- Main symptoms
- 1. Cutaneous leishmaniasis
- 2. Mucous or mucocutaneous leishmaniasis
- How to confirm the diagnosis
- How the treatment is done
- How to prevent
Human cutaneous leishmaniasis is an infectious disease that spreads around the world, caused by infection with the Leishmania protozoan, which causes painless wounds on the skin and mucous membranes of the body.
In Brazil, American cutaneous leishmaniasis, popularly known as "bauru ulcer" or "wild sore", is transmitted by mosquitoes of the genus Lutzomyia , known as straw mosquitoes, and treatment is carried out under the guidance of a dermatologist, and it may be necessary to use injectable drugs, known as pentavalent antimonials.
The way to contract the disease is through the mosquito bite, which is contaminated by Leishmania after biting people or animals with the disease, mainly dogs, cats and mice, and, therefore, the disease is not contagious and there is no transmission of person to person. Mosquitoes usually live in hot, humid and dark environments, especially in forests or backyards with an accumulation of organic waste.
Main symptoms
The main forms of presentation of cutaneous leishmaniasis are:
1. Cutaneous leishmaniasis
Cutaneous leishmaniasis is the most common form of the disease, and usually causes the development of a wound, which:
- Starts as a small lump at the mosquito bite; Evolves to a painless open wound in a few weeks or months; Heals slowly without the need for treatment between 2 to 15 months; Lymph nodes may be swollen and painful.
The lesion measures from a few millimeters to a few centimeters, has a hardened consistency with raised edges and a reddish bottom that may contain secretions. When there is an associated bacterial infection it can cause local pain and produce a purulent secretion.
In addition to the traditional localized wound, the form of presentation of the lesions may vary, according to the type of protozoan responsible and the person's immunity, and may also appear as lumps spread through the body or infiltrations in the skin, for example.
2. Mucous or mucocutaneous leishmaniasis
It is more rare, most of the time appearing after the classic cutaneous lesion, and is characterized by destructive lesions in the mucosa of the upper airways, such as nose, oropharynx, palates, lips, tongue, larynx and, more difficultly, trachea and upper part of the lungs.
In the mucosa, redness, swelling, infiltration and ulceration can be observed and, if there is secondary infection by bacteria, the lesions may present with purulent discharge and crusts. In addition, in the mucosa of the nose, there may be perforation or even destruction of the cartilaginous septum and, in the mouth, there may be perforation of the soft palate.
How to confirm the diagnosis
In most cases the doctor is able to diagnose cutaneous leishmaniasis only by observing the lesions and reporting the patient, especially when the patient lives or has been in regions affected by the parasite. However, the disease can also be confused with other problems such as cutaneous tuberculosis, fungal infections or leprosy, for example.
Thus, it may also be necessary to perform a diagnostic test for which there are some options, such as reactive skin test for leishmaniasis, called Montenegro's Intradermoreaction, examination of the lesion aspiration or biopsy, to identify the parasite, or the blood tests, ELISA or PCR.
It is important to remember that leishmaniasis can also present itself in its most severe form, which is visceral, also known as kala azar. This disease evolves very differently from cutaneous leishmaniasis, spreading through the bloodstream. Understand how to identify visceral leishmaniasis.
How the treatment is done
Lesions of cutaneous leishmaniasis usually heal without treatment. However, in the case of wounds that increase in size, they are very large, they multiply or are located on the face, hands and joints, it may be recommended to do the treatment with remedies, such as creams and injections, guided by dermatologists.
The first choice remedies for the treatment of leishmaniasis are pentavalent antimonials, which, in Brazil, are represented by N-methylglucamine antimoniate or Glucantime, made in daily, intramuscular or venous doses, for 20 to 30 days.
If the wounds become infected during the healing process, it may also be advisable to have treatment with a nurse for better care and to avoid worsening the wound.
In addition, after healing, scars can remain on the skin and cause aesthetic changes. Therefore, it may be necessary to do psychological counseling or resort to plastic surgery to treat changes in the face, for example.
How to prevent
In order to prevent the transmission of leishmaniasis by mosquitoes, it is important to invest in individual and collective attitudes such as:
- Use repellents when you are in environments where the straw mosquito is found, and avoid exposure during times of high mosquito intensity; Use fine mesh mosquito nets, as well as placing screens on doors and windows; Keep nearby land and yards clean, removing debris and dirt, and pruning trees, to decrease the humidity that facilitates the breeding of the mosquito; avoid organic waste in the soil, so as not to attract animals, such as rats, that can contain the disease; keep domestic animals out of the house during the night, so reduce the attraction of mosquitoes to this environment; avoid building houses less than 4000 or 500 meters from the forest.
In addition, in the presence of wounds that do not heal easily, and that may indicate this disease, it is important to seek care at the health center so that the causes and appropriate treatment are identified more quickly.
