Post on 06-May-2015
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LeishmaniasisLeishmaniasis
Infection caused by parasite belongs Infection caused by parasite belongs to subgenus leishmania or vianniato subgenus leishmania or viannia
Its an obligate intracellular protozoaIts an obligate intracellular protozoa
Subgenus leishmania includesSubgenus leishmania includes
L.donovani complexL.donovani complex
L.donovaniL.donovani L.infantum L.infantum L.chagasiL.chagasi
L.Mexicana complexL.Mexicana complex L.mexicanaL.mexicana L.amzonensisL.amzonensis L.tropicaL.tropica L.majorL.major L.aethiopicaL.aethiopica Subgenus vianniaSubgenus viannia V.braziliensisV.braziliensis V.panamensisV.panamensis V.guanesisV.guanesis
Mode of transmissionMode of transmission
Infection transmitted by the bite of Infection transmitted by the bite of female sandflies- genus female sandflies- genus phlebotomus (old world) or phlebotomus (old world) or Lutzomyia (new world)Lutzomyia (new world)
Insect vectorsInsect vectors
Genus- phlebotomus or lutzomyia sand fliesGenus- phlebotomus or lutzomyia sand flies
Commonly found in house-hold rubbish, bark of old trees,cracks in Commonly found in house-hold rubbish, bark of old trees,cracks in wallswalls
Usually feed at night while the host asleepUsually feed at night while the host asleep
30 of 500 spp.. Of phlebotomine sand flies can transmit ds.30 of 500 spp.. Of phlebotomine sand flies can transmit ds.
Ex P.argentipes (Indian sub- continent)Ex P.argentipes (Indian sub- continent) P.oriantalis (Africa, mediterranean basin)P.oriantalis (Africa, mediterranean basin) P.chinensis&alexandri (china)P.chinensis&alexandri (china)
. .
P. Argentipes (vector for VL)P. Argentipes (vector for VL)
Life cycleLife cycle Reservoir hosts – wild and domestic animals Reservoir hosts – wild and domestic animals
such as fox,jackal,rodents and wolvessuch as fox,jackal,rodents and wolves
Domestic dogs plays imp role in harbouring Domestic dogs plays imp role in harbouring and transmitting disease to humansand transmitting disease to humans
Man – incidental hostMan – incidental host
Source of infectionSource of infection – – asymptomatic carriers asymptomatic carriers and PKDL patientsand PKDL patients
Parasite occures in two stages
Amastigote- Aflagellar stage (seen in the R.E.vertebrate host)
Promastigote-Flagellar stage( seen in gut of sandfly,Artificial culture)
1. AMASTIGOTE FORM
2.PROMASTIGOTE FORM
Life cycle of leishmaniaLife cycle of leishmania
TYPESTYPES VISCERAL LEISHMANIASISVISCERAL LEISHMANIASIS CUTANEOUS LEISHMANIASISCUTANEOUS LEISHMANIASIS MUCOSAL LEISHMANIASISMUCOSAL LEISHMANIASIS
Visceral leishmaniasisVisceral leishmaniasis Also called as kala-azar(black-fever)Also called as kala-azar(black-fever) >90% of vl occurs in Bangladesh ,India >90% of vl occurs in Bangladesh ,India
(Bihar),Nepal, Sudan and brazil.(Bihar),Nepal, Sudan and brazil. Caused by especially L. donovani complex Caused by especially L. donovani complex
transmitted by bite of female sand fly transmitted by bite of female sand fly (P.argentipes)(P.argentipes)
Ds.can also be transmitted congenitally and Ds.can also be transmitted congenitally and parenterally.parenterally.
Clinical featuresClinical features Subclinical, but can be occures in acute, Subclinical, but can be occures in acute, subacute, orsubacute, or chronic form chronic form I.P. weeks to months but can be, as long as I.P. weeks to months but can be, as long as years alsoyears also
Symptoms-Symptoms- 1.fever-highgrade,2peaks in 1.fever-highgrade,2peaks in 24hrs,ass.with24hrs,ass.with chills and rigors chills and rigors 2.drenching sweats (malaria)2.drenching sweats (malaria) 3.weight loss, poor appetite, anorexia3.weight loss, poor appetite, anorexia 4.cough,burning feet, insomnia4.cough,burning feet, insomnia 5.abdominal pain, joint pain, epistaxis,5.abdominal pain, joint pain, epistaxis, diarrhoea diarrhoea 6.neurological affects are rare 6.neurological affects are rare
signssigns
Splenomegaly (soft, non tender),can Splenomegaly (soft, non tender),can be massivebe massive
HepatomegalyHepatomegaly Peripheral lymphadenopathyPeripheral lymphadenopathy Dark skinDark skin anemiaanemia
complicationscomplications
Sec. bact.infections - Sec. bact.infections - pneumonia, dysentery, pulm.Tbpneumonia, dysentery, pulm.Tb
Rare hemolytic anemia, ARF, Rare hemolytic anemia, ARF, mucosal hemorrhagemucosal hemorrhage
