Leiszmanioza jest chorobą pasożytniczą, która może przyjmować postać skórną, skórno-śluzówkową i trzewną. We wszystkich odmianach obserwuje się zmiany skórne, m.in. pod postacią charakterystycznych owrzodzeń, zniekształceń twarzoczaszki czy złuszczania się naskórka. W przypadku podróży do krajów endemicznych leiszmaniozy i zaobserwowania u siebie objawów schorzenia konieczna jest pilna konsultacja lekarska.
Leiszmanioza jest pasożytniczą chorobą tropikalną wywołaną przez pierwotniaki z rodzaju Leishmania, przenoszonych przez krwiopijne samice muchówek z rodzaju Phlebotomus i Lutzomyia. Do zakażenia człowieka dochodzi w wyniku ukłucia przez komara, ale możliwa jest również transmisja pierwotniaka przez transfuzję krwi, narkotyki dożylne czy drogą wertykalną z matki na płód. Pierwotniaki, które dostaną się do organizmu człowieka, zarażają białe krwinki (makrofagi), a patogen rozsiewa się m.in. do wątroby, śledziony czy szpiku kostnego. Okres inkubacji objawów jest stosunkowo długi i może potrwać od kilku tygodni do kilku miesięcy.
Występowanie choroby jest ograniczone zasięgiem geograficznym i najczęściej obserwuje się ją w obszarach, gdzie temperatura nie spada poniżej 16 stopni Celsjusza. W praktyce klinicznej wyróżnia się trzy postacie choroby: skórną, skórno-śluzówkową i trzewną.
Jakie są objawy laiszmaniozy?
- Leiszmanioza skórna
Ta postać choroby każdego roku może dotykać nawet 1,5 mln ludzi, a w 90 proc. przypadków występuje w Afganistanie, Algierii, Brazylii, Peru, Arabii Saudyjskiej, Iranie, Iraku i Syrii. Schorzenie często ustępuje samoistnie (w przeciągu 2-10 miesięcy), jednak pozostawia po sobie szpecące, zanikowe blizny.
W miejscach ukłucia przez owada, najczęściej na odkrytych częściach ciała, obserwuje się zaczerwienioną grudkę, która powiększa się do rozmiarów guzka, a następnie ulega charakterystycznemu owrzodzeniu z uniesionymi brzegami i wysiękiem surowiczym lub centralną martwicą i strupami. Zmiany mogą być rozsiane, ale często nie są bolesne. Niejednokrotnie dołączające do nich wtórne zakażenie może jednak zmienić obraz choroby. U pacjentów obserwuje się również powiększenie węzłów chłonnych.
Schorzenie należy różnicować z rakiem skóry, czyrakiem, niesztowicą, gruźlicą skóry. Ponadto leiszmanioza skórna może przyjąć nietypową postać: głęboką – zmiany skórne przypominają trąd, nawrotową – zmiany skórne przypominają toczeń rumieniowaty, trzewnopodobną.
- Leiszmanioza skórno-śluzówkowa
Występuje na obszarach krajów Ameryki Południowej, w 90 proc. w Brazylii, Peru i Boliwii. Tę postać choroby rozróżnia się jeszcze na dwa typy – espundię i w postać skórną.
Espundia objawia się w obrębie błon śluzowych jamy ustnej, nosowej i prowadzi do zniekształceń twarzoczaszki. Uszkodzeniu ulega skóra, błony śluzowe, struktury chrzęstne i kostne nosa, podniebienia oraz krtani, które prowadzą do trudności w oddychaniu i przyjmowaniu pokarmów. Zmiany chorobowe niejednokrotnie ulegają nadkażeniu bakteryjnemu, przyczyniając się do zgonu. Postać skórna tej odmiany choroby manifestuje się na odkrytych częściach ciała pod postacią guzkowego nacieczenia, ulegającego owrzodzeniu z towarzyszącym stanem zapalnym okolicznych węzłów chłonnych.
- Leiszmanioza trzewna
W 90 proc. przypadków występuje w Bangladeszu, Brazylii, Indiach, Nepalu, Etiopii, Sudanie i jest najgroźniejszą postacią choroby. Objawem najczęściej jest długotrwała gorączka sięgająca nawet 40 stopni Celsjusza, która charakteryzuje się dwoma szczytami w ciągu doby (około południa i przed północą). Ponadto u pacjentów obserwuje się utratę masy ciała, powiększenie wątroby, śledziony i węzłów chłonnych oraz pancytopenię. W tej postaci choroby również obserwowane są zmiany skórne obejmujące okolicę twarzy i rąk pod postacią złuszczenia naskórka, łamliwości włosów i paznokci, ciemnego zabarwienia skóry wokół ust, na policzkach, stopach, rękach i w linii środkowej brzucha.
Zaburzenia odporności towarzyszące tej chorobie prowadzą do wtórnych zakażeń bakteryjnych płuc i przewodu pokarmowego, gruźlicy i posocznicy. Z kolei występujące również zaburzenia krzepnięcia mogą być przyczyną zagrażających życiu krwotoków.
Rozpoznanie i diagnostyka leiszmaniozy
W przypadku podróży do krajów endemicznych leiszmaniozy i zaobserwowania u siebie objawów schorzenia konieczna jest pilna konsultacja w poradni specjalistycznej, np. chorób zakaźnych, tropikalnych, lub na odpowiednim oddziale.
W leiszmaniozie skórnej oraz śluzówkowo-skórnej specjalista rozpoznaje schorzenia na podstawie wykrycia pierwotniaków pod mikroskopem w wycinkach pobranych z obrzeży zmian. Z kolei w przypadku leiszmaniozy trzewnej chorobę diagnozuje się na podstawie mikroskopowej oceny obecności pierwotniaków w aspiratach szpiku kostnego oraz molekularnej oceny obecności materiału genetycznego pierwotniaków z rodzaju Leishmania. Rzadko wykonuje się badania serologiczne w kierunku wykrycia leiszmaniozy, ponieważ obarczone są dużym ryzykiem błędu.
Leczenie leiszmaniozy
W większości przypadków leiszmaniozy skórnej nie ma konieczności stosowania leków ogólnoustrojowych. U 90 proc. chorych obserwuje się samoistne wygojenie zmian w ciągu roku. Wskazane są jedynie miejscowe preparaty i zabiegi. Z kolei w leiszmaniozie skórno-śluzówkowej i trzewnej wskazane są leki doustne i dożylne. Istotne jest także wdrożenie leczenia wspomagającego, np. niewydolność narządową, niedożywienie, zakażenie bakteryjne oraz innych chorób towarzyszących (HIV, gruźlica).
Nawroty schorzenia nie są częste, mogą pojawiać się u osób z zaburzeniami odporności. Do czasu ustąpienia objawów pacjent powinien pozostawać pod kontrolą lekarską (zwykle około 6 miesięcy).
Źródła: mp.pl, medycynatropikalna.pl
Przeczytaj także: Spożywanie zanieczyszczonej wody może wywołać drakunkulozę – chorobę pasożytniczą tkanki podskórnej
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