Summary about Disease
Biskra button, also known as cutaneous leishmaniasis, is a parasitic skin infection caused by protozoa of the Leishmania genus. It's transmitted to humans through the bite of infected sandflies. It typically manifests as one or more skin sores or ulcers.
Symptoms
A small, painless papule (bump) appears at the site of the sandfly bite.
The papule slowly enlarges and develops into an ulcer, often with a raised, hardened edge.
The ulcer may be covered with a crust or scab.
Multiple lesions can occur, especially if the person is bitten multiple times.
Swollen lymph nodes near the site of the lesion may occur.
The lesions are usually painless, but can sometimes be itchy or painful.
Causes
Biskra button is caused by Leishmania parasites. These parasites are transmitted to humans through the bite of infected female sandflies (primarily *Phlebotomus* species). The sandflies become infected by feeding on infected animals, such as rodents, dogs, and other mammals.
Medicine Used
Topical Medications: For small, uncomplicated lesions, topical medications like paromomycin cream may be used.
Systemic Medications: For larger, multiple, or complicated lesions, or when topical treatment fails, systemic medications like pentavalent antimonials (sodium stibogluconate or meglumine antimoniate), miltefosine, amphotericin B, or fluconazole may be prescribed. The choice of medication depends on the species of Leishmania, the severity of the infection, and the patient's overall health.
Is Communicable
Biskra button is not directly communicable from person to person. The infection is transmitted through the bite of an infected sandfly.
Precautions
Avoid Sandfly Bites: Use insect repellent containing DEET, picaridin, IR3535, oil of lemon eucalyptus (OLE), para-menthane-diol (PMD), or 2-undecanone.
Wear Protective Clothing: Wear long-sleeved shirts, long pants, and socks, especially during dawn and dusk when sandflies are most active.
Use Bed Nets: Sleep under mosquito nets, especially in areas where leishmaniasis is common. Nets should be treated with insecticide.
Control Sandfly Breeding Sites: Eliminate standing water and other breeding grounds for sandflies around your home.
Control Reservoir Animals: Implement programs to control infected animal reservoirs (e.g., rodents, dogs) in affected areas.
How long does an outbreak last?
Individual lesions can last for months or even years if left untreated. The duration of an "outbreak" in a population depends on factors like sandfly control measures, availability of treatment, and environmental conditions. A single lesion if left untreated, can last for months to years.
How is it diagnosed?
Clinical Examination: A doctor will examine the skin lesion and ask about travel history and exposure to sandflies.
Microscopic Examination: A sample of tissue or fluid from the lesion is taken and examined under a microscope to look for Leishmania parasites.
Culture: A sample of tissue or fluid from the lesion can be cultured to grow Leishmania parasites in the lab.
Polymerase Chain Reaction (PCR): PCR can be used to detect Leishmania DNA in a sample of tissue or fluid.
Serological Tests: Blood tests to detect antibodies against Leishmania may be used, but these are not always reliable for cutaneous leishmaniasis.
Timeline of Symptoms
1. Incubation Period: A few weeks to several months after the sandfly bite. 2. Initial Papule: A small, painless bump appears at the bite site. 3. Ulcer Development: Over days to weeks, the papule enlarges and forms an ulcer with a raised, hardened edge. 4. Chronic Ulcer: The ulcer persists for months or years if untreated. 5. Healing (with or without treatment): The ulcer eventually heals, leaving a scar. Healing can take weeks to months with treatment, or longer without.
Important Considerations
Species Identification: Identifying the specific Leishmania* species is important because it can influence treatment choices.
Coinfection: Patients may be coinfected with other diseases, such as HIV, which can affect the severity and treatment of leishmaniasis.
Immune Status: The patient's immune status can also influence the severity and treatment response.
Pregnancy: Some medications used to treat leishmaniasis are not safe for pregnant women.
Travel History: Always inform your doctor about your travel history, especially if you have visited areas where leishmaniasis is common.
Scarring: Cutaneous leishmaniasis often leaves a permanent scar, even with treatment.
Relapse: Relapse is possible, even after successful treatment. Regular follow-up is important.