of rodents in a radius of up to 1.5 km from the accommodation, liquidation in breeding sites of mosquitoes. Protection of the population from the attacks of mosquitoes (grid, valances, repellents). Killing dogs, cases of leishmaniasis.
Identification, hospitalization and treatment of patients.
In the centers of cutaneous leishmaniasis appropriate vaccination of the newly arrived persons living culture leyshmany.


Leishmaniasis (leishmanioses) - a group of protozoan infectious disease transmitted by mosquitoes and proceeding or when events ulcerative lesions of the skin and mucous membranes on the site of the bite (cutaneous leishmaniasis), or severe destruction of internal organs (visceral leishmaniasis).
Etiology. The cause of cutaneous leishmaniasis in 1898 discovered and described P. F. Borovsky, the causative agent of visceral HP - English doctor of Lachman (W. Leishman) in 1900
Leishmania (Leishmania) are a genus of SEM. trypanosome, detachment protomonadina, class flagellate, type the simplest animals. The genus leyshmany include pathogens leishmaniasis (cutaneous and visceral) man and parasitic forms in mammals and reptiles.
Human parasites three types leyshmany, which are undoubtedly complex modular forms.
1. L. tropica Wright, 1903 - the cause of cutaneous L. in several countries in Europe, Middle East and Africa. Owners - rodents (great gerbil, squirrel, hedgehog and others) and people. The view includes the whole group of smaller systematic categories (RAS, Dimov, clones). In the USSR there are two subspecies: L. tropica minor - the causative agent of urban type of skin L. and L. tropica major zoonotic pathogen (desert) type of cutaneous leishmaniasis.
2. L. brasiliensis Vianna, 1911 - exciter Muco-cutaneous L. Occurs in South and Central America people, rodents, insectivores and others is Divided into five distinct species (RAS): L. brasiliensis brasiliensis, L. brasiliensis guyanensis, L. brasiliensis mexicana, L. brasiliensis peruviana, L. brasiliensis pifanoi. The basis of division is based on two criteria: geographical distribution and clinical data.
3. L. donovani Laveran, Mesnil, 1903 - exciter visceral L. Parasite predatory animals (dogs, jackals), rodents and some others, as well as man.
Nicoli (K. M. Nicoli, 1963) distinguishes between the following categories: L. donovani sinensis
Nicoli, 1953 (parasite dogs and humans in North America. China; carrier - Phlebotomus chinensis chinensis), L. donovani donovani Laveran, Mesnil, 1903 (a parasite of man in India; carrier Ph. argentipes argentipes), L. donovani infantum Nicolle, 1908 (parasite dogs, rarely person in the Mediterranean; carrier Ph. perniciosus).
In mammals also described L. myoxi Laveran, Franchini, 1921 [Sonia (Glis glis) in Italy; carrier unknown], L. enrietti Muniz, Medina, 1948 (parasite Guinea pigs in South Africa. America; carrier unknown); L. caprae Curson, 1926 (goats in South Africa). Leishmania described in reptiles - L. chameleonis, L. henrici, L. agamae, L. adleri and other
In humans and other mammals Leishmania (leishmanial form) parasitize in the cytoplasm of faguoqitirute cells (Fig. 1, 2): skin, mucous membranes, liver, spleen, bone marrow, blood is rare. The size 2-6 X 2-3 MK, oval shape. In the cytoplasm, stainable method Romanovsky - Himsi in blue tones, has a core and a rod-shaped blepharoplasty. Multiply by Leishmania longitudinal dividing asunder (Fig. 2). According to morphological characteristics of different types leyshmany parasites in humans, it is not always possible to distinguish.
Getting sucking the blood of the patient in the intestinal canal vectors (see Mosquitoes), Leishmania become leptomonas forms, which have an elongated shape and is equipped with a flagellum (Fig. 1, 1). Their sizes up to 25 microns in length. We must bear in mind that in the intestine of mosquitoes and some other insects inhabit other flagellate - not pathogenic, similar to leptomonads forms leyshmany.
Cultivate leyshmany different (including liquid) environments (usually NNN agar) and in tissue culture.