People who travel a lot can contract cutaneous leishmaniasis, a disease of the skin and mucous membranes for which there is no vaccine and which can be severe with a number of complications. It is also popularly known as Oriental bump. Vacationers should therefore prevent it as best they can and seek medical attention if they experience the typical symptoms of cutaneous leishmaniasis.
What is cutaneous leishmaniasis?
Cutaneous leishmaniasis is an infectious skin disease. Its name comes from the pathogens that cause the disease. These are various parasites, all of which belong to the genus Leishmania. Depending on the area of the world where the disease is contracted, the disease is caused by a different type of parasite. For this reason, different types of the disease are distinguished, which are classified either as cutaneous leishmaniasis of the “Old World” or cutaneous leishmaniasis of the “New World”. The latter is usually a more serious disease and can also occur as a special form, so-called mucocutaneous leishmaniasis, in which the mucous membranes are predominantly affected instead of the epidermis. Cutaneous leishmaniasis is particularly common in southern Europe, in Asia, in parts of the Orient, and in Central and South America.
Causes
The causes of disease with cutaneous leishmaniasis are parasitic, as mentioned earlier. The so-called sandfly or butterfly mosquito usually transmits the parasites by biting a human. The parasites, which in biology belong to the flagellate-bearing protozoa, (also called flagellates) enter the skin of the human through the site of the bite. There they multiply and cause irritation of the skin in the form of nodules or ulcers. The pathogens survive only by implanting themselves in a host. The hosts can be both animals and humans. For this reason, in addition to the typical transmission from a mosquito to a human, it is also possible for a human to become infected through contact with a larger animal, such as a dog or even a rodent. In rare cases, direct transmission from person to person is also possible, for example through skin contact or the donation of blood and organs.
Symptoms, complaints, and signs
Cutaneous leishmaniasis can cause a variety of symptoms depending on its type and severity. Cutaneous leishmaniasis of the “Old World” is mainly manifested by skin lesions. A few weeks after the bite, the bite site becomes inflamed and swollen. Subsequently, a flat, usually painless and reddish discolored lump forms, which reaches a diameter of two to four centimeters. Occasionally, a yellowish crust develops, which can be easily scraped off. The skin lesion persists for several months before healing spontaneously. A scar usually remains, which may be accompanied by sensory disturbances. Cutaneous leishmaniasis occurs predominantly on unclothed skin areas such as the neck, arms and ankles. In isolated cases, multiple ulcers and nodules form at the injection site and may persist for years, spreading to other areas of the skin as the disease progresses. The cutaneous leishmaniasis of the “New World” is usually more aggressive – deep skin damages up to extensive ulcers are formed. The mucocutaneous form manifests itself by an ulcer, and in the further course by a parasitic infestation of the mucous membranes. The nasal mucosa and the oral mucosa are particularly affected, which can result in obstructed breathing, nosebleeds and pain. In severe cases, the parasites spread through the blood and lymph vessels, causing further discomfort.
Diagnosis and course
Cutaneous leishmaniasis is easy for a medical professional to recognize based on the symptoms of the disease. These are usually reddened and swollen areas of skin where a flat lump or ulcer up to five centimeters in size forms. If a patient has traveled to a risk area within the last few months (sometimes even years), a first guess can already be made as to which potential parasite it could be. In order to be able to detect the pathogen and thus substantiate the assumption, the physician then performs a tissue examination of the ulcer and prescribes a specific therapy. If cutaneous leishmaniasis of the “Old World” is not treated, it usually heals spontaneously after some time.Since the specific skin irritations are usually comparatively mild, not even scars usually remain. Nevertheless, if cutaneous leishmaniasis is suspected, a doctor should always be consulted to determine the type of leishmaniasis. If cutaneous leishmaniasis of the “New World” is not treated, this can sometimes have fatal consequences. For example, destruction of the mucous membranes or disintegration of the surrounding tissue may occur. Considerable visual disfigurement is often the result. In the case of mucocutaneous leishmaniasis, it is not uncommon for secondary diseases to occur, such as pneumonia or tuberculosis, which are due to the weakened immune system and, in the worst case, can lead to the death of the affected person. With each form of cutaneous leishmaniasis one can be infected only once in a lifetime, because the disease makes immune against the respective pathogen. However, re-infection with cutaneous leishmaniasis by a different pathogen is still possible.
Complications
In this disease, affected individuals suffer from various symptoms and complications, but all of them significantly reduce the quality of life of the affected individual. Usually, this involves redness on the skin and swelling. Not infrequently, these complaints are also associated with itching, and there are also inferiority complexes or reduced self-esteem. Sometimes many sufferers are ashamed of the complaints and feel uncomfortable with them. This can possibly also lead to psychological upsets or even depression. Scars can also remain on the skin. It is not uncommon for the disease to also lead to nosebleeds or a blocked nose. As a result, the patient’s ability to cope with stress also decreases and permanent fatigue and exhaustion occur. Furthermore, the immune system weakens and pneumonia develops. In the worst case, this can also be fatal. The disease is treated with the help of medications and creams. Most of the symptoms can be alleviated relatively well. As a rule, there are no particular complications. The life expectancy of the patient is also not changed by this disease.
