Anyone who travels a lot can become infected with cutaneous leishmaniasis, a disease of the skin and mucous membranes for which there is no vaccine and which can be serious with a number of complications. It is also popularly known as the Orient bump. Vacationers should therefore take preventative measures as far as possible and consult a doctor if they experience the typical symptoms of cutaneous leishmaniasis.
What is cutaneous leishmaniasis?
Cutaneous leishmaniasis occurs mainly after returning from a risk area and progresses rapidly. Therefore, a medical examination should always be carried out after traveling to Asian countries.
Cutaneous leishmaniasis is an infectious skin disease. Their name comes from the pathogens that cause the disease. See AbbreviationFinder for abbreviations related to Cutaneous Leishmaniasis.
These are different parasites, all of which belong to the Leishmania genus. Depending on where in the world you contract the disease, the disease is due to a different type of parasite. For this reason, there are different types of the disease, which are classified as either “Old World” cutaneous leishmaniasis or “New World” cutaneous leishmaniasis.
The latter is usually a more serious disease and can also occur as a special form, known as mucocutaneous leishmaniasis, in which the mucous membranes are primarily affected instead of the epidermis. Cutaneous leishmaniasis is particularly widespread in southern Europe, Asia, parts of the Orient, and Central and South America.
Causes
As already mentioned, the causes of cutaneous leishmaniasis are parasitic. The so-called sand or butterfly fly usually transmits the parasites by biting a human.
The parasites, which in biology belong to the scourge-bearing protozoa (also called flagellates), get into the human skin through the puncture site. There they multiply and irritate the skin in the form of lumps or ulcers. The pathogens only survive by nesting 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 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, Ailments & Signs
Depending on its type and severity, cutaneous leishmaniasis can cause various symptoms. The cutaneous leishmaniasis of the “Old World” manifests itself mainly through skin changes. A few weeks after the sting, the puncture site becomes inflamed and swollen. A flat, mostly painless and reddish lump then forms, which reaches a diameter of two to four centimeters.
Occasionally, a yellowish crust develops that is easy to scrape off. The skin lesion persists for several months before spontaneously healing. A scar usually remains, which can be accompanied by sensory disturbances. Cutaneous leishmaniasis occurs predominantly on unclothed skin areas such as the neck, arms and ankles. In individual cases, several ulcers and lumps form at the puncture site, which can persist for years and spread to other areas of the skin over time.
The cutaneous leishmaniasis of the “New World” is usually more aggressive – deep skin damage and extensive ulcers form. The mucocutaneous form manifests itself as an ulcer and, as the disease progresses, as a parasitic infestation of the mucous membranes. The nasal mucosa and the oral mucosa are particularly affected, which can result in impaired breathing, nosebleeds and pain. In severe cases, the parasites spread through the blood and lymph vessels and cause further problems.
Diagnosis & History
Cutaneous leishmaniasis is easy for a doctor to recognize based on the symptoms of the disease. These are usually red and swollen patches of skin that form a flat lump or an ulcer up to two inches in size.
If a patient has traveled to a risk area within the last few months (sometimes even years), an initial guess can be made as to which potential parasite it could be. In order to be able to prove the pathogen and thus secure the suspicion, the doctor then carries out a tissue examination of the ulcer and prescribes a specific therapy.
If “old world” cutaneous leishmaniasis is not treated, it usually heals spontaneously after some time. Since the specific skin irritations are usually comparatively weak, scars usually do not even remain . Nevertheless, if cutaneous leishmaniasis is suspected, a doctor should always be consulted to determine the type of leishmaniasis.
If cutaneous leishmaniasis in the “New World” is not treated, it can have fatal consequences. For example, the mucous membranes can be destroyed or the surrounding tissue can disintegrate. Significant optical distortions are often the result. Mucocutaneous leishmaniasis often leads to complications 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.
You can only get infected with each form of cutaneous leishmaniasis once in a lifetime, since the disease makes you immune to the respective pathogen. However, a renewed illness with cutaneous leishmaniasis by another pathogen is still possible.
Complications
With this disease, those affected suffer from various symptoms and complications, all of which, however, significantly reduce the quality of life of the affected person. This usually leads to reddening of the skin and swelling. It is not uncommon for these symptoms to be associated with itching, which can also lead to inferiority complexes or reduced self-esteem.
Sometimes those affected are ashamed of the symptoms and feel uncomfortable with them. This can possibly lead to psychological upsets or even depression. Scars can also remain on the skin. It is not uncommon for the disease to lead to nosebleeds or a stuffy nose. This also reduces the patient’s resilience and permanent tiredness and exhaustion occurs.
