Leishmaniasis is a parasitic disease caused by Leishmania parasites and transmitted by the bite of infected sandflies. It exists in three main forms: visceral leishmaniasis (VL), cutaneous leishmaniasis (CL), and mucocutaneous leishmaniasis. VL affects internal organs and is fatal without treatment. It is endemic in parts of India, where it is known as kala-azar. CL causes skin sores but is not fatal. Treatment involves antimony-based drugs or amphotericin B. Prevention focuses on controlling sandfly vectors and reservoirs through insecticides, bed nets, and treating infected dogs.
Leishmaniasis is caused by a protozoa parasite from over 20 Leishmania species. Over 90 sandfly species are known to transmit Leishmania parasites. There are 3 main forms of the disease:
Visceral leishmaniasis (VL), also known as kala-azar is fatal if left untreated in over 95% of cases. It is characterized by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia. Most cases occur in Brazil, East Africa and in South-East Asia. An estimated 50 000 to 90 000 new cases of VL occur worldwide each year out of which only an estimated 25–45% are reported to WHO. In 2017, more than 95% of new cases reported to WHO occurred in 10 countries: Bangladesh, Brazil, China, Ethiopia, India, Kenya, Nepal, Somalia, South Sudan and Sudan.
Cutaneous leishmaniasis (CL) is the most common form of leishmaniasis and causes skin lesions, mainly ulcers, on exposed parts of the body, leaving life-long scars and serious disability or stigma. About 95% of CL cases occur in the Americas, the Mediterranean basin, the Middle East and Central Asia. In 2017 over 95% of new CL cases occurred in 6 countries: Afghanistan, Algeria, Brazil, Colombia, Iran (Islamic Republic of), Iraq and the Syrian Arab Republic. It is estimated that between 600 000 to 1 million new cases occur worldwide annually.
Mucocutaneous leishmaniasis leads to partial or total destruction of mucous membranes of the nose, mouth and throat. Over 90% of mucocutaneous leishmaniasis cases occur in Bolivia (the Plurinational State of), Brazil, Ethiopia and Peru.
Transmission
Leishmania parasites are transmitted through the bites of infected female phlebotomine sandflies, which feed on blood to produce eggs. The epidemiology of leishmaniasis depends on the characteristics of the parasite and sandfly species, the local ecological characteristics of the transmission sites, current and past exposure of the human population to the parasite, and human behaviour. Some 70 animal species, including humans, have been found as natural reservoir hosts of Leishmania parasites.
(WHO, 2019)
https://www.who.int/news-room/fact-sheets/detail/leishmaniasis
Visceral leishmaniasis (VL), also known as kala-azar, is the most severe form of leishmaniasis caused by the protozoan parasite Leishmania donovani and transmitted by the infected sandflies. It characterized by irregular bouts of fever, substantial weight loss, swelling of the spleen and liver, and anaemia.
Leishmaniasis is caused by a protozoa parasite from over 20 Leishmania species. Over 90 sandfly species are known to transmit Leishmania parasites. There are 3 main forms of the disease:
Visceral leishmaniasis (VL), also known as kala-azar is fatal if left untreated in over 95% of cases. It is characterized by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia. Most cases occur in Brazil, East Africa and in South-East Asia. An estimated 50 000 to 90 000 new cases of VL occur worldwide each year out of which only an estimated 25–45% are reported to WHO. In 2017, more than 95% of new cases reported to WHO occurred in 10 countries: Bangladesh, Brazil, China, Ethiopia, India, Kenya, Nepal, Somalia, South Sudan and Sudan.
Cutaneous leishmaniasis (CL) is the most common form of leishmaniasis and causes skin lesions, mainly ulcers, on exposed parts of the body, leaving life-long scars and serious disability or stigma. About 95% of CL cases occur in the Americas, the Mediterranean basin, the Middle East and Central Asia. In 2017 over 95% of new CL cases occurred in 6 countries: Afghanistan, Algeria, Brazil, Colombia, Iran (Islamic Republic of), Iraq and the Syrian Arab Republic. It is estimated that between 600 000 to 1 million new cases occur worldwide annually.
Mucocutaneous leishmaniasis leads to partial or total destruction of mucous membranes of the nose, mouth and throat. Over 90% of mucocutaneous leishmaniasis cases occur in Bolivia (the Plurinational State of), Brazil, Ethiopia and Peru.
