Leishmaniasis

Promastigotes of Leishmania

Amastigote of Leishmania

The life cycle of Leishmania

Leishmania Parasites and Diseases

SPECIESDisease

Leishmania tropica*

Leishmania major*

Leishmania aethiopica

Leishmania mexicana

Cutaneous leishmaniasis

Leishmania braziliensisMucocutaneous leishmaniasis

Leishmania donovani*Leishmania infantum*

Leishmania chagasi

Visceral leishmaniasis

* Endemic in Saudi Arabia

World distribution of Visceral Leishmaniasis

Sand fly

Amastigotes of Leishmania

Promastigotes of Leishmania

lesion

lesion

Clinical types of cutaneous leishmaniasis

• Leishmania major: Zoonotic cutaneous leishmaniasis: wet lesions with severe reaction

• Leishmania tropica: Anthroponotic cutaneous leishmaniasis: Dry lesions with minimal ulceration

Oriental sore (most common) classical self-limited ulcer

Uncommon types• Diffuse cutaneous leishmaniasis (DCL):

Caused by L. aethiopica, diffuse nodular non-ulcerating lesions. Low immunity to Leishmania antigens, numerous parasites.

• Leishmaniasis recidiva (lupoid leishmaniasis):

Severe immunological reaction to leishmania antigen leading to persistent dry skin lesions, few parasites.

Diffuse cutaneous leishmaniasis

Leishmaniasis recidiva

cutaneous leishmaniasis

Diagnosis:

• Smear: Giemsa stain – microscopy for LD bodies (amastigotes)

• Biopsy: microscopy for LD bodies or culture in NNN medium for promastigotes

NNN medium

Pentostam ( sodium stibogluconate) for treatment of all types of leishmaniasis

Visceral leishmaniasis

• There are geographical variations.

• The diseases is called kala-azar

• Leishmania infantum mainly affect children

• Leishmania donovani mainly affects adults

Presentation• Fever

• Splenomegaly, hepatomegaly, hepatosplenomegaly

• Weight loss

• Anaemia

• Epistaxis

• Cough

• Diarrhoea

Untreated disease can be fatal

After recovery it might produce a condition called post kala-azar dermal leishmaniasis (PKDL)

Fever 2 times a day due to kala-azar

Hepatosplenomegaly in visceral leishmaniasis

Mucocutaneous leishmaniasis

Visceral leishmaniasis

Diagnosis(1) Parasitological diagnosis:

Bone marrow aspirate 1. microscopy

Splenic aspirate 2. culture in NNN medium

Lymph node

Tissue biopsy

Bone marrow aspiration

Bone marrow amastigotes

(2 )Immunological Diagnosis:

• Specific serologic tests: Direct Agglutination Test (DAT), ELISA, IFAT

• rK39 antigen-based immunochromatographic tes .

TWO LIMITATIONS FOR SEROLOGIC TESTS:– Do not diagnose relapses.

– In endemic areas it is sometimes +ve in healthy individuals.

DAT test

ELISA test

Antileishmanial drugs1.Pentavalent antimonials

meglumine antimoniate ,sodium stibogluconate:IM IV ,can be administered Intralesionally for the treatment of cutaneous leishmaniasis.Cardiotoxicity and sudden death are serious but uncommon side-effects.

2.Amphotericin B deoxycholateAmphotericin B is a polyene antibiotic, should always be given in hospital to allow continuous

monitoring of patients.3.Lipid formulations of amphotericin B

Several formulations, they are similar to amphotericin B deoxycholate in their efficacy but are significantly less toxic.

4.ParomomycinParomomycin (aminosidine) is an aminoglycoside antibiotic, usually IM. A topical formulation

is available for cutaneousleishmaniasis.5.Pentamidine isethionate

IM or IV.Severe adverse effects—diabetes mellitus, severe hypoglycaemia, shock,myocarditis and renal toxicity—limit its use.

6.MiltefosineThis alkyl phospholipid (hexadecylphosphocholine) was originally Miltefosine is potentially teratogenic and should not be used by pregnant women

•Azoles medicines: ketoconazole, fluconazole, itraconazoleThese oral antifungal agents have variable efficacy in leishmaniasis treatment

Treatment Of Cutaneous Leishmaniasis

• No treatment – self-healing lesions• Medical:

o Pentavalent antimony (Pentostam), Amphotericin Bo Antifungal drugso +/- Antibiotics for secondary bacterial infection.

• Surgical: o Cryosurgeryo Excisiono Curettage

REFERENCE :WHO (2010) Control of leishmaniasis. Report of a meeting 571 of the WHO expert committee on the control of leishmaniasis. http://whqlibdoc.who.int/trs/WHO_TRS_949_eng.pdf

• Recommended treatment varies in different endemic areas: – Pentavalent antimony- sodium stibogluconate

(Pentostam)– Amphotericin B

Treatment of complications:

• Anaemia

• Bleeding

• Infections etc.REFERENCE :WHO (2010) Control of leishmaniasis. Report of a meeting 571 of the WHO expert committee on the control of leishmaniasis. http://whqlibdoc.who.int/trs/WHO_TRS_949_eng.pdf

Treatment of visceral leishmanisis