3. Leishmaniasis is a parasitic disease that is found in
parts of the tropics, subtropics, and southern
Europe. Leishmaniasis is caused by infection
with Leishmania parasites, which are spread by the
bite of infected sand flies. There are several
different forms of leishmaniasis in people. The
most common forms are cutaneous leishmaniasis,
which causes skin sores, and visceral
leishmaniasis, which affects several internal
organs (usually spleen, liver, and bone marrow).
4. Epidemiology-
• Currently, leishmaniasis occurs in 4 continents and is considered to
be endemic in 88 countries, 72 of which are developing countries:
90% of all VL: Bangladesh, Brazil, India, Nepal and Sudan
90% of all MCL: Bolivia, Brazil and Peru
90% of all CL : Afghanistan, Brazil, Iran, Peru, Saudi Arabia
and Syria
• Annual incidence: 1- 1.5 million cases of CL
: 500,000 cases of VL
• Prevalence: 12 million people
• Population at risk: 350 million
(WHO, 2010)
5. SITUATION IN INDIA
• 40-50% of global burden
(Bora 1999, Natl Med J India)
• INDIA: 15538 cases and 47
deaths by VL (2010)
• Endemic states in Eastern
India: Bihar, Jharkhand, West
Bengal, Uttar Pradesh
• Estimated 165.4 million
population at risk in 4 states
(NVBDCP, 2010)
6. Types and taxonomy of Leishmania
Kingdom
Phylum
Class
Order
Family
Genus
Species
Protista
Sarcomastigophora
Zoomastigophora
Kinetoplastida
Trypanosomatidae
Leishmania
Donavani, Tropica,
Major
• Transmitted to the mammalian hosts by the bite of
infected sandflies, Phlebotomus and Lutzomyia
7. Leishmaniasis
Leishmania donovani (complex) (VL)
Leishmania tropica (CL)
Leishmania major (CL)
Leishmania aethiopica (CL)
Leishmania mexicana (Complex) (CL)
Leishmania brazilliensis (complex) (MCL)
Species Pathogenic in Humans
8. Three important Species
Leishmania donovani (VL )
VISCERAL LEISHMANIASIS : involving endothelial tissue liver,
spleen, and bone marrow.
Leishmania tropica (CL)
OLD WORLD CUTANEOUS LEISHMANIASIS : involving epithelial cells
the skin at the site of a sand fly bite.
Leishmania brazilliensis (MCL)
NEW WORLD MUCO CUTANEOUS LEISHMANIASIS : involving mucous
membranes of the mouth and nose after spread from a
nearby cutaneous lesion.
10. Leishmania donovani (VL )
• Visceral leishmaniasis (VL), also
known as kalaazar,black fever, Dum-
Dum fever. Kala-azar means dark
pigmentation which is characteristic of
cases of visceral leishmaniasis. It is
caused by Leishmania donovani bodies
and may be present either in endemic,
epidemic or sporadic forms. It is widely
prevalent in India in epidemic form in
states of Bihar, Assam and Bengal.
11. Sand fly taxonomy
Kingdom: Animalia.
Phylum: Arthropoda.
Class: Insecta.
Order: Diptera.
Family: Psychodidae.
Genus: Phlebotomous, Sergentomyia, Lutzomyia.
Species: P. papatasi, P. sergenti, S. antennata,
S. clydi.
12. • It has a brownish body colour.
• The body covered with dense hairs.
• V wing shape at rest.
• It has a weak flight for short distance and for
short levels.
• Nocturnal habit.
General
characteristics
14. • The eggs are elongated oval-shaped
• The first larval instar has a dark head capsule
and can be distinguished by the presence of
two caudal bristles, all subsequent instars
bearing four bristles.
17. The intermediate host and vector of Leismania are species
of sandflies (Phlebotomus and Lutzomyia spp.). Female
sandflies become infected when taking a blood meal
containing amastigotes in white blood cells
(macrophages).
In the gut of the sandfly, amastigotes transform into
promastigotes, attach to the gut wall and multiply by
longitudinal binary fission. After approximately 1 week,
they transform into the infective metacyclic
promastigotes which are so numerous in the anterior gut
and pharynx that they may block it.
18. • Humans are infected when an infected sandfly
regurgitates the metacyclic promastigotes
while taking a blood meal. Promastigotes that
enter the bloodstream are phagocytized by
macrophages, in which they transform into
amastigotes and multiply.
21. Diagnostic Methods of Leishmaniasis
• Antibody detection. Specific sero diagnostic
tests are also employed. Conventional
methods include gel diffusion, complement
fixation test, indirect haem agglutination test,
indirect immuno-fluorescent antibody test
(IFAT) and counter immuno electro phoresis.
Most of these tests have limited sensitivities
and specifies.
22. Culturing of the Parasite
• Organisms can be cultured in
Nicolle- NovyMacneal (NNN
media) media from clinical
specimens obtained from
splenic or bone marrow
aspirates.
23. Immunological Diagnosis:
• Specific serologic tests: Direct Agglutination
Test (DAT), ELISA, IFAT
• Skin test (leishmanin test) for survey of
populations and follow up after treatment.
• Non specific detection of
hypergammaglobulinaem by formaldehyde
(formal-gel) test or by electrophoresis.
24. Direct agglutination test
• Direct agglutination test (DAT) based on
agglutination of the trypsenized whole
promastigotes is useful in endemic regions. Its
sensitivity ranges from
• 91-100% and specificity from 72 to 100%.
25. ELISA
• ELISA is an important sero diagnostic tool for
leishmaniasis. It is a highly sensitive test and
its specificity depends upon the antigen used.
26. Chromatographic strip test
• A ready to use immune chromatographic strip
test based on rk 39 antigen has been
developed as a rapid test for diagnosis of kala
azar. An important limitation of this test is the
presence of antibodies in healthy controls
hailing from endemic regions.
28. prevention
• All patients of Kala azar should preferably be
hospitalized. Any infection complicating the disease be
treated by use of proper antibiotics. Nutrition must be
maintained.
• Pentavalent antimony compounds are the drug of
choice. Sodium antimony gluconate (Pentostam) is the
most commonly used drug.
• Sand-flies are extremely sensitive to insecticides &
vector control through insecticide spray is very
important.
• Mosquito nets or curtains treated with insecticides will
keep out the tiny sand-flies.