When should one go to the doctor?
If skin changes are noticed on the face or arms, a visit to the doctor’s office is recommended. Cutaneous leishmaniasis occurs primarily after returning from a high-risk area and progresses rapidly. Therefore, after traveling to Asian countries, a medical examination should always be performed. This is particularly necessary if there are clear symptoms of the disease. For example, conspicuous lumps, fever and a general feeling of indisposition must be examined and treated immediately. If larger changes have already developed on the skin, one must go to the doctor on the same day. This applies in particular in the case of a concrete suspicion, i.e. if the complaints occur immediately after a trip to the risk areas of cutaneous leishmaniasis. Persons suffering from immunodeficiency or cardiovascular problems should speak directly to a doctor and, if necessary, visit a specialist clinic due to the increased risk of health complications. Tropical infectious disease is treated by the family physician, an otolaryngologist or an internist.
Treatment and therapy
Illness with cutaneous leishmaniasis occurs depending on the pathogen and the severity of the disease. In many cases, antibiotic ointments applied locally are helpful. In other cases, active substances are injected. In mild cases, icing of the affected skin areas is sometimes sufficient. Especially cutaneous leishmaniasis of the “Old World” can often be treated with a topically applicable drug. Since cutaneous leishmaniasis of the “New World” is a more aggressive form of cutaneous leishmaniasis, treatment as in cutaneous leishmaniasis of the “Old World” is often not sufficient. This is especially true for mucocutaneous leishmaniasis, as it is usually the mucous membranes that are affected. Therefore, locally applicable ointments are not usually used. Instead, patients often have to take so-called antimony preparations or similar drugs over a longer period of time to fight the disease from the inside.
Outlook and prognosis
In cutaneous leishmaniasis, the course is usually much milder than in other forms of leishmaniasis. Only scars must be accepted as an after-effect.Mucocutaneous and visceral leishmaniasis require more comprehensive treatment. In them, the prognosis is much worse. Visceral leishmaniasis can even be fatal. This is usually not the case with cutaneous leishmaniasis. The subtype of the triggering insect is as decisive for the development of one of the mentioned types of leishmaniasis as the immune quality of the affected person. Typical for the cutaneous type of leishmaniasis are skin changes called Aleppo bumps. Although cutaneous leishmaniasis, which is milder in itself, has a good prognosis, this can be altered by poor immune status. Patients who are undergoing chemotherapy or have HIV have a significantly worse prognosis. Other risk factors for a worse prognosis may include malnutrition, poverty, and precarious housing. Malnutrition can even turn cutaneous leishmaniasis into visceral leishmaniasis. This significantly worsens the prognosis for the affected person. Climate change favors the development of cutaneous leishmaniasis due to the further spread of the causative sandfly species. As average temperatures rise and humidity levels increase, the disease is likely to spread worldwide. Aleppo bumps can take up to two years to heal. Medical science has not yet found a strategy to combat the associated scarring.
Prevention
Those who wish to prevent cutaneous leishmaniasis must protect themselves on vacation with appropriate clothing or mosquito nets against bites from insects that could transmit the disease, as no vaccine against the disease has yet been developed.
Aftercare
In this disease, only a few measures of aftercare are available to the patient in most cases, as this primarily involves a rapid diagnosis with subsequent treatment. Only in this way can further complications be prevented, with the affected person’s symptoms usually continuing to worsen if no treatment is initiated. Self-cure cannot occur, so that the affected person is always dependent on medical treatment for this disease. During treatment, contact with other people should be avoided as far as possible to prevent further infection. In this case, the affected person should usually go to a hospital so that the disease can be treated properly. During treatment, strict bed rest should also be observed. Even after treatment, exertion or physical and stressful activities should not be performed. Regular check-ups are necessary to permanently monitor the condition of the internal organs and to detect possible damage at an early stage. Since the affected person is not immune to the infection after the disease, contact with the respective animals should be avoided, so that it can not come to a new infection.
This is what you can do yourself
The extent to which patients affected by cutaneous leishmaniasis are restricted by the disease in their daily lives depends largely on the individual severity of the infectious disease. In principle, all self-help measures should be discussed with the treating specialist beforehand to reduce the risk of complications. Medications are often used for treatment, both in the form of ointments with antibiotic effect and systemically acting drugs. To support the therapy of cutaneous leishmaniasis, patients pay special attention to personal hygiene at home. However, it should be borne in mind that contact of the diseased skin areas with cosmetics must be avoided at all costs. Contact with water is also critical and must be clarified by a doctor in advance. In addition, patients should be careful not to engage in any risky activities that could possibly injure the lesions on the skin and jeopardize their recovery. This is the case, for example, when cooking, where hot splashes of fat or water quickly reach the diseased skin areas. In order to keep the quality of life as high as possible during the treatment of cutaneous leishmaniasis, patients pay increased attention to their well-being and possible side effects caused by the prescribed medication. In such cases, affected persons immediately contact the specialist or an emergency physician.