Post kala-azar dermal Post kala-azar dermal leishmaniasis (PKDL)leishmaniasis (PKDL)
Usually follows recovery from kala azarUsually follows recovery from kala azar Begins with small measles like skin leisons-Begins with small measles like skin leisons-
hypopigmented macules,papuples, noduleshypopigmented macules,papuples, nodules Typically more prominent on face,eventuall Typically more prominent on face,eventuall
spread to other areas.spread to other areas. Can dev.during therapy,few moths,years Can dev.during therapy,few moths,years
later (india)later (india) Self limiting (resolving in six months)Self limiting (resolving in six months)
Cutaneous leishmaniasisCutaneous leishmaniasis
It’s a most common form of leishmaniasisIt’s a most common form of leishmaniasis >90% cases occures in afghanistan, algeria, iraq, >90% cases occures in afghanistan, algeria, iraq,
iran soudi arabiairan soudi arabia It is transmitted by P.sergenti,P.papatasiIt is transmitted by P.sergenti,P.papatasi Papule, nodules, ulcerative lesionsPapule, nodules, ulcerative lesions Resembles warts, acne, psoriasisResembles warts, acne, psoriasis Not painfulNot painful Extremities and faceExtremities and face Heal over months to years-scars-burnsHeal over months to years-scars-burns Diffuse cutaneous L. – severe formDiffuse cutaneous L. – severe form
Muco cutaneous leishmaniasisMuco cutaneous leishmaniasis(Espundia)(Espundia)
Less common Less common Most commonly caused by viannia sub Most commonly caused by viannia sub
gen. (V. brazilliensis)gen. (V. brazilliensis) Involves nose ,mouth, larynxInvolves nose ,mouth, larynx Unusual nasal symptoms- epistaxis, Unusual nasal symptoms- epistaxis,
edema, erythema of nasal mucosaedema, erythema of nasal mucosa Nodules like CL, Inside nose- perforation Nodules like CL, Inside nose- perforation
nasal septum ,enlarged lips&nose ,larynx-nasal septum ,enlarged lips&nose ,larynx-voice changevoice change
Differential diagnosisDifferential diagnosis
Includes-Includes- MalariaMalaria TyphoidTyphoid SchistosomiasisSchistosomiasis Tb, SyphilisTb, Syphilis Histoplasmosis Histoplasmosis
Diagnosis
Lab. Findings 1.pancytopenia- 2.hyper gammaglobulinemia(IgG) 3.hypo albuminemia 4.reversed albumin\globulin ratio
1. VISCERAL LEISHMANIASIS 1.clinical features but not sufficient 2.microscopic exam (amastigote form) 3.blood cultures 4.serological tests-ELISA 5.strip test-using k39 (recombinent protein)
2.CUTANEOUS & MUCOCUTANEOUS LEISHMANIASIS
staining method- Giemsa-stain(smears of dermal scrapings),
in vitro cultures (using aspirates from lymph nodes & skin lesions)
biopsy specimens for culture & PCR methods
serological tests-insensitive (AB titers low)
LEISHMANIN TEST
*+Ve in 6-8 wks after recovery*Delayed hyper sensitivity*+Ve in african kala azar, not in Indian
kala azar*-Ve in PKDL,untreated cases
TREATMENT 1. VISCERAL LEISHMANIASIS *
1.Pentavalent antimonial compounds- Inj.sodium stibogluconate (pentostam) IV\IM 20mg\kg body wt. for 28days
*Inj.pentamidine IM 2-4mg\kg body wt. for 10-15days
* Inj.Amphotericine B( preffered in India) IV 2-5mg\kg qd ( total 2-3gm) given
*Inj. paromomycine IV\IM 15-20mg\kg qd for 21days
*Miltefosine orally 50-100mg\day for 28days
*Allopurinol ORAL\IV 20mg\kg for 3days
2.CUTANEOUS LEISHMANIASIS * self healing (within 6 months)
* treatment depends on spp.and country of acquisition * Pentavalent antimonial compounds IV\IM
20mg\kg qd for 10-20days * Pentamidine IV\IM 3mg\kgfor 4 doses or
2mg\kg for 7 doses
*Amphotericine B(deoxycholate) IV 0.5-1mg\kg qd (total 20mg\kg) for 8wks
*Oral-Fuconazole 200mg qd or bd for 6wks
Ketoconazole 600mg\day 28 days Itraconazole 200mg bd for 28 days Dapsone 100mg bd for 6 wks
Local OR Topical- drugtherapy Paromomycine ointment,
methylbenzethonium chloride Intra-lesional inj. of
megutamineantimoniate Non drug therapy-local heat therapy,
cryo
3.MUCUCUTANEOUS LEISHMANIASIS
*Pentavalent antimony IV\IM 20mg\kg qd for 28 days
*Amphotericine B(deoxycholate) IV 1mg\kg qd (total 20-40mg)
*Pentamidine IV\IM 2-4mg\kg thrice\wkly for >15 doses
prognosis
*CL rarely fatal-disfiguring scars
*VL-untreated&severe cases almost fatal
*Death –organ failure,wasting synd.
*Pt.with HIV- Treat HIV, along the leishmaniasis avoid relapses.
Prevention and control
By avoiding the bite of female sandflies Insect repellents-DEET Bed-nets,cloths,and screens impregnated
with permethrin Treat human cases (L. donovani inf. in
India)
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