Transmission
Leishmania parasites are transmitted through the bites of infected female phlebotomine sandflies, which feed on blood to produce eggs. The epidemiology of leishmaniasis depends on the characteristics of the parasite and sandfly species, the local ecological characteristics of the transmission sites, current and past exposure of the human population to the parasite, and human behaviour. Some 70 animal species, including humans, have been found as natural reservoir hosts of Leishmania parasites.
(WHO, 2019)
https://www.who.int/news-room/fact-sheets/detail/leishmaniasis
Visceral leishmaniasis (VL), also known as kala-azar, is the most severe form of leishmaniasis caused by the protozoan parasite Leishmania donovani and transmitted by the infected sandflies. It characterized by irregular bouts of fever, substantial weight loss, swelling of the spleen and liver, and anaemia.
A comprehensive description of leischmaniasis with its types, transmission, epidemiology, pathogenesis, prevention and control. It also includes details regarding lab diagnosis, disease agent, vector and host.
infestation with or disease caused by Clonorchis sinensis
invades bile ducts of the liver after ingestion in uncooked fish and when present in large numbers causes severe systemic reactions
This is the presentation on Trypanosomiasis that covers classification and diseases caused by Trypanosoma, its life cycle, Geographical distribution, Transmission, diagnosis and treatment and finally its scenario in India.
Some flow charts have been taken from published articles, that can be searched directly from net.
Anthrax is also known as Wool sorter's disease and is zoonotic in nature. The organism responsible for this disease has been discussed here. The organism has also been used in bioterrorism attacks.
A comprehensive description of leischmaniasis with its types, transmission, epidemiology, pathogenesis, prevention and control. It also includes details regarding lab diagnosis, disease agent, vector and host.
infestation with or disease caused by Clonorchis sinensis
invades bile ducts of the liver after ingestion in uncooked fish and when present in large numbers causes severe systemic reactions
This is the presentation on Trypanosomiasis that covers classification and diseases caused by Trypanosoma, its life cycle, Geographical distribution, Transmission, diagnosis and treatment and finally its scenario in India.
Some flow charts have been taken from published articles, that can be searched directly from net.
Anthrax is also known as Wool sorter's disease and is zoonotic in nature. The organism responsible for this disease has been discussed here. The organism has also been used in bioterrorism attacks.
Leishmaniasis is a vectorborne disease that is transmitted by sand flies and caused by obligate intracellular protozoa of the genus Leishmania. Human infection is caused by more than 20 species. These include the L. donovani complex with 2 species (L. donovani, L. infantum [also known as L. chagasi in the New World]); the L. mexicana complex with 3 main species (L. mexicana, L. amazonensis, and L. venezuelensis); L. tropica; L. major; L. aethiopica; and the subgenus Viannia with 4 main species (L. [V.] braziliensis, L. [V.] guyanensis, L. [V.] panamensis, and L. [V.] peruviana). The different species are morphologically indistinguishable, but they can be differentiated by isoenzyme analysis, molecular methods, or monoclonal antibodies.
Medical Parasitology
Life cycle, Medical menifestation, signs, Diagnosis and Prevention.
Trypanosoma brucei brucei
Chagas disease
visceral leishmaniasis
By the end of this presentation we’ll be able to learn about- -Geographical distribution of leishmania parasites- Know the different stages of leishmania parasites and their morphology.-Describe the lifecycle of leishmania.-Causes and pathogenesis of leishmania -Preventive measures of leishmaniasis
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
2. SYNONYMS
kala azar, black fever, sandfly disease,
Dum-Dum fever and espundia.
1903 – Sir William Leishman discovered L.
donovani in spleen smears of a soldier who died
of fever at Dum-Dum, India. The disease was
known locally as Dum-Dum fever or kala-azar.
1903 – Charles Donovan found same parasite
in a spleen biopsy.
•Cultured by Rogers(1904)
•Amastigote and promastigote forms were
described by Batton(1907)
•Phlebotomus argentipes identified as vector.
