PECULIARITIES OF MANIFESTATION OF THE SKIN FORM OF LEISHMANIASIS OF MAXILLOFACIAL LOCALIZATION
Authors: Skikevych M.G. , Voloshyna L.I. 
Published: June 2020

Leishmaniasis is a vector-borne disease in humans. Simple intracellular parasites cause the disease. Risk factors: socio-economic conditions, poverty. The disease is associated with malnutrition, with population displacement, with poor housing conditions, with a weak immune system, poor sanitary conditions, and lack of waste disposal. Up to 1 million new infections and up to 65,000 deaths from this disease occur annually. About 95% of cases of skin form disease occur in the countries of the American continent. Leishmaniasis occurs in Uzbekistan and Turkmenistan.
The carriers of this disease are female mosquitoes. In the mosquito, parasites are in flagellate form. The natural reservoirs of Leishmania can be around 70 species of animals and humans. Infection occurs through mosquito saliva. After a bite, the parasite invades human mononuclear phagocytes. There may be infection of a person in contact with ulcers and other types of damage. Veterinarians have noted a dramatically increasing number of cases of disease in domestic animals.
The following forms are clinically distinguished: cutaneous, mucocutaneous, diffuse cutaneous and visceral forms of leishmaniasis. After the disease develops, a stable immunity to this particular type of leishmaniasis develops.
Cutaneous leishmaniasis is the most common form. Ulcers form in open areas of the body. Typical places of localization: face, ears, knees, elbows. Some nodules may have a warty surface or resemble xanthomas, keloids. After healing of these ulcers, scars remain for life.
The nasopharynx, oral cavity, or nasal mucosa can be affected without destroying the nasal septum. For cutaneous leishmaniasis, the formation of an infectious granuloma is also characteristic.
Treatment of cutaneous leishmaniasis can be local or systemic, depending on the damage and pathogen. Local treatment is suitable for minor and uncomplicated lesions. Local treatment options: heat therapy, cryotherapy. Systemic therapy is used in patients with multiple extensive rashes.
Patient K. turned to the maxillofacial department. The patient came home to Ukraine for the purpose of diagnosis and treatment. The patient works in Poland at a construction site. According to the patient, several courses of treatment. The treatment had no result. The pharmacotherapy of our Polish colleagues is not known to us. Clinically: superficial skin lesions on the face. On the face are three ulcers of different sizes. Two ulcers on the cheeks and one on the nose. Palpation of the edges of the ulcers is very painful.
Diagnostic search for the etiology of this process. Consultation of a rheumatologist ̶ the goal of eliminating Wegener's disease, rheumatological diseases. Hematologist consultation ̶ exclude hematology. Infectionist consultation ̶ rule out parasitic diseases. Laboratory examination: biochemical blood test, immunogram, rheumatic tests. CT scan of the abdomen.
Consultation of a parasitologist. The diagnosis was not in doubt.The patient refused examination and treatment in the infectious diseases hospital. The further fate of this patient is not known to us. We want to draw the attention of doctors to the need for a thorough history taking. An epidemiological history is crucial in such cases.
Treatment of leishmaniasis is long and toxic. No method of treatment gives 100% of the result. The choice of treatment method will depend on the type of pathogen and the geographical location of the infection.This disease can be brought by tourists, students from relevant countries of the world to Ukraine.