Oriental Sore: Clinical Presentations, Diagnosis, Treatment And Prevention
Physical Presentation Of Oriental Sores
Oriental Sore (Delhi Boil, Baghdad Boil)
Oriental Sore is a chronic granulomatous lesion of the skin and subcutaneous tissue which ulcerates to form an indolent ulcer. It is caused mainly by L. tropica and L. major. The disease is present in the western part of India, Pakistan, Afghanistan, Iran, Iraq, the whole of Arabia, Egypt, Mediterranean region, coastal states of Africa, Sudan, Ethiopia, Nigeria, and Russia.
The vectors are sandflies- P. papatasi in India and Pakistan and other species in other regions. Infected man and animal reservoirs such as gerbil provide the source of infection. Infection produces substantial immunity and therefore, adults show resistance, whereas most of the victims are children. At the site of inoculation of promastigotes by the sandfly, local lesion develops with the formation of granulomatous ulcer. The organism does not cause visceral lesions.
Oriental Sores In Cutaneous leishmaniasis
Clinical Manifestations Of Oriental Sore
Two patterns are seen. In the desert and semi-desert regions, the lesions are moist and tend to ulcerate early and the incubation period is 1 to 6 weeks. In the urban type ulceration is later and the lesion tends to be dry. In this form, the incubation is prolonged to 8 to 24 weeks.
The ulcers are multiple and occur on exposed parts such as face, ears, extremities and the trunk. Early lesions start as itchy papules which enlarge to form nodules and ulcerate to form circular ulcers with clearcut margins. The ulcers are covered with thin adherent scabs. Regional lymph nodes may enlarge due to spread. Bacterial infection supervenes in due course. The ulcers heal spontaneously in about 6 months to one year and produce deep scarring and depigmentation.
Diagnosis: In persons living in endemic areas and in those who have recently visited such areas, the characteristic lesion should suggest the diagnosis. Other ulcerating lesions such as lupus vulgaris, leprosy, syphilis and rodent ulcer have to be differentiated. The organism can be demonstrated in smears made from scrapings of ulcer margin or in the tissue obtained for biopsy from the depth of the ulcer. The organism can be cultured in NNN medium from material obtained from the lesion.
Treatment: Local treatment is indicated when the sores are only a few. This consists of infiltration of the ulcer base by mepacrine methane sulphonate 5% solution or berberine sulphate 2% solution. Infiltration is done at intervals of 3 to 4 days repeatedly and all the lesions are covered by repeated sessions. A single small sore may heal with a single infiltration but larger sores heal only with 3 or 6 infiltrations. When the lesions are numerous or not easily accessible to infiltration therapy, systemic administration of sodium stibogluconate or methyl glucamine antimoniate is resorted to. The lesions heal with one or two courses of injections.
Prevention: Oriental sore can be prevented by adopting antisandfly measures, but these are difficult to implement under desert and semi-desert conditions. An ingenious method adopted by natives is to introduce the infective material in an area which is concealed. Natural immunity occurs when this lesion heals.
© 2014 Funom Theophilus Makama