9. • 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, India(Central & Western India)
• 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)
11. 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, Assam, Orissa, Tamil
Nadu, Uttar Pradesh
•
(NVBDCP, 2010)
Surveillance being done by
NVBDCP
Estimated 165.4 million
population at risk in 4 states
13. procyclics and metacyclics
(detached)
(attached)
• Infected macrophages are
taken up with the blood
meal and amastigotes are
released by digestion,
transform into procyclic
promastigotes and attach to
the midgut epithelium
• Attached promastigotes
divide rapidly (procyclics
are not infective to
mammals)
• Metacyclic (infective)
promastigotes cease
replication, detach and pass
forward into the pharynx
from where they are
regurgitated into the bite
site
14. TYPES OF LEISMANIASIS
• VISCERAL LEISHMANIASIS or Kala-azar ( Middle east,
Africa, Bangladesh, Brazil, India,China, South America, Europe,
Nepal and Sudan)
•
Post kala azar dermal leishmaniasis (Endemic to India and the
Sudan)
• India(Bihar, West bengal, Orissa, Assam, Tamil Nadu, Gujarat,
Punjab & Jammu)
• Species responsible: L.donovani
• Vector: P.argentipes
• Resvoir: Man
15. Other species causing Visceral Leishmaniasis
Leishmania infantum: Cause Zoonotic visceral leishmaniasis
(ZVL) in Mediterranean areas, Middle east, and China
Reservoir: Dogs, foxes and jackals
Leishmania chagasi: Zoonotic visceral leishmaniasis(ZVL) in
New World.
Reservoir: Dogs and foxes
16. Pathogenicity of Leishmania donovani(Visceral
leishmaniasis
•
•
•
•
•
•
•
•
•
•
•
Weeks to months incubation period.
May exceed one and sometimes two years.
Clinical features.
High fever. Fever often oscillates with a
peak every second day
The lead symptom is abdominal swelling
due to hepato- and splenomegaly
Lymphadenopathy
Progressive drastic weight loss (kachexia).
Epistaxix(presenting symptom)
In fully developed cases, emaciation and
anaemia become noticeable.
Darkening of the skin
Mortality of untreated disease 75-95%
18. • Enlarged spleen and liver in an autopsy of an
infant dying of visceral leishmaniasis.
19. Post Kala Azar Dermal Leishmaniasis
•
•
•
•
•
•
•
•
•
Non ulcerative cutaneous lesion prevalent in
endemic areas of kala azar in India.
In 10 % treated cases of Kala azar, Normally
develops <2 years after recovery(When Visceral
infection disappears but skin infection persists).
Clinical feature:
Depigmented macules: earliest lesion, trunk,
extremities and face
Erythematous patches: Nose, cheeks and chin
Yellowish pink nodules: Nodules mostly on face
& are soft, painless granulomatous growth of
varying sizes(Absences of ulceration is a
noticeable feature)
Do not heal spontaneously.
Recrudescence
Restricted to skin
Extensive nodular
lesion, resembling
lepromatous leprosy.
A very resistant case
cured after long
continued treatment
20. CUTANEOUS LEISHMANIASIS (Oriental Sore /Old World
Cutaneous Leishmaniasis PKDL):
(Middle east, Mediterranean areas, N.Africa, N.W. India and Pakistan)
Cause dry type of cutaneous lesion(non-ulcerating type)
Urban distribution
Incubation period (2 months to > year)
Lesion usually facial. Ulcer starts as small itching papule covered with
fine whitish scale which subsequently becomes thick, dark and finally
falls off. The lesion may be found on the face, feet, legs and arms.
Children are usually affected.
Reservoir: man, domestic dog
VL in exceptional cases
Species: Leismania tropica
Leishmania major: Cause a moist type local cutaneous lesion(Ulcerating
type).
Ulcer found on extremities with regional lymphadenitis. Incubation period
2-6 weeks
21. Leishmania tropica (Cutaneous Leishmaniasis or Oriental Sore or
Tropical Sore)
Life Cycle: Same as L.donovani except
amastigote
form resides
in
large
mononuclear cells of the skin and not in the
viscera.
Reservoir: Dogs
Clinical features: Cutaneous lesion begins
as a raised nodule, its ulcerates, heal
spontaneously taking about 6 months or
more by Ulcer filled up by granaluation
tissues and a depressed white scar is often
left.
Laboratory Diagnosis:
Smear made from specimen obtained by
puncture of indurated edges of the sore and
stained by Leishman method.
Leishmanin reaction
Oriental Sore on the face)
22. DIFFUSE CUTANEOUS LEISHMANIASIS / MUCO
CUTANEOUS LEISHMANIASIS / New world Cutaneous
Leishmaniasis OR ESPUNDIA
Geographical Distribution: Central and South America
(Bolivia, Brazil,Argentina, Columbia,Mexico, panama,
Paraguay, Venezuela and Peru.
Species: Leishmania braziliensis
Clinical feature: Two stages primary cutaneous lesion
followed by secondary mucosal involvement which occurs
after a variable time of latency of primary cutaneous lesion
Nasal mucous membrane, pharynx, larynx & upper lip are
involved.
mouth
and throat cavities
Develops in 5 % patients suffering from primary cutaneous lesion.
