parasite

1. Leishmaniasis
Leishmaniasis

2.  Infection caused by parasite belongs to
Infection caused by parasite belongs to
subgenus leishmania or viannia
subgenus leishmania or viannia
 Its an obligate intracellular protozoa
Its an obligate intracellular protozoa

3.  Subgenus leishmania includes
Subgenus leishmania includes
L.donovani complex
L.donovani complex
L.donovani
L.donovani
L.infantum
L.infantum
L.chagasi
L.chagasi
L.Mexicana complex
L.Mexicana complex
L.mexicana
L.mexicana
L.amzonensis
L.amzonensis
L.tropica
L.tropica
L.major
L.major
L.aethiopica
L.aethiopica
 Subgenus viannia
Subgenus viannia
V.braziliensis
V.braziliensis
V.panamensis
V.panamensis
V.guanesis
V.guanesis

4.  Mode of transmission
Mode of transmission
Infection transmitted by the bite of female
Infection transmitted by the bite of female
sandflies- genus
sandflies- genus
phlebotomus (old world) or Lutzomyia
phlebotomus (old world) or Lutzomyia
(new world)
(new world)

5.  Insect vectors
Insect vectors
 Genus- phlebotomus or lutzomyia sand flies
Genus- phlebotomus or lutzomyia sand flies
 Commonly found in house-hold rubbish, bark of
Commonly found in house-hold rubbish, bark of
old trees,cracks in walls
old trees,cracks in walls
 Usually feed at night while the host asleep
Usually feed at night while the host asleep
 30 of 500 spp.. Of phlebotomine sand flies can
30 of 500 spp.. Of phlebotomine sand flies can
transmit ds.
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)

6. P. Argentipes (vector for VL)
P. Argentipes (vector for VL)

7. Life cycle
Life cycle
 Reservoir hosts – wild and domestic animals
Reservoir hosts – wild and domestic animals
such as fox,jackal,rodents and wolves
such as fox,jackal,rodents and wolves
 Domestic dogs plays imp role in harbouring and
Domestic dogs plays imp role in harbouring and
transmitting disease to humans
transmitting disease to humans
 Man – incidental host
Man – incidental host
 Source of infection
Source of infection –
– asymptomatic carriers and
asymptomatic carriers and
PKDL patients
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
Life cycle of leishmania

11.  TYPES
TYPES
 VISCERAL LEISHMANIASIS
VISCERAL LEISHMANIASIS
 CUTANEOUS LEISHMANIASIS
CUTANEOUS LEISHMANIASIS
 MUCOSAL LEISHMANIASIS
MUCOSAL LEISHMANIASIS

12.  Visceral leishmaniasis
Visceral 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.

13.  Clinical features
Clinical features
Subclinical, but can be occures in acute, subacute, or
Subclinical, but can be occures in acute, subacute, or
chronic form
chronic form
I.P. weeks to months but can be, as long as years also
I.P. weeks to months but can be, as long as years also
Symptoms-
Symptoms-
1.fever-highgrade,2peaks in 24hrs,ass.with
1.fever-highgrade,2peaks in 24hrs,ass.with
chills and rigors
chills and rigors
2.drenching sweats (malaria)
2.drenching sweats (malaria)
3.weight loss, poor appetite, anorexia
3.weight loss, poor appetite, anorexia
4.cough,burning feet, insomnia
4.cough,burning feet, insomnia

14. signs
signs
 Splenomegaly (soft, non tender),can be
Splenomegaly (soft, non tender),can be
massive
massive
 Hepatomegaly
Hepatomegaly
 Peripheral lymphadenopathy
Peripheral lymphadenopathy
 Dark skin
Dark skin
 anemia
anemia

15. complications
complications
 Sec. bact.infections - pneumonia,
Sec. bact.infections - pneumonia,
dysentery, pulm.Tb
dysentery, pulm.Tb
 Rare hemolytic anemia, ARF, mucosal
Rare hemolytic anemia, ARF, mucosal
hemorrhage
hemorrhage

16. Post kala-azar dermal leishmaniasis
Post kala-azar dermal leishmaniasis
(PKDL)
(PKDL)
 Usually follows recovery from kala azar
Usually follows recovery from kala azar
 Begins with small measles like skin leisons-
Begins with small measles like skin leisons-
hypopigmented macules,papuples, nodules
hypopigmented 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)

17. Cutaneous leishmaniasis
Cutaneous leishmaniasis
 It’s a most common form of leishmaniasis
It’s a most common form of leishmaniasis
 >90% cases occures in afghanistan, algeria, iraq, iran
>90% cases occures in afghanistan, algeria, iraq, iran
soudi arabia
soudi arabia
 It is transmitted by P.sergenti,P.papatasi
It is transmitted by P.sergenti,P.papatasi
 Papule, nodules, ulcerative lesions
Papule, nodules, ulcerative lesions
 Resembles warts, acne, psoriasis
Resembles warts, acne, psoriasis
 Not painful
Not painful
 Extremities and face
Extremities and face
 Heal over months to years-scars-burns
Heal over months to years-scars-burns
 Diffuse cutaneous L. – severe form
Diffuse cutaneous L. – severe form

18. Muco cutaneous leishmaniasis
Muco cutaneous leishmaniasis
(Espundia)
(Espundia)
 Less common
Less common
 Most commonly caused by viannia sub gen.
Most commonly caused by viannia sub gen.
(V. brazilliensis)
(V. brazilliensis)
 Involves nose ,mouth, larynx
Involves nose ,mouth, larynx
 Unusual nasal symptoms- epistaxis,
Unusual nasal symptoms- epistaxis,
edema, erythema of nasal mucosa
edema, erythema of nasal mucosa
 Nodules like CL, Inside nose- perforation nasal
Nodules like CL, Inside nose- perforation nasal
septum ,enlarged lips&nose ,larynx-voice change
septum ,enlarged lips&nose ,larynx-voice change

19. Differential diagnosis
Differential diagnosis
Includes-
Includes-
 Malaria
Malaria
 Typhoid
Typhoid
 Schistosomiasis
Schistosomiasis
 Tb, Syphilis
Tb, Syphilis
 Histoplasmosis
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)

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