Visceral leishmaniasis

Visceral leishmaniasis (cachectic fever). The visceral leishmaniasis causes Leishmania donovani with four subspecies - L. d. donovani (the Indian variant), L. d. infantum (the sredizemno-morsko-Central Asian variant), L. d. archibaldi (the East African variant), L. d. chagasi (the South American variant). Morphologicallies these subspecies do not differ, antigenic and biochemical differences however are found. There are also epidemiological differences. The Sredizemnomorsko-Central Asian leishmaniasis is a zoonosis. The infection contamination reservoir are dogs, jackals, foxes. In the endemial locuses children till 5 years are ill mainly. The visceral leishmaniasis of the South America is close to this variant (clinically and epidemiologically) (Bolivia, Venezuela, Brazil, Colombia, Paraguay, Ecuador, Peru).

The Indian visceral leishmaniasis is an anthroponosis, the big flashes (India) are quite often observed. The East African visceral leishmaniasis is a zoonosis with a sporadic case rate, however can extend and as an anthroponosis. Somalia, Kenya, Uganda, Ethiopia is extended in Sudan.

Symptoms and flow. The incubation interval proceeds from 3 weeks till 1 year (was rarely till 2-3 years). Initial implications of disease quite often remain not noticed, patients arrive under observation already with the expressed picture of disease. The disease beginning gradual, the fever long, often has wavy character. Duration of feverish waves and remissions fluctuates from several days about several months. The big daily allowances ranges quite often become perceptible, sometimes within days it is possible to tap at three-hour thermometry some episodes of a fervescence to high digits.

At survey of patients attracts attention pallor of integuments owing to an anaemia. The dark coloration of a skin at some variants of a visceral leishmaniasis (feces-azar) is bound to a lesion of adrenals. At a hemorrhagic syndrome there can be a petechial eruption. The condition of patients quickly worsens, patients grow thin, the anaemia, a leukopenia accrues. At the expressed leukopenia as result of an agranulocytosis ulcerous-necrotic changes in fauces and an oral cavity educe. A characteristic symptom - substantial growth of a liver (hepatomegalia) and liens (splenomegaly). The liver usually reaches an umbilical line, the lien bottom edge reaches a lumen of a small basin, top - VI-VII ribs. Lien infarcts, diarrhoeia are observed. In blood the anaemia, a leukopenia, an agranulocytosis, a thrombocytopenia, sharp augmentation of an ESR and the maintenance of globulins (especially gamma-globulins), reduction of level of albumins become perceptible. In the absence of etiotropic treatment there can come the cachectic season characterised by a sharp weight loss, muscle tone depression. At a feces-azare the generalised eruption consisting of nodules (leishmanioids) of the small dimensions, erythematic maculae and papillomas can be observed. Can be and stratifications of a purulent infection contamination (plural pustules, furuncles, abscesses).

Complications - a pneumonia, a coloenteritis, a nephritis, a thrombus - a hemorrhagic syndrome, a larynx edema, a stomacace, a noma.