LEISHMANIASIS— DERMAL 65 



After three to four months ulceration begins with a yellowisli 

 secretion which dries hard. Some forms do not ulcerate, e.g., the 

 Soudanese. The ulcers sj^read under the scab, the surrounding tissue 

 becomes oedematous, the ulcer, when the scab is removed, reveals 

 fungating" granulations. The proximal lymphatic glands do not 

 usually enlarge. 



The peripheral blood shows distinct mononucleosis. 



The time of coagulation is increased. 



There may be leucocytosis during the fevers, and leucopasnia 

 between them. 



Healing begins from the sixth to twelfth month by granulation 

 commencing in the centre. A pinkish disfiguring scar remains which 

 may readily break down again. The sore may be multiple or simple. 



The ulcer may spread to the mouth or nose and may attack the 

 mucous membrane. 



The sores are auto-inoculable by scratching. 



Uncovered parts are generally attacked; the face, hands, feet, &c., 

 are most afifected. Repeated attacf^s often occur. 



The non-ulcerating type has been called male, and the ulcerating 

 the female type. In some cases one patient may show both types of 

 the condition. 



The ulcers may contain pyogenic organisms. 



There are no constitutional symptoms. The parasites are not 

 found in the blood (Wenyon). 



DIAGNOSIS. 



In the endemic areas the diagnosis is not difficult. 



The following points should be noted : — 



(i) Does the patient come from an infected area? 



(2) Are the nodules and ulcers on uncovered parts? 



(3) Is the course of its development tvpical ? 



(4) Have the proximal glands enlarged ? If so, it is probably not 

 Leishmaniasis. 



(5) Have the L. tropica been found in the scrapings? 

 vSyphilis and Yaws are excluded by treatment. 



A chancroid on the face is difficult. One should decide by the 

 scrapings. 



PROGNOSIS. 



It is good as regards life. 



Phagedcena may cause death by secondary septicaemia and 

 pyaemia. 



Serious disfigurement may ensue about the face. 



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