by Kimberly Allen R.N.
The other day at the school where I volunteer one of the mothers that has children at the school came to me complaining of severe pain in her left ankle. I looked down and the ankle and foot were obviously swollen and the ankle and lower calf were wrapped. I asked her to remove the wrap so I could see what the problem was.
I can not begin to describe what I was thinking or feeling when I saw what was under the wrap. She has what is called a stage IV ulceration 6in long by 3in wide on the outer side of her left lower leg. OUCH! Physically she appeared as someone with type II diabetes that either isn’t aware that she’s a diabetic or she doesn’t care. I asked the director who is fluent in Spanish to assist and translate for me so that I could get a more accurate picture of what might be happening. She denied being a diabetic and stated that she had had the ulcer for 3 years. The director explained to me that he felt she probably had lieshmaniasis.
Lieshmaniasis is an infection caused by sand flies that are infected with protozoan parasites. Lieshmaniasis can be found from the rain forests of Central and South America to the deserts of the Middle East. There are a reported 1.5 – 2 million new cases diagnosed each year with as many as 12 million cases world wide. There have been a number of cases of lieshmaniasis reported by soldiers stationed in Saudi Arabia, Iraq, and Afganistan since the Gulf War of 1990. The most common form of lieshmaniasis is known as cutaneous lieshmaniasis. The less common, but more severe type is vsisceral lieshmaniasis.
Cutaneous lieshmaniasis can develop week to months after being bitten by an infected sand fly. Skin sores will develop at the site of the bite that is very slow to heal. Other symptoms that can develop anytime for a few months to years after becoming infected include fever, anemia, as well as spleen and liver damage. Cutaneous lieshmaniasis can become diffuse, producing multiple widespread lessions that appear like leprosy. When the lieshmaniasis becomes diffuse and spreads it can also spread to the mucous membranes, especially in the mouth and nose causing tissue damage.
The most common treatment use drug containing antimony, glucantine, and pentosan. The current drug of choice is amphotericin for cutaneous lieshmaniasis. There is a new drug Impavido that has been effective in the treatment of both visceral and cutaneous lieshmaniasis. There is no vaccine for visceral lieshmaniasis though there are several that are being developed. Recently the Infectious Disease Institute began the worlds first clinical trial on humans for a vaccine for visceral lieshmaniasis. Other clinical trials are taking place in Washington state and another in India. The Bill and Melinda Gates foundation has also awarded a grant for research into lieshmaniasis in Ethiopia. There is also a project called drug Search for Lieshmaniasis by the world community Grid.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.