Espundia (Brazilian mucocutaneous leishmaniasis)
Espundia (Espundio) (Synonym: Brazilian mucocutaneous leishmaniasis).
Mucocutaneous leishmaniasis American has several forms of diseases, pathogens which belong to the L. brasiliensis complex.
The reasons espundia (Brazilian mucocutaneous leishmaniasis)
Distribution espundia (Brazilian mucocutaneous leishmaniasis)
Epidemiology espundia (Brazilian mucocutaneous leishmaniasis)
Pathogenesis espundia (Brazilian mucocutaneous leishmaniasis)
Symptoms espundia (Brazilian mucocutaneous leishmaniasis)
Treatment espundia (Brazilian mucocutaneous leishmaniasis)
The most severe form of Brazilian leishmaniasis (espundia) . in 80% of cases in addition to ulcers on the skin at the injection of the pathogen are also extensive lesions of the mucous membranes of the nasopharynx, larynx, cartilages and soft tissues and even bones.
The reasons espundia
Espundia (Brazilian mucocutaneous leishmaniasis) is caused by L. brasiliensis. Carriers represent more than 12 species of mosquitoes of the genus Lutzomya, but is most common Lu. Wilcomei.
The spread of Brazilian mucocutaneous leishmaniasis
Mucocutaneous leishmaniasis (espundia) occurs predominantly in South America. Cases such zabolevaemosti in some countries of Asia and Africa (Sudan, Somalia, Kenya, India).
The spread of the disease is associated with climatic conditions, time of year and the nature of the terrain. High temperatures and high humidity are necessary conditions accompanying the occurrence of diseases. Espundia often marked in the autumn, the rainy season. The value is the altitude (2000 m above sea level). The disease is more common in rural, forested areas, and is related to the density distribution of mosquitoes. Skin-mucous form of leishmaniasis often occurs in people working in forests, especially collecting resinous substances for the manufacture of “gum” rubber, so espundia called the disease “gum”.
Disease carriers are mosquitoes, natural reservoirs-carriers — rodents and perhaps dogs. Kiri in 1946 espundia observed after experimental infection of monkeys Sudanese Kala-Azar. From all experimental infection of animals, only apes were able to reproduce the lesions of the oral and nasal cavity.
The Brazilian pathogenesis of mucocutaneous leishmaniasis
Muco-cutaneous lesions begin in the form of perivascular infiltrate, and then develops the disease, which can lead to destruction of surrounding tissue. The microscopic nature of the skin lesions may be similar to the Eastern plague. The parasites can penetrate the blood circulating macrophages in the nose, mouth and soft palate, where they proliferate in macrophages cartilage or connective tissue, causing destructive inflammation. The process may spread to the throat and larynx; sometimes it affects also the external genitals. The frequency of this severe (sometimes fatal) complications depends on the strain of parasite and ranges from 5 to 85%; the strains circulating in southern Brazil and in Paraguay are particularly frequent dissemination. Metastatic lesions may appear even before the formation of the primary lesion; in other cases they may occur even 30 years after “recovery”.
Espundia classic symptoms found in Brazil, Peru, Chile, Ecuador, Bolivia, Paraguay, lie in the appearance of papulo-pustular skin lesions that occur on the face, ears and legs. Lesions of the mucous membranes or skin lesions accompany, or appear in a few years. In the mucosa of the nasal cavity are observed congestion, further there is ulceration. During the introduction of the parasites in the area of the lips, soft palate, pharynx here you can observe the destruction that lead to severe pain and deformation. The nose typically thickens, becomes deformed, bent downward, and the upper lip as a result of swelling and deformation is visibly forward and upward (“tapir nose”). The disease duration ranges from 4 months to 4 years.
In addition espundia in South America there are several endemic forms of cutaneous leishmaniasis that vary in landscape preferences, the epidemiology and clinical course. For example, in the high mountain valleys of the Andes in Peru and Bolivia known cutaneous leishmaniasis Uta occurring without lesion of the mucous membrane. Infection occurs at an altitude of about 2800 m. a Reservoir of the pathogen Leishmania peruana are dogs. In most cases, affects the ears, the illness may last for many years. Lesions begin as small, painful pimples (papules — pimles).
The Brazilian treatment of mucocutaneous leishmaniasis
Espundia (Brazilian mucocutaneous leishmaniasis) treatment responds poorly. Takes a lot of therapy drugs 5-valent antimony. Recovery is observed only in 20%.