Leishmaniasis
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Leishmaniasis

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Leishmaniasis Presentation Transcript

  • 1. Leishmaniasis
  • 2.
    • Infection caused by parasite belongs to subgenus leishmania or viannia
    • Its an obligate intracellular protozoa
  • 3.
    • Subgenus leishmania includes
    • L.donovani complex
    • L.donovani
    • L.infantum
    • L.chagasi
    • L.Mexicana complex
    • L.mexicana
    • L.amzonensis
    • L.tropica
    • L.major
    • L.aethiopica
    • Subgenus viannia
    • V.braziliensis
    • V.panamensis
    • V.guanesis
  • 4.
    • Mode of transmission
    • Infection transmitted by the bite of female sandflies- genus phlebotomus (old world) or Lutzomyia (new world)
  • 5.
    • Insect vectors
    • Genus- phlebotomus or lutzomyia sand flies
    • Commonly found in house-hold rubbish, bark of old trees,cracks in walls
    • Usually feed at night while the host asleep
    • 30 of 500 spp.. Of phlebotomine sand flies can transmit ds.
    • Ex P.argentipes (Indian sub- continent)
    • P.oriantalis (Africa, mediterranean basin)
    • P.chinensis&alexandri (china)
    • .
  • 6. P. Argentipes (vector for VL)
  • 7. Life cycle
    • Reservoir hosts – wild and domestic animals such as fox,jackal,rodents and wolves
    • Domestic dogs plays imp role in harbouring and transmitting disease to humans
    • Man – incidental host
    • Source of infection – asymptomatic carriers and PKDL patients
  • 8.
    • 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)
  • 9.
    • 1. AMASTIGOTE FORM
    • 2.PROMASTIGOTE FORM
  • 10. Life cycle of leishmania
  • 11.
    • TYPES
    • VISCERAL LEISHMANIASIS
    • CUTANEOUS LEISHMANIASIS
    • MUCOSAL LEISHMANIASIS
  • 12.
    • Visceral leishmaniasis
    • Also called as kala-azar(black-fever)
    • >90% of vl occurs in Bangladesh ,India (Bihar),Nepal, Sudan and brazil.
    • Caused by especially L. donovani complex transmitted by bite of female sand fly (P.argentipes)
    • Ds.can also be transmitted congenitally and parenterally.
  • 13.
    • Clinical features
    Subclinical, but can be occures in acute, subacute, or chronic form I.P. weeks to months but can be, as long as years also Symptoms- 1.fever-highgrade,2peaks in 24hrs,ass.with chills and rigors 2.drenching sweats (malaria) 3.weight loss, poor appetite, anorexia 4.cough,burning feet, insomnia 5.abdominal pain, joint pain, epistaxis, diarrhoea 6.neurological affects are rare
  • 14. signs
    • Splenomegaly (soft, non tender),can be massive
    • Hepatomegaly
    • Peripheral lymphadenopathy
    • Dark skin
    • anemia
  • 15. complications
    • Sec. bact.infections - pneumonia, dysentery, pulm.Tb
    • Rare hemolytic anemia, ARF, mucosal hemorrhage
  • 16. Post kala-azar dermal leishmaniasis (PKDL)
    • Usually follows recovery from kala azar
    • Begins with small measles like skin leisons-
    • hypopigmented macules,papuples, nodules
    • Typically more prominent on face,eventuall spread to other areas.
    • Can dev.during therapy,few moths,years later (india)
    • Self limiting (resolving in six months)
  • 17. Cutaneous leishmaniasis
    • It’s a most common form of leishmaniasis
    • >90% cases occures in afghanistan, algeria, iraq, iran soudi arabia
    • It is transmitted by P.sergenti,P.papatasi
    • Papule, nodules, ulcerative lesions
    • Resembles warts, acne, psoriasis
    • Not painful
    • Extremities and face
    • Heal over months to years-scars-burns
    • Diffuse cutaneous L. – severe form
  • 18. Muco cutaneous leishmaniasis (Espundia)
    • Less common
    • Most commonly caused by viannia sub gen. (V. brazilliensis)
    • Involves nose ,mouth, larynx
    • Unusual nasal symptoms- epistaxis, edema, erythema of nasal mucosa
    • Nodules like CL, Inside nose- perforation nasal septum ,enlarged lips&nose ,larynx-voice change
  • 19. Differential diagnosis
    • Includes-
    • Malaria
    • Typhoid
    • Schistosomiasis
    • Tb, Syphilis
    • Histoplasmosis
  • 20. Diagnosis
    • Lab. Findings
    • 1.pancytopenia-
    • 2.hyper gammaglobulinemia(IgG)
    • 3.hypo albuminemia
    • 4.reversed albuminglobulin ratio
  • 21.
    • 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)
  • 22.
    • 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)
  • 23.  
  • 24.
    • 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
  • 25. TREATMENT
    • 1. VISCERAL LEISHMANIASIS
    • * 1.Pentavalent antimonial compounds-
    • Inj.sodium stibogluconate (pentostam)
    • IVIM 20mgkg body wt. for 28days
    • *Inj.pentamidine IM 2-4mgkg body
    • wt. for 10-15days
    • * Inj.Amphotericine B( preffered in India) IV
    • 2-5mgkg qd ( total 2-3gm) given
  • 26.
    • *Inj. paromomycine IVIM 15-20mgkg qd for 21days
    • *Miltefosine orally 50-100mgday for 28days
    • *Allopurinol ORALIV 20mgkg for 3days
  • 27.
    • 2.CUTANEOUS LEISHMANIASIS
    • * self healing (within 6 months)
    • * treatment depends on spp.and country
    • of acquisition
    • * Pentavalent antimonial compounds IVIM
    • 20mgkg qd for 10-20days
    • * Pentamidine IVIM 3mgkgfor 4 doses or 2mgkg for 7 doses
  • 28.
    • * Amphotericine B(deoxycholate) IV 0.5-1mgkg qd (total 20mgkg) for 8wks
    • * Oral-Fuconazole 200mg qd or bd for 6wks
    • Ketoconazole 600mgday 28 days
    • Itraconazole 200mg bd for 28 days
    • Dapsone 100mg bd for 6 wks
  • 29.
    • Local OR Topical- drugtherapy
    • Paromomycine ointment, methylbenzethonium chloride
    • Intra-lesional inj. of megutamineantimoniate
    • Non drug therapy-local heat therapy, cryo
  • 30.
    • 3.MUCUCUTANEOUS LEISHMANIASIS
    • * Pentavalent antimony IVIM 20mgkg qd for 28 days
    • * Amphotericine B(deoxycholate) IV 1mgkg qd (total 20-40mg)
    • * Pentamidine IVIM 2-4mgkg thricewkly for >15 doses
  • 31. 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.
  • 32. 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)
  • 33. THANK YOU