Leishmania spp and Leishmaniasis

1. University of Duhok
College of Health Sciences
Dep. of Medical Laboratories
Parasitology Theory
3rd Stage
Lecture 6
Dr.: Shameeran S. Ismael
BVM & S, M.Sc Medical Microbiology(Parasitology),
PhD Molecular Parasitology
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

2. II Class: Flagellates
3. Haemo-Flagellate parasite:
2. Leishmania spp.
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

3. Key
Kingdome: Protista
Phylum: Protozoa
Sub-phylum: Sarcomastigophora
Class: Mastigophora
Order: Kinetoplastida
Family: Trypanosomatidae
Genus: Leishmania
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

4. There are 6 species:
Leishmania donovani (complex) (VL)
Leishmania tropica (CL)
Leishmania major (CL)
Leishmania aethiopica (CL)
Leishmania mexicana (Complex) (CL)
Leishmania brazilliensis (complex) (MCL)
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

5. Final host: Man
Vector: Sand fly (Female)
Site of infection: Macrophage and reticulo-endotheial
cells
Infective stage: Promastigote
Infection: occur during biting and blood meal by the
female sand fly
Station: Anterior station
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

6. Leishmania spp.
• Is a genus of trypanosomatid protozoa, which causes a
fatal vector-borne parasitic disease called Leishmaniasis
• Leishmaniasis is a zoonotic disease.
• It is spread by the bite of sandflies of the genus
Phlebotomus
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

7. • Is the second-largest parasitic killer in the
world (after malaria) and is endemic in many
parts of Africa, Asia and South America.
• Are essentially the parasites of visceral organs.
Promastigote forms found in sand fly and in
culture, while Amastigote forms found in man
(reticuloendothelial cells of spleen, bone
marrow, liver, intestinal mucosa and mesentric
lymph node)
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

8. Three important Species
Leishmania donovani (VL ):
Disease: Visceral Leishmaniasis or Kala-azar disease,
involving endothelial tissue liver, spleen, and bone
marrow.
Leishmania tropica (CL):
Disease: Old World Cutaneous Leishmaniasis, involving
epithelial cells of the skin at the site of a sand fly bite.
Leishmania brazilliensis (MCL):
Disease: New World Muco-Cutaneous Leishmaniasis,
involving mucous membranes of the mouth and nose after
spread from a nearby cutaneous lesion.
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

9. Morphology
• There are two stages:
1. Promastigote (Infective stage) , found in
midgut ofinsect stage
2. Amastigote (Diagnostic stage), mammalian
stage (intracellular)
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

10. Life Cycle of leishmaniasis
Promastigote Amasitgote
Transformation
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

11. Promastigote stage
flagella
Promastigote stage inside the Sandfly
Sand fly : Vectors Intermediate host,
transmitted disease
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

12. Promastigotes in
rosettes in a culture of
an orient sore on N.N.N.
medium (Giemsa stain).
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

13. Ovoid small intracellular parasites in a bone marrow
aspirate. The typical rod shaped kinetoplast is seen besides
the nucleus.(Giemsa stain).
Leishmania sp.
amastigote stage
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

14. Clinical types
Leishmaniasis is divided into clinical syndromes
according to what part of the body is affected
most:
1.Visceral type:
• Fatal (90% untreated)
• infect: Liver, Spleen and Bone marrow
• Causative agent: Leishmania donovani
• Name of Disease: Kala-zar disease or visceral
leishmamiasis
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

15. 2. Cutaneous type:
• Generally Self- healing
• Infect: Skin and Mucous membranes
• Causative agent: Leishmania tropica
• Name of disease: Old World Cutaneous leishmaniasis,
Oriental sore , Delhi boil and Baghdad boil
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

16. I.Kala-azar (visceral laishmaniasis)
 Most severe form of the disease, may be fatal if left
untreated
Causative agent:
Leishmania donovani
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

17. There are 3 serotypes :
a/ L.d. donovani : causing Indian kala azar
b/ L.d. lato : causing African kala azar
c/ L.d. sensu : causing kala azar of Sudan and Chad
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

