1. Parasitic disease
Leishmaniasis
Amoebiasis
Giardiasis

2. Visceral leishmaniasis
 Called Kala-azar
 Caused by Leishmania donovani
 A zoonotic disease
 Spread by sandfly
 Man is the only reservoir
 Life-cycle-
Amastigotes sucked with blood by sandflymature into
promastigotestransmitted to humans with salivainvade
macrophages, turn into amastigotes & spread to various organs
having macrophages

3. Clinical features
 Older children & young adults
 Males>females
 Incubation period- ~3 months
 Fever, cough, loose motions
 Splenomegaly ± hepatomegaly
 Edema, cachexia, hyperpigmentation
 Death due to opportunistic infections

4. Management
 Dx-
 Amastigotes in buffy-coat smear or
spleen/BM aspirate
 K39 dipstick serological test-
problem false +ve & -ve
 Rx-
 Amphotericin- 1-2 mg/kg x 6 days
 Miltefosine- oral drug x 28 days
 Paromomycin- IV

5. Cutaneous leishmaniasis
 Caused by L. tropica
 Reservoir- man
 More in young
 Incubation period- 2-24 months
 Erythematous papule, commonly over face, that
enlarges & ulcerates
 Regional LNE- common
 Rarely involves viscera
 Dx- smear/ Bx, PCR
 Rx- as for visceral disease, for shorter duration;
Fluconazole/Itraconazole also used for Rx

6. Amoebiasis
 Infection of large intestine
 Caused by Entamoeba histolytica
 Humans are host & reservoir
 Trophozoite- parasitic form,
cyst- responsible for transmission
 Transmission by fecal-oral route
 Recurrent infection is common, partial
immunity after invasive infection

7. Clinical features
 Infection mostly asymptomatic
 Symptomatic- intermittent foul-smelling diarrhea (1-4
loose stools a day), with cramping & occasional
mucus/blood
 Fulminant dysentery with fever & abdominal
tenderness in immunocompromised
 Complication- perforationperitonitis,
amoebic hepatitis
 Hepatic abscess- mostly single liver abscess with
fever & tender hepatomegaly; jaundice uncommon;
may rupture into
pleura/peritoneum/pericardium

8. Liver abscess
 Amoebic
 Insidious onset
 Single
 h/o chronic diarrhea
 More in right lobe
 Pleuritic chest pain
 ‘Anchovy sauce’
 Pyogenic
 Fulminant onset
 Multiple
 Jaundice
 Any/both lobe
 Foul-smelling pus

9. Management
 Dx-
 Organism in stool- trophozoites
 Sigmoid/rectal ulcer with normal interspersed mucosa on s’scopy
 ELISA/IHA positive in 2-3 weeks
 US/CT-scan
 Rx-
 Metronidazole- oral/IV- tissue amoebicide
 Paromomycin, diloxanide furoate, iodoquinol- luminal amoebicides
 Abscess drainage- impending rupture, left lobe abscess,
failure to respond in 48 hours
 Prognosis- good with proper Rx
 Prevention- sanitation

10. Giardiasis
 A diarrheal infection of small-intestine
 Caused by Giardia lamblia
 Person-to-person transmission
 Cysts are the infective stage;
trophozoites are disease causing stage
 Incubation period- ~7 days

11. Clinical
 Majority, gradual onset of symptoms of
loose greasy malodorous
stools with bloating, anorexia, malaise
 Symptoms last for 2-6 weeks
 Dx- clinical, stool for cyst/trophozoites,
ELISA, duodenal biopsy
 Rx-
 Metronidazole, 250 TID x 5 days
 Tinidazole, 2 gm once