Diagnosis by demonstrating amastigote forms of L.brazilensis in skin
and mucocutaneous lesions
26. • Amastigotes (*)
of Leishmania
donovani in the
cells of a spleen.
The individual
amastigotes
measure
approximately 1
µm in diameter.
27. Susceptible Animal: Dog naturally infected with L.donovani
Common laboratory animals mice, rats and guinea pigs not
susceptible.
Hamster very susceptible.
28. Leishmania infects and thrives in
macrophages
•
•
•
•
•
Macrophages are important
“microbe killers”, however
several pathogens have found
ways to escape killing
Trypansoma cruzi -- induces
phagocytosis but then escapes
into the cytoplasm
Toxoplasma -- active invasion,
parasitophorous vacuole is
never part of the endocytic
pathway
Mycobacterium tuberculosis -induce phagocytosis and block
lysosomal maturation
Leishmania ...
29. Leishmania parasites exist Amastigote & Pro
mastigote)
•
The parasite lives in the
digestive tract of sandflies as
extracellular promastigote
• In
the
mammalian
parasites
multiply
intracellular amastiogotes
host
as
31. 1. Leishmaniasis is transmitted by the bite of female
phlebotomine sandflies. The sandflies inject the
infective stage, promastigotes, during blood meals.
2. Promastigotes that reach the puncture wound are
phagocytized by macrophages.
3.They transform into amastigotes.
4. Amastigotes multiply in infected cells and affect
different tissues.
5. Sandflies become infected during blood meals on
an infected host when they ingest macrophages
infected with amastigotes.
6. In the sandfly's midgut, the parasites differentiate
into promastigotes.
7. They multiply and migrate to the proboscis.
32. Other method of transmission
Congenital infection of a child in utero
Transmission by blood transfusion
Transmission by inoculation of cultures of L.donovani
Possibly transmission during coitus.
36. Direct evidence:
Demonstration of Leishmania
Specimens that may be collected
• Splenic aspirate and biopsy
• Bone marrow (Sternum or iliac crest)
• Blood buffy coat
• Liver biopsy
• FNAC and biopsy
• Tegumantary leishmaniasis- dermal scrapings, sections
from skin biopsy
DEMONSTRATION OF Leishmania
AMASTIGOTES/ L.D. BODIES
38. CULTURE
Culture media for axenic culture
• SOLID MEDIUM
NNN medium (Novy, MacNeal & Nicolle)
(2ml of patient blood + 10ml of Citrated saline kept at 22 0 C
overnight and deposit inoculated into the water of
condensation of NNN medium and incubated at 220 C for
1 to 4 wks
Evan’s modified Tobie’s medium
• LIQUID MEDIA
Schneider’s Drosophila medium
Grace’s insect tissue culture medium
DEMONSTRATION OF Leishmania PROMASTIGOTES
Animal inoculation
• Golden hamsters inoculated intraperitoneally
40. IMMUNOLOGICAL METHODS (Indirect Evidence)
• Leishmanin test: 0.1 to 0.2 ml of a suspension(having 6 to 10 million
promastigotes/ml) injected intradermally. Positive reaction after 72
hours in cured kala azar cases 6 to 8 wks after recovery.
• Blood Count: Leucopenia(Neutropenia)
• Aldehyde (formol gel) Test (Napier)(To test the rise of gamma globulin):
1 to 2 ml of a serum + one or two drop of 40% formalin: Jellification of
milk white opacity
• Complement fixation test with W.K.K Ag.(Not used nowadays).
• Other Serological tests: CIEP, IHA, IFA(Most Commonly Used), ELISA,
Direct agglutination test and Latex particle agglutination test)
• Molecular(PCR)
41. Indirect Fluorescent
Antibody test
•
Detection of anti-leishmanial
antibody using fixed promastigotes
•
Demonstrated in the very early
stages of infection and
undetectable six to nine months
after cure
•
Titers >1:20 are significant and
above 1:128 are diagnostic
•
Cross reaction with trypanosomal
sera (overcome by
using Leishmania amastigotes as
the antigen instead of the
promastigotes)
42. Direct Agglutination Test
•
•
•
Use of whole, stained
promastigotes either as a
suspension or in a freeze-dried
form.
