Leishmaniasis Promastigotes of Leishmania Amastigote of - - PowerPoint PPT Presentation

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Leishmaniasis Promastigotes of Leishmania Amastigote of - - PowerPoint PPT Presentation

May 21, 2023 431 likes •760 views

Leishmaniasis Promastigotes of Leishmania Amastigote of Leishmania The life cycle of Leishmania Leishmania Parasites and Diseases SPECIES Disease Leishmania tropica* Cutaneous leishmaniasis Leishmania major* Leishmania aethiopica

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Leishmaniasis

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Promastigotes of Leishmania

Amastigote of Leishmania

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The life cycle of Leishmania

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Leishmania Parasites and Diseases Disease SPECIES

Cutaneous leishmaniasis

Leishmania tropica* Leishmania major* Leishmania aethiopica Leishmania mexicana

Mucocutaneous leishmaniasis

Leishmania braziliensis

Visceral leishmaniasis

Leishmania donovani* Leishmania infantum* Leishmania chagasi * Endemic in Saudi Arabia

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World distribution

  • f Visceral Leishmaniasis
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Sand fly

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Amastigotes of Leishmania

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Promastigotes of Leishmania

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lesion

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lesion

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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

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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.

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Diffuse cutaneous leishmaniasis Leishmaniasis recidiva

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cutaneous leishmaniasis

Diagnosis:

  • Smear: Giemsa stain – microscopy for LD

bodies (amastigotes)

  • Biopsy: microscopy for LD bodies or

culture in NNN medium for promastigotes

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NNN medium

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

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Visceral leishmaniasis

  • There are geographical variations.
  • The diseases is called kala-azar
  • Leishmania infantum mainly affect children
  • Leishmania donovani mainly affects adults
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Presentation

  • Fever
  • Splenomegaly, hepatomegaly,

hepatosplenomegaly

  • Weight loss
  • Anaemia
  • Epistaxis
  • Cough
  • Diarrhoea
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Untreated disease can be fatal After recovery it might produce a condition called post kala-azar dermal leishmaniasis (PKDL)

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Fever 2 times a day due to kala-azar

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Hepatosplenomegaly in visceral leishmaniasis

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Mucocutaneous leishmaniasis

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Visceral leishmaniasis

Diagnosis

(1) Parasitological diagnosis: Bone marrow aspirate 1. microscopy Splenic aspirate 2. culture in NNN medium Lymph node Tissue biopsy

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Bone marrow aspiration Bone marrow amastigotes

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(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.

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DAT test ELISA test

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Antileishmanial drugs

  • 1. 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 deoxycholate

Amphotericin 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. Paromomycin

Paromomycin (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. Miltefosine

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

  • 7. Azoles medicines: ketoconazole, fluconazole, itraconazole

These oral antifungal agents have variable efficacy in leishmaniasis treatment

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Treatment Of Cutaneous Leishmaniasis

  • No treatment – self-healing lesions
  • Medical:
  • Pentavalent antimony (Pentostam), Amphotericin B
  • Antifungal drugs
  • +/- Antibiotics for secondary bacterial infection.
  • Surgical:
  • Cryosurgery
  • Excision
  • 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

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  • 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