Summary about Disease
Zoonotic cutaneous leishmaniasis (ZCL) is a parasitic disease transmitted from animals (typically rodents) to humans through the bite of infected female sandflies. It primarily affects the skin, causing sores or lesions. It's considered a public health problem in many parts of the world, particularly in certain regions of the Middle East, Central Asia, Africa, and South America. The Leishmania parasite is the causative agent.
Symptoms
The primary symptom is one or more skin sores. These sores typically:
Start as small papules (bumps) or nodules.
Gradually enlarge over weeks or months.
May develop into ulcers with raised borders.
Are usually painless but can sometimes be itchy or painful.
May heal spontaneously, leaving a scar.
Lesions can appear anywhere on the body but are commonly found on exposed areas like the face, arms, and legs.
Causes
ZCL is caused by infection with Leishmania parasites. The parasites are transmitted through the bite of infected female phlebotomine sandflies. These sandflies acquire the parasite by feeding on infected reservoir animals, which are usually rodents or other small mammals, depending on the geographic location. Humans are infected incidentally when bitten by an infected sandfly.
Medicine Used
Treatment options depend on the severity, location, and number of lesions, as well as the Leishmania species involved. Common medications include:
Topical treatments: For small, uncomplicated lesions, topical treatments like paromomycin ointment or miltefosine may be used.
Systemic treatments: For more severe or multiple lesions, or when topical treatments fail, systemic medications such as:
Pentavalent antimonials (e.g., sodium stibogluconate, meglumine antimoniate) - These are older drugs but still used in some regions.
Miltefosine - An oral medication.
Amphotericin B - An antifungal medication, typically used in more severe cases or when other treatments fail.
Fluconazole or Itraconazole - Oral antifungal medication which is used
Other therapies: Cryotherapy, local heat therapy, or surgery might be considered in certain circumstances. It is important to consult a healthcare professional for diagnosis and appropriate treatment.
Is Communicable
? ZCL is not directly communicable from person to person. Transmission occurs only through the bite of an infected sandfly. An infected human cannot directly pass the parasite to another person.
Precautions
Precautions to prevent ZCL include:
Avoid sandfly bites:
Use insect repellent containing DEET or picaridin.
Wear long-sleeved shirts and pants, especially during dusk and dawn when sandflies are most active.
Use mosquito nets (impregnated with insecticide) while sleeping, especially in endemic areas.
Avoid outdoor activities during peak sandfly hours if possible.
Environmental control:
Reduce sandfly breeding sites by eliminating standing water.
Use insecticides to control sandfly populations.
Control rodent populations around homes and agricultural areas, as rodents are often reservoir hosts.
Protective clothing: Wear appropriate clothing when working or recreating in areas known to harbor sandflies.
How long does an outbreak last?
The duration of an outbreak varies depending on factors such as the size of the affected area, the effectiveness of control measures, and environmental conditions that favor sandfly breeding. Outbreaks can last for several months to years if left unaddressed. Sporadic cases might continue to occur even after an outbreak is officially declared over.
How is it diagnosed?
Diagnosis typically involves:
Clinical examination: Assessing the appearance and location of the skin lesions.
Laboratory tests:
Microscopy: Examining a sample from the lesion under a microscope to identify the Leishmania parasite.
Culture: Growing the parasite in a laboratory culture from a lesion sample.
PCR (Polymerase Chain Reaction): Detecting the parasite's DNA in a lesion sample. This is a highly sensitive and specific test.
Serology: Antibody testing (though less reliable for cutaneous leishmaniasis than for visceral leishmaniasis).
Skin test: The leishmanin skin test (Montenegro skin test) can be used to assess past exposure to Leishmania, but it may not be reliable in all cases and doesn't indicate active infection. It is important to note that diagnosis should be performed by a qualified healthcare professional.
Timeline of Symptoms
Incubation period: After a sandfly bite, the incubation period (time between the bite and the appearance of symptoms) can range from a few weeks to several months, sometimes even longer.
Initial lesion: A small papule or nodule appears at the bite site.
Progression: Over weeks to months, the papule/nodule gradually enlarges.
Ulceration: The lesion may ulcerate, forming a sore with a raised border.
Healing: If left untreated, the lesion may eventually heal spontaneously, but this can take months or even years, and often leaves a noticeable scar.
Important Considerations
Species Identification: Identifying the specific Leishmania* species is crucial, as different species may respond differently to treatment.
Co-infections: Consider the possibility of co-infections with other diseases, as these can complicate diagnosis and treatment.
Immune Status: The patient's immune status can affect the severity and course of the disease. Immunocompromised individuals may experience more severe or disseminated disease.
Geographic Location: Knowledge of the geographic region where the infection was acquired is important because it helps narrow down the possible Leishmania species.
Treatment Monitoring: Regular monitoring during treatment is essential to assess the response to medication and to detect any potential side effects.
Prevention is Key: Emphasize preventive measures, especially for individuals living in or traveling to endemic areas.
Consultation with Specialists: Complex cases may require consultation with specialists in infectious diseases or dermatology.