The freeze-dried form is heat
stable
Utilized for field purposes
•
•
•
•
Relative long incubation time
of 18 hours
Need for serial dilutions of
serum
No prognostic value
Remain positive for several
years after cure
43. Modifications of DAT
• Fast Agglutination Screening Test
(Schoone et al, 2001)
Need of only 1 serum dilution
Rapid: results available in less than 3 hours
• EasyDAT method
(Gomez-Ochoa et al, 2003, Clin Diagn Lab Immunol)
45. Many antigens have been explored for the diagnosis of
leishmaniasis:
• Whole soluble antigens (Ld-ESM—Excretory, secretory
and metabolic antigen by L.donovani)
• Purified antigens such as fucose- mannose
• Defined, synthetic peptides
• Recombinant antigens
rGBP (L.major protein encoding a hydrophilic protein)
rORFF (L. infantum)
gp63
rK39
rK26, rK9
rKE16
46. rK39
• Rapid dipstick test
• Based on the recombinant k39 protein, a 39-amino acid
cloned in Escherichia coli, from the C terminus of the
kinesin protein of Leishmania major in India
47. GOAL OF NATIONAL HEALTH POLICY
(INDIA) 2002
ELIMINATION OF KALA AZAR
2010
48. TREATMENT
• SODIUM ANTIMONY COMPOUND: SODIUM ANTIMONY
GLUCONATE(SAG 600mg daily for 6-10 days IV route)
• PENTAMIDINE ISTHIONATE
• AMPHOTERICIN-B
• Phase III Trials with a first-generation vaccine (killed
Leishmania organism mixed with a low concentration of
BCG as an adjuvant) have also yielded promising results
•
Leishmania major mixed with BCG have been successful
in preventing infection with Leishmania donovani.
49. Prevention
• Suppress the reservoir: dogs, rats, gerbils, other small
mammals and rodents
• Suppress the vector: Sandfly
• Critical to preventing disease in stationary troop populations
• Prevent sandfly bites: Personal Protective Measures
•
•
•
•
•
Most important at night
Sleeves down
Insect repellent w/ DEET
Permethrin treated uniforms
Permethrin treated bed nets
Editor's Notes
The lesion generally commences as a small papulopustular swelling of the skin localised in the region of nostrils, mouth or eyes or widespread on the face, ears, elbows and knees.
After a variable period of time the Mucosal surface of the mouth and nose are involved causing destructive and mutilating erosions.
Some time the whole of the nasal septum are involved.
Nasal mucous membrane, pharynx, larynx and upper lips are involved. Sometimes whole of the nasal septum is destroyed. Granulomas develop at mucocutaneous junction followed by gross destruction of soft tissue and cartilage causing disfigurement of nose and mouth. Death may occur from severe respiratory infection due to respiratory acute obstruction.
A classical lesion shows a nodule at the site of inoculation followed by a formation of a central crust. The crust may fall away exposing a wet type of ulcer.
A depressed scar and altered pigment develops on healing of that nodule at the edge of lesion are characteristic features.
Or
CL may be presented with papulonodular lesion covered by sperficial scales(dry type of ulcer).
Whole of the nasal septum is destroyed producing the typical tapir or camel nose.
Nasal mucous membrane, pharynx, larynx and upper lips are involved. Sometimes whole of the nasal septum is destroyed. Granulomas develop at mucocutaneous junction followed by gross destruction of soft tissue and cartilage causing disfigurement of nose and mouth. Death may occur from severe respiratory infection due to respiratory acute obstruction.
Profile view of a teenage boy suffering from visceral leishmaniasis. The boy exhibits splenomegaly, distended abdomen and severe muscle wasting.
Pyrexia: Must say One of the early symptom
Splenic enlargement: One of the most striking features
The lesion commences as a papulopustular swelling of the skin localised in the region of nostrils, mouth or eyes or widespread on the face, ears, elbows and knees.
After a variable time the mucosal surface of the mouth and nose are involved causing destructive and mutilating erosions. Sometimes the whole of nasal septum is destroyed.
Amastigote stage is present in man only
Promastigote stage is present in Sandflies as well as cultures.
The cells of the R.E. system of the affected organs proliferate and become heavily parasitised, accompained by an increase in the IgG fraction of the serum gamma globulin(hypergammaglobulinaemia) which however is not protective.
The increase in gamma globulin causes a reversal of albumin-globulin ration.
In variably cause infection once bite any susceptible person
Must talk of Leishmanin tests.
Drawback with the culture: Slow and takes a long time(about one month)
L.Donovani can be cultured in a medium composed of two parts of salt agar and one part of defibrinated rabbit’s blood.
The medium was first introduced by Novy, MacNeal and later modified by Nicolle.
Average total count is 3000 to 7-8000 per mm3 and there is progressive diminution during the course of the disease, the count falling to 1000 per mm3.
Must talk about drawback of Aldehyde test.
There is a reversal of albumin:globulin ratio