DISEASES OF THE SKIN : LEISHMANIASIS OF THE SKIN OR PENZENSKAYA ULCER (LEISHMANIOSIS CUTIS. ULCUS TROPICUM) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Pathogen - calf Borowski is a parasite belonging to Рrotozoa. Carriers of the virus - rodents (ground squirrels, gerbils), vectors - mosquitoes (phlebotomus).
Symptoms. Initially, there is one or more infiltrated, dense, painless nodules in the thickness of the skin, dark red in color, gradually increasing in size. There are 2 forms: early ulcerated, or acute Microtiterwells and later ulcerate caused by two different species of the pathogen. In early ulcerated form after an incubation period of 10 - 40 days infiltrate increases rapidly and dissociate in the center with the formation of deep ulcers with irregular pitted edges, pitted, often granular or warty bottom; ulcers surrounded by erythematous rim with tongue-shaped contours, and lymphangioma that palpated in the form of nodules. Within 3 to 6 months is the healing of the ulcer scar. When later ulcerate form the incubation period can last more than 3 months (up to 1½ years). The infiltrate consists of a cluster of tubercles, surrounded by a hyperemic rim, irregular shapes. Ulceration of infiltration occurs late, long.
The sores sometimes superficial, often covered with a tight-fitting cork; lymphangitis are less frequent. Sometimes on the edge of the scar after healing of the ulcer celebrated rash bumps, very reminiscent of lupus (lupoid leishmaniasis).
For a very long period, sometimes for years. Localization, usually on exposed parts of the skin, most often on the face, limbs. The number of ulcers from one to several dozen.
Will govern the form of an ulcer, its corroded edges, bluish color infiltration, presence of lymphangitis in circumference and history (place of residence, more precisely, the location of the disease - the Central Asian republics, the Caucasus). Need repeated microscopic examination of the juice extracted by squeezing the sores, and tissue scrapings from the edges of the ulcer: Leishmania detected in the plasma of macrophages and outside of them.
In the presence of acute-onset ulcers apply compresses of Ichthyol, rivanol, potassium permanganate. If there papulose infiltration injection in the lesion of a 5% solution of quinacrine in 1% solution of novocaine; administration of quinacrine in the hearth be repeated after 3 to 4 weeks. Good results often gives radiotherapy, surgical diathermy.