Cutaneous leishmaniasis are skin infections due to leishmanias, single-celled organisms included among the protozoa responsible for various diseases.
These protozoa are transmitted by insect vectors, more specifically by the bites of infected phlebotomus (pappatacio). The skin disease can occur sporadically anywhere in the world, but there are geographic areas where it is endemic, that is, cases of cutaneous leishmaniasis are observed with regularity.
The areas affected are: the Mediterranean basin, the Middle East, Ethiopia and North Africa in particular (Africa in general), Central Asia, and Central and South America.
The etiological agents differ by area of distribution:
The incubation period for the cutaneous form of Leishmaniasis can range from 15 days to 2 months. The initial lesion may be a papule or nodule that ulcerates (numerous skin lesions especially in cases of immune changes) and appears at the site of the infected phlebotomist's bite.
In the case of L. Peruviana and L. Mexicana it may present as an ulcerating nodule, numerous lesions and destruction of cartilage, while when L. Braziliensis is involved extensive ulceration, destruction of mucous membrane and cartilage.
It is appropriate when one returns from a trip to (particularly endemic) Leishmania areas and has memory of some unidentified insect bite or a small ruby-red/red-brown papule appears to have a dermatologic checkup to rule out this disease. Acting in a timely manner is important in order to eventually institute appropriate treatment because, although lesions usually heal well, scarring may remain at the involved sites.
The dermatologist may, in addition to diagnosis through careful history and objective examination, have a microscopic and cultural examination of ulcer aspirate, for example, or PCR from skin biopsy. Treatment may include paromomycin ointment 15% for African or European origin of lesions; paromomycin ointment 15% + gentamicin 0.5% for New World Leishmaniasis (Central and South America). Always in galenic preparation.
Intralesional N. methylglucamine antimoniate, at the margins and base of the ulcer, to eliminate protozoa but if the lesions are multiple and widespread, intramuscular administration of the drug is used.
Amphotericin B is a polyene macrolide (an antibiotic structurally akin to classical macrolides, but with an additional cyclic loop consisting of a greater number of termini) produced by Streptomyces nodosus, and treatment with this active ingredient in a low-dose lipid complex is effective against forms with possible or established visceral involvement (in visceral leishmaniasis resistant to conventional antimony therapy, anyway). However, the drug has an important level of toxicity.
We focused that the skin disease is transmitted by vectors/flebotomas or pappatacea, hematophagous dipterans, and the species involved in Italy for example are Phlebotomus papatasi, perniciosus or perfiliewi, while Lutzomyia is a typical type in America, Colombia and Peru.
Parrots are predominantly nocturnal and prefer warm climate with high humidity and in fact are particularly found in areas near the coasts. Female ones sting humans and animals (especially dogs) to feed on their blood that is essential for reproduction and egg laying.
The papular lesion that can' result from the sting is often painful and itchy, a typical reaction due to the phlebotomist's saliva being injected at feeding time. When they sting a Leishmania-infected animal, these protozoa enter the phlebotomes and can be transmitted to healthy animals and humans, and this is referred to as zoonosis.
Finally, it should be mentioned that Leishmaniasis has three different clinical forms:
In our travels, it is therefore advisable to consider the above and make use of spray or stick repellents to avoid the bite of the parasite, which is also useful for mosquitoes and other insects. In indoor environments ventilate and give light to rooms of disturbance to the insect and if you can mosquito nets with dense weave. But ultimately a checkup on our return to the dermatologist if we detect a reddish lesion is still useful for these and other "surprise" diseases of the tropics.