Leishmaniasis and rheumatic disease 4.2/5 (5)

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Leishmaniasis (ICD-10 B55)

Definition

Tropical disease caused by the leishmania protozoans belonging to the parasite group flagellates. Kala-Azar ("Black fever") corresponds to the visceral form. Joint and muscle pain may be part of the disease picture. People with impaired immune defenses, such as the use of immunosuppressive drugs against rheumatic disease, can more easily become ill.

Three main types:

  1. Visceral type (spleen, liver, anemia, fever) (Kala Azar)
  2. Cutaneous shape (sore wounds)
  3. 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
  • 500 000 new cases of visceral leishmaniasis annually
  • Dogs and other animals are reservoirs in the Mediterranean countries
  • People's only reservoir on the Indian subcontinent

Kutan leishmaniasis

  • 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

Cutaneous form (mostly skin)

  • Development of red-brown nodules with central wound formation ("Oriental wound")
    • In the face
    • On the shoulders or upper arm

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

  • Detection of protozoa by direct microscopy of ulcer, liver, bone marrow or lymph node biopsy
  • PCR tests
  • Nucleic acid amplification tests for detection in blood have been developed

Treatment

Systemic, specific antibiotic treatment (antimony preparations) against 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

Tropic diseases, BINDEVEVSSYKDOMMER.no


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