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File: 970805_DOC_222_CUTANEOUS_LEISHMAN_02.txt
Page: 02
Total Pages: 2

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    P~CF C? RHIP~~~%\..%.\ lJNFf..~?
    IS rIOPE r~BUNfl~~T NHERE THIS YECTOR IS PRESENT IN L~RCE
    NUMBERS.   THE ~ISE~SE H~S H'~LSO BEEN MORE NI~ESPRE~fl ~T LO~JFP
    ~LTITUI:3ES OF THE TIH~rt~      THERE IS SPECUL~TION TH~T PHLEBOTOMUS
    BEROEROTI ~`Nfl.~OR PHLEBOTOMUS ~PIENT~LIs M~Y BE SECOND.~P....................`rCTZ\Pc=
    3.   CLINIC~L:      OLID kiORLD OONOTIC CUT~NEOUS LEISHM~NI~SIS               (ORIENT~L
    ~ORE   B(~OHfl~r1 BOIL   ~LEPPO EYIL)   INCl~Br~TION PERIO~ Y~pIES FROM E?
    NEE~:S TO SEVER~L friONTHS.     M~NIFEST~TIONS ~RE V~RI~BLE WITH THE RURHL
    OR MOIST FORM       (L. M(~JOR) LESIONS BEING MULTIPLE.        M~TURI[AG R~PIEiLy..
    ~N~ TENO TO HE~L i~~FTER SE\iERF~L MONTHS.            THE LESION ST~RTS ~S 4
    P~PULE TH4T GR~DU4LLY INCRE~SES IN SIE.                BECOMES. CRUSTE £3 44£)
    FIN~LLY ULCER~TES.       Sr~TELLITE LESIONS M~Y BE PRESENT 4N£3 REGION~L
    LYMPH4£3ENOP~THY M4Y OCCUR........£31 r~GNOS I S £)EPENflS ON I£3ENT IF I C4T I ON OF
    THE P~R~SITE IN STH~INE£3 SME~RS OF SCR~PINOS.             BIOPSY SPECIMENS.       OR
    ~SPIR4TES.       SECOt4£34RY B4CTERI~L INFECTIONS 4-RE NOT UNCOMMON 4Nri M4\'
    OBSCURE VISU~LI~4TION OF THE P~R~SITE tr~S LEISHM~NI~~INFECTEO
    M~CROPHp1GES 4RE £3ESTROYEfl.     THE £3IFFEREJ?jTI~L flI4GNOSIS INCLU£3ES
    CUT4NEOUS FUNG4L INFECT IONS       Y4WS.         SYPHILIS  LEPROSY        TUBERCULOSIS
    4TYPIC4L M\iCOBPiCTERI4',   ~N£3 LtJPUS YlJLGHRI~.
    4.   TRE~TMENT.       THE £3FCISION TO TRE~T £3EPFNOS ON THE LOC4TION 4N£3
  ~ EXTENT OF THE LESION.       ORTIMr~L £3OS4GE 4N£3 £)(JR4TION OF THER4R\' WITH


    P4GE (:4 RHIP444\.'. `-  UNrL~s
    PENT~V4LENT 4NTIi.......-  - ~RE J.iNCERT4IN WITH 4.. RECOM{1ENE4TION FOR
    ~CJ--2C) MG/r;G/£3~Y  (M~XIM(jM OF B~O NCi/£3~Y) FOR 1~)-2o £3~YS £3EPEN£3ING ON
    RESPONSE.   RETRE4TMENT OR PROLONGEE TRE4TMENT M4Y BE RECUIREE 1.4
    NON-RESPONEERS.        4.NEC£3OT4L REPORTS OF EFFIC4CY WITH ~NTIFUNG~L~ flP
    4NTIMICROBI4LS SHOULE BE INTEPPRETEE WITH C4'UTION BEC4USE OL£3 ~4GF:.L£)
    CUT~NEOUS LE I SHM~N I 4515 C4N RESOLVE SPONT4NEOUSLY.
    5.   PREVENTION:       PERSON4.L PROTECTI~{E ME4SURES INCLUflE USE 0 - Il-4-r.CT
    REPELLENTS 4N0 PROTECTIVE CLOTHING                 r--mVOIO4NCE OF F:;NOWN ENEEMI
    4RE45.  INSECT CONTROL.     4N£3 ELIMIN4TIOl...i or VECTOR BREEflING 4RE            -~ JEH
    H~ RUBBISH HE4PS.       NOSGUITO NETTINr~ UNTRE4TE£3 WITH INSECTIClEE OP
    REPELLENT M4Y H4VE 4 L4RGE EN~UGH~ME~H TO .`~LLOW RENETR4..TIOI..4 BY THE
    TIN'.. S4N£3FL~'.                    ___
         PC.'? Is.. irO B4'LES r~N'.E M4'..J T'yN4~i    Nh.EFCt~',i_ -j~ I  r~~e. 1 --4?-- -~
    E>;T ~j  flr:
    BT


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