It also weakens the immune system and can lead to pneumonia. In the worst case, this can also be fatal. Treatment of the disease is carried out with the help of drugs and creams. Most complaints can be alleviated relatively well in this way. As a rule, there are no special complications. The life expectancy of the patient is also not changed by this disease.
When should you 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 mainly after returning from a risk area and progresses rapidly. Therefore, a medical examination should always be carried out after traveling to Asian countries. This is particularly important when there are clear symptoms of an illness. Conspicuous lumps, fever and general malaise must be examined and treated immediately.
If major changes have already developed on the skin, you must go to the doctor on the same day. This applies in particular if there is a concrete suspicion, i.e. if the symptoms occur immediately after a trip to the risk areas for cutaneous leishmaniasis. People who suffer from an immune deficiency or cardiovascular problems should speak to a doctor directly due to the increased risk of health complications and, if necessary, visit a specialist clinic. The tropical infectious disease is treated by the family doctor, an ENT doctor or an internist.
Treatment & Therapy
A disease with cutaneous leishmaniasis occurs depending on the pathogen and the severity of the disease. In many cases, topical antibiotic ointments are helpful. In other cases, active ingredients are injected.
In mild cases, freezing the affected skin areas is sometimes sufficient. In particular, “Old World” cutaneous leishmaniasis can often be treated with a topical drug. Because “New World” cutaneous leishmaniasis is a more aggressive form of cutaneous leishmaniasis, treatment as for “Old World” cutaneous leishmaniasis is often insufficient.
This applies in particular to mucocutaneous leishmaniasis, since the mucous membranes are usually affected. As a rule, no locally applicable ointments are used here. 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 out.
Outlook & Forecast
The course of cutaneous leishmaniasis is usually much easier than that of other forms of leishmaniasis. Only scars have to be accepted as an after-effect. Mucocutaneous and visceral leishmaniasis require more comprehensive treatment. The prognosis for them is much worse. Visceral leishmaniasis can even be fatal. This is usually not the case with cutaneous leishmaniasis.
The subtype of the triggering insect also decides whether one of the types of leishmaniasis develops, as does the immune quality of the person affected. Skin lesions called Aleppo bumps are typical of the cutaneous type of leishmaniasis. Even if cutaneous leishmaniasis, which is actually milder, has a good prognosis, this can change if the immune status is poor. Patients undergoing chemotherapy or who have HIV have a significantly poorer prognosis.
Other risk factors for a worse prognosis can be malnutrition, poverty and precarious housing. Malnutrition can even turn cutaneous leishmaniasis into visceral leishmaniasis. This significantly worsens the prognosis for those affected. Climate change favors the development of cutaneous leishmaniasis through the further spread of the triggering sand fly species.
With rising average temperatures and higher humidity levels, the disease is likely to spread worldwide. Aleppo bumps can take up to two years to heal. Medicine has not yet found a strategy against the associated scarring.
Prevention
If you want to prevent cutaneous leishmaniasis, you have to protect yourself 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 most cases, the patient has only a few follow-up measures available for this disease, since the priority is a quick diagnosis and subsequent treatment. This is the only way to prevent further complications, and the symptoms of those affected usually continue to worsen if no treatment is initiated.
Self-healing cannot occur in this case, so that the person affected with this disease is always dependent on medical treatment. During treatment, contact with other people should be avoided as far as possible to prevent further infection. As a rule, the person concerned should go to a hospital so that the disease is treated properly. Strict bed rest should also be observed during treatment.
Even after the therapy, exertion or physical and stressful activities should not be carried out. Regular checks are necessary in order to permanently monitor the condition of the internal organs and to identify possible damage at an early stage. Since the affected person is not immune to the infection after the illness, contact with the respective animals should be avoided so that a new infection cannot occur.
You can do that yourself
The extent to which patients affected by cutaneous leishmaniasis are restricted in their everyday life depends largely on the individual severity of the infectious disease. In principle, all self-help measures must be discussed with the treating specialist beforehand so that the risk of complications is reduced. Drugs are often used for treatment, both in the form of ointments with antibiotic effects and drugs with a systemic effect.
In order to support the therapy of cutaneous leishmaniasis, patients pay particular attention to personal hygiene at home. However, it must be taken into account 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 are careful not to engage in risky activities that may 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 areas of the skin.
In order to keep the quality of life as high as possible during the treatment of cutaneous leishmaniasis, patients pay more attention to their well-being and possible side effects from the prescribed medication. In such cases, those affected contact a specialist or an emergency doctor immediately.