Cutaneous Leishmaniasis in Children

What is Cutaneous Leishmaniasis in Children?

Cutaneous leishmaniasis is a disease also known under the names Borowsky’s disease, Pendin ulcer, year-old, eastern ulcer. This is a localized skin disease with typical ulceration and scarring. Called by Leishmania tropica.

Causes of Cutaneous Leishmaniasis in Children

Leishmania tropica is a species of flagellate parasitic protists of the genus Leishmania, the causative agent of anthroponous cutaneous leishmaniasis in adults and children. Leishmania data are obligate parasites. Man is their natural reservoir. Leishmania also inhabit rodent, dog and daman organisms. Infected mosquitoes belonging to the species Phlebotomus sergenti.

Pathogenesis during Cutaneous Leishmaniasis in Children

At the point of entry into the human body, the causative agent of cutaneous leishmaniasis begins to multiply, which leads to a local proliferative process with the formation of a specific granuloma (leishmanioma). They include: prasmatic and lymphoid cells, macrophages (they contain a large number of Leishmania) and fibroblaston.

Later, granulomas-leishmaniomas are necrotic, ulcerated, and then become a scar. In some cases, in children, the granulomatous process progresses, but ulcers may not form. This is characteristic of tuberculoid leishmaniasis.

Symptoms of Cutaneous Leishmaniasis in Children

Forms of cutaneous leishmaniasis in a child:

  • dry (anthroponous urban leishmaniasis)
  • weeping (zoonotic rural leishmaniasis).

The source of the dry form of cutaneous leishmaniasis is a person with open foci of lesion, the weeping form of the disease is rodents. Both forms of mosquito disease are carried.

Incubation during infections with a dry form of cutaneous leishmaniasis in children takes place for at least 2-3 months, and for a maximum of more than a year. At the site of the mosquito bite, one or several papules appear, which look like medium-sized, painless pink or brownish tubercles, the size of which is up to 3 mm.

Later, papules grow, ripening, and after 3-5 months turn into ulcers, then become crusty. Ulcers resemble craters, rather deep. Around them is determined by a dense infiltrate, which rises above the surface of the skin of the child. At the bottom of the ulcer – purulent raids. At a certain period, the ulcers increase due to the breakdown of the infiltrate, and by the 10-12th month of the disease, they begin to clear and fill with granulation tissue.

Instead of an ulcer, a scar is later formed. The disease proceeds for a long time, from the appearance of a tubercle to the formation of a scar, it may take a year, or sometimes even two. Therefore, one of the names of cutaneous leishmaniasis in children is one year old.

In some cases, the process can take years. Often this happens with tuberculoid leishmaniasis in children. In such children, multiple nodules form at the site of leishmania entering the body, they grow and form nodular leprosy infiltrates without a tendency to form ulcers.

From infection with a weeping form of cutaneous leishmaniasis to the onset of symptoms, it takes at least a few days, a maximum of 1 month. A tubercle appears at the site of infection in the body, it quickly increases and ulcerates – literally in 1-2 weeks. A large ulcer (15-20 cm) is formed, the edges of which are saped, there is an abundant serous-purulent discharge, pain on palpation. Such an ulcer is called pendinsky.

Around Pendin ulcers in children scattered small tubercles can form, which quickly increase and turn into sores. They merge, forming ulcerative fields. Granulation begins after 2-3 months. She heals, forming a scar, 6 months after the onset of the first symptoms (average period). Tuberculoid variants of the weeping form of the disease last longer.

Diagnosis of Cutaneous Leishmaniasis in Children

The diagnosis of cutaneous leishamniosis in children is made according to the characteristic clinical picture, taking into account the epidemiological data, and they also detect the pathogen in the biomaterial taken from the bottom of the ulcer and from the regional infiltrate. In some cases, a biological test is performed on white laboratory mice.

Cutaneous leishmaniasis requires differentiation with syphilis, a boil, trophic ulcers, leprosy, and other skin lesions.

Treatment of Cutaneous Leishmaniasis in Children

Antimony preparations have a small effect in case of cutaneous leishmaniasis in children. Lotions from a solution of furatsilin, acrikhina, gramicidin and Vishnevsky ointment locally should be used. Also, monomycin ointment has a good effect in this disease.

If the child has extensive infiltrates, monomycin is administered intramuscularly in a dose corresponding to the patient’s age. The course is 7 days. When secondary bacterial flora is attached, antibiotic therapy is necessary. Stimulating and restorative therapy is also recommended.

Prevention of Cutaneous Leishmaniasis in Children

  1. Fight mosquitoes and rodents according to current relevant instructions.
  2. As early as possible, identify and treat sick children and adults.
  3. To prevent the spread of infection throughout the patient’s body, dressings should be applied to the affected areas.
  4. Vaccinations with a vibrant Leishmania culture are recommended.