Summary about Disease
Oriental sore, also known as cutaneous leishmaniasis, is a parasitic disease transmitted through the bite of infected female sandflies. It primarily affects the skin, causing lesions, ulcers, or sores. It's prevalent in tropical and subtropical regions around the world.
Symptoms
The main symptom is a skin lesion that typically begins as a small, raised bump (papule). This papule slowly grows into an ulcer with a raised, hardened edge. The ulcer is usually painless, but can become painful if secondarily infected. Other symptoms can include:
Itching around the sore
Swelling around the sore
Swollen lymph nodes near the sore (rare)
Causes
Oriental sore is caused by infection with protozoan parasites of the Leishmania genus. These parasites are transmitted to humans through the bite of infected female sandflies. Different species of *Leishmania* can cause different forms of cutaneous leishmaniasis, which may affect the appearance and severity of the sores.
Medicine Used
Treatment options for Oriental sore depend on the severity, location, and the Leishmania species involved. Common medications include:
Topical treatments: Paromomycin cream, miltefosine.
Intralesional injections: Antimony-based drugs (e.g., sodium stibogluconate) injected directly into the lesion.
Systemic medications: For severe or widespread cases, or when topical treatments are ineffective, systemic medications like miltefosine, amphotericin B, or pentavalent antimonials may be used.
Fluconazole or Itraconazole: May be used in some cases.
Is Communicable
Oriental sore is not directly communicable from person to person. It is transmitted through the bite of an infected sandfly. Transmission occurs when the sandfly bites an infected animal (reservoir host) or human and then bites another human.
Precautions
Preventing sandfly bites is crucial:
Use insect repellent: Apply DEET-containing insect repellent to exposed skin, especially during dawn and dusk when sandflies are most active.
Wear protective clothing: Cover arms and legs with long sleeves and pants, particularly in endemic areas.
Use mosquito nets: Sleep under insecticide-treated mosquito nets, especially if sleeping outdoors or in unscreened buildings.
Control sandfly breeding sites: Eliminate standing water and other breeding areas around homes.
Spray insecticides: Consider spraying insecticides in and around homes, especially in areas where sandflies are common.
How long does an outbreak last?
Without treatment, Oriental sore lesions can persist for months or even years. The natural course of the disease can vary depending on the Leishmania species and the individual's immune response. With appropriate treatment, the sores typically heal within weeks to months.
How is it diagnosed?
Diagnosis typically involves:
Physical examination: Assessment of the skin lesion.
Microscopy: Taking a scraping or biopsy from the lesion and examining it under a microscope to identify Leishmania parasites.
Culture: Growing Leishmania parasites from a sample of the lesion.
Polymerase Chain Reaction (PCR): Detecting Leishmania DNA in a sample from the lesion.
Skin test (Montenegro test): To assess past exposure to leishmaniasis. This test is not always reliable.
Timeline of Symptoms
Incubation period: Typically ranges from a few weeks to several months after the sandfly bite.
Initial lesion: A small, raised bump (papule) appears at the bite site.
Ulcer formation: Over weeks to months, the papule gradually grows into an ulcer with a raised, hardened edge.
Healing: Without treatment, the ulcer may persist for months or years. With treatment, healing typically occurs within weeks to months. Scarring is common after healing.
Important Considerations
Travel history: Inform your doctor if you have recently traveled to an area where leishmaniasis is common.
Differential diagnosis: Other skin conditions can mimic Oriental sore, so it's essential to get a proper diagnosis.
Treatment adherence: Follow your doctor's instructions carefully and complete the entire course of treatment, even if the sores start to heal.
Scarring: Be aware that scarring is common after the sores heal.
Relapse: Although uncommon, relapse can occur.
Species identification: Identifying the Leishmania species is important as treatment protocols can vary.