18. 12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

19. Pathogenesis
• Since leishmaniasis is primarily a disease of the
reticulo-endothelial system, Parasite develop
within Macrophages and reticuloendothelial
cells.
• Replacement of infected cells produces
hyperplasia and consequent enlargement of the
visceral organs associated with the system (e.g.,
spleen and liver)
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

20. Clinical signs
Irregular fever
Hepato-splenomegaly
General anaemia & Cachexia
Dry skin and pigmentation of skin
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

21. Visceral disease (Kala-azar)
Most severe form of disease, the disease typically starts
with irregular bouts of fever, chills, and general anemia
Hepatosplenomegaly
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

22. Post Kala Azar Dermal Leishmanoid
• Normally develops <2 years after recovery
• Restricted to skin, rare but varies geographically
• Some people recover spontaneously
• Some people who were treated later develop Post-
Kala- azar dermal leishmanoid
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

23. Dogs can act as reservoirs
of Leishmania parasites.
They also exhibit
symptoms of infection.
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

24. II.Cutaneous leishmaniasis
Oriental sore , Old World Cutaneous Leishmaniasis
(OWCL), Delhi boil and Baghdad boil
Causative agent:
Leishmania tropica
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

25. Different clinical form of
Cutaneous Leishmaniaiasis
1) Old world C.L.
2) New world C.L.
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
Anthroponotic C.L.(L.tropica)
(Dry sore or Urban C.L.)
Zoonotic C.L.( L.major)
(Wet sore or Rural C.L.)
Diffuse or Disseminated C.L.
(L. aethiopica)
Cutaneous L.(L. mexicana Complex)
Muco-cutaneous L.( L. braziliensis)
12/9/2020

26. Pathogenesis
 Promastigote infect macrophages within the
cutaneous tissue and multiply, then lesions appear
as reddish papule which develop as crust then
forming shallow ulcer, ulcer heal within 2-12
months leaving deeply pigmented depressed scar.
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

27. Clinical signs
• Skin ulcers on the exposed parts of the body such as the
face, arms and legs, characterized by one or more papules,
nodules and sores on the skin
• Sore like a volcano with a raised edge and central crater
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

28. Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
•Mucocutaneous forms of leishmaniasis , lesions can lead
to partial or total destruction of the mucosa
membranes of the nose, mouth and throat cavities and
surrounding tissues
Pathogenesis
12/9/2020

29. • Lesions can be very disfiguring and destroy all soft
parts of the nose and the lips.
• Death can occurs through secondary bacterial
infection.
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

30. Clinical Signs
• Nasal stuffiness, runny nose , bleeding of nose,
rectum &vagina
• Ulcer and erosion of mouth, lips, nose, rectum, and
vagina
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

31. Diagnosis
1. Clinical Diagnosis:
 Patient history ( endemic region or travel)
 Signs & symptoms:
Sores that will not heal, have to be referred for
evaluation.
• Individuals with irregular fevers, weight loss,
gastrointestinal complaints, anemia,
hypergammaglobulinemia, abnormal liver tests
should be referred for evaluation
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

32. 12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
1.Peripheral blood by thick blood smear
(Amastigote form).
Amastigote in a macrophage
A.Visceral leishmaniasis :
2. Laboratory Diagnosis of leishmaniasis

33. 2.Blood culture in N.N.N. Medium(Promastigote
form)
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
Promastigote from culture in NNN medium

34. 3. Biopsy material obtained by:
• lymph node puncture
• Sternal or iliac crest puncture(marrow)
• spleen puncture(spleen pulp)
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
Amastigote form in a stained
smear Promastigote in
culture in NNN medium

35. 4.Animal inoculation
Inoculate serum of infected person in lab. animals.
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

36. B.Cutaneous Leishmaniasis
• Tissue sample (scraping, aspirate or punch biopsy)
for smear and culture
 Take scrapings from the sore, put on slides, stain with
Wright’s or Giemsa’s stains, and look for amastigotes,
when the amastigotes are not found by scraping can
be culture it on NNN media
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020

37. Prevention and Control:
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

38. Treatment:
12/9/2020
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD

39. Thanks for attension,,
Shameeran S. Ismael Parasitology theory,
Medical Laboratories/ College of Health
Sciences/UOD
12/9/2020