"Leishmaniasis world map - DALY - WHO2002" by Lokal_Profil. Licensed under CC BY-SA 2.5 via Commons - https://commons.wikimedia.org/wiki/File:Leishmaniasis_world_map_-_DALY_-_WHO2002.svg#/media/File:Leishmaniasis_world_map_-_DALY_-_WHO2002.svg
Leishmaniasis (ICD-10 B55)
Contents
Definition
Tropical disease caused by the leishmania protozoa belonging to the parasitic group flagellates and spread by sand flies. Kala-Azar ("Black fever") corresponds to the visceral form. Joint and muscle pain can be part of the disease picture. People with a weakened immune system, such as when using immunosuppressive drugs for rheumatic disease, can get sick more easily.
Three main types:
- Visceral type (spleen, liver, anemia, fever) (Kala Azar)
- Cutaneous form (orient wound)
- Mucocutaneous form (mouth and mucous membranes)
Occurrence
Insidence in Norway: Leishmaniasis was required to be reported in MSIS 1975-94. During this period MSIS reported 4 cases of visceral leishmaniasis. Infection site in all cases was Spain in persons of Norwegian origin.
Visceral leishmaniasis (Kala-Azar = black fever)
- Mediterranean countries, Middle East (including Turkey)
- China (Leishmania infantum)
- Indian subcontinent
- East Africa (L.donovani)
- South and Central America (L.chagasi)
- 90% of cases in the world occur in Bangladesh, Brazil, India, Nepal and Sudan
- Children are most affected in the Mediterranean, most adults are affected in India and Africa
- 500 new cases of visceral leishmaniasis annually
- Dogs and other animals are reservoirs in the Mediterranean countries
- People's only reservoir on the Indian subcontinent
- Mainly in South and Central America (L. brasiliensis)
- Mediterranean and Middle East (L.tropica and L.major)
- 90% of cases in the world occur in Afghanistan, Algeria, Brazil, Iran, Peru, Saudi Arabia, and Syria
- 1,5 million new cases of cutaneous leishmaniasis annually
Both forms of leishmaniasis may occur in Norway as imported cases.
Contamination
- Increased risk of infection for persons with reduced immune system
- Bite of sandflies transmits infection
- Sand flies are found mainly in dry and semi-dry areas in villages, underground rodent marshes, scrub forests and rocky rocks, in South America also in tropical forests. The flies have a short action radius
- The reservoir for the parasite is human and animal, and vector is blood-sucking butterflymosquito of the genera Phlebotomus and Lutzomyia, so-called sandflies
- Woundmaterial by the cutaneous type may in rare cases infect one person to another
- The parasite can also be transmitted through the use of unclean syringes
- The genus Phlebotomus occurs in Europe, Asia and Africa and Luzomyia in South America
Incubation time (from infection to symptom)
- Skin: Cutaneous form: from 1 week to several months
- Internal organs: Visceral form: from 2 - 6 months
Symptoms and course
Visceral form (mostly in the stomach and intestines)
- Systemic disease
- May be a serious course
- Fever over weeks without response to steroids
- Diarrhea and weight loss
- Medical investigation and findings
- Enlarged spleen and liver (hepatosplenomegaly)
- Large lymph nodes
- Anemia and pancytopenia (low blood cell count indicating bone marrow infiltration)
- Dark pigmentation in the skin may occur in palms or temples
- High CRP, SR and IgG
Cutaneous form (mostly skin)
- Development of reddish-brown nodules with central ulceration ("oriental ulcer")
- In the face
- On the shoulders or upper arm
- Punch biopsy for biopsy and PCR
Mucocutaneous form (mostly in mucous membranes and skin)
- Wounds in the mucous membrane can erode the palate and nasal septum over the years
Rheumatic symptoms
- Joint pain
- Muscle pain
Diagnostics
- PCR tests are routine
- Detection of protozoa by direct microscopy of ulcer, liver, bone marrow or lymph node biopsy
- Serological test
Treatment
Systemic, specific antibiotic treatment (antimony preparations, amphotericin B) for both forms of the disease.
Preventive measures
- Covering the body to avoid stinging. There is no vaccine.
- No special measures on imported cases. People who have or have had Kala-Azar (Visceral form) are permanently excluded from blood donation. Not notifiable to Norwegian MSIS.
Literature
- Aronsen N, 2016 (American guidelines for diagnosis and treatment)
- Müller KE, 2021
- Pagliano P, 2017
- Maritime M, 2018
- Blomberg B, 2019 (Patient Case Study in Norwegian)
- Wikipedia
Tropic diseases, BINDEVEVSSYKDOMMER.no