1. Classification of Leishmania parasites
Kingdom :
Protista
Phylum :
Sarcomastigophora
Class
:
Zoomastigophora
Order
:
Kinetoplastida
Family : Trypanosomatidae
Genous :
Leishmania
Subg.
:
Leishmania
Viania
(Suprapylarian) (Peripylarian)
2. Leishmaniaiasis
Leishmaniasis is the collective name for a
number of diseases caused by protozoan
flagellates of genous leishmania , which have
diverse clinical manifestations
3. Causative agent
Parasitic protozoa of the genus leishmania
,transmitted to human by sandflies.
Over 20 species and subspecies infect humans,
each causing a different spectrum of
symptoms.
6. Vectors of Cutaneous Leishmaniasis
in the world
Human are infected via bite of sandflies ( subfamily
phlebotominae)-tiny sand-coloured blood-feeding flies
that:- breed in dark,damp places, forest area,
caves,or the burrows of small rodents
-are relatively weak flyers, with a range of only 50
metres from their breeding sites
-are most
active in the evening and at night
- Their numbers
are related to natural factors
such as rainfull, and
may increase with global warming.
A ) IN Old World: are phlebotomus sp.;P. sergenti &
P.papatasi(mainly vectors in Iran) and other vectors are P.
prrfiliewi, P. caucasicus, P. perniciosus
B)In New World: are Lutzomyia sp.
11. Different clinical form of
Leishmaniaiasis
A) Visceral leishmaniasis
B) Cutaneous leishmaniasis
C) Muco-cutaneous leishmaniasis
12. Distribution of Leishmaniaiasis
in the world
are developing countries 72
-Endemic in 88 countries
are among the least developed 13
countries
-Population at risk: 350 millions
millions cases of 1-1.5
-Annual incidence: estimated at
C.L
.cases of V.L 500,000
-Overall prevalence: 12 millions people
- More than 90% of C.L. cases occur in; Iran, Algeria Afghanistan,,
Brazil, Peru, Saudi Arabia and Syria
More than 90% of V.L. Cases occur in 5 countries ; Bangladesh,
India , Nepal, Sudan, and Brazil
male 1,410,000
-The DALY burden is 2,357,000
946,000
-Annual death due to V.L. is
female
female 24,000
59,000 cases
male 35,000
*DALYS-Disability Adjusted Life Years (due to premature death
and disability)
13. Disturbing increase in the
number of C.L. cases in
several area
In Brazil
: 1998; 21,800 cases, 2003; 60,000 cases
In Afghanistan : 1994; 14,200 cases, 2002; 67,500 cases
In Syria
: 1998; 3900 cases, 2002; 6,275 cases
Related factors:
- Economic development
Behavioural and enviromental changes including :
development of new settlements, deforestatio, massive
migration from rural to urban area, fast and unplaned
urbanization,………
17. Different clinical form of
Cutaneous Leishmaniaiasis
(AnthroponoticC.L.(L.tropica
.(Dry sore or Urban C.L(
1) Old world C.L.
(Zoonotic C.L.( L.major
.(Wet sore or Rural C.L(
.Diffuse or Disseminated C.L
(L. aethiopica
(
2) New world C.L.
(Cutaneous L.(L. mexicana Complex
(Chiclero ulcer
(
(Muco-cutaneous L.( L. braziliensis
( spoundia or Pian bois or Uta (
18. Clinical Features
of cutaneous leishmaniasis
• The factors determining the form of disease include;
leishmania species, geographic location, and immune
response of the host.
• Cutaneous leishmaniasis is characterized by one or more
cutaneous lesions on areas where sandflies have fed.
• Persons who have cutaneous leishmaniasis have one or
more sores on their skin. The sores can change in size and
appearance over time. They often end up looking somewhat
like a volcano, with a raised edge and central crater.
• A scab covers some sores. The sores can be painless or
painful. Some people have swollen glands near the sores
(for example, in the armpit if the sores are on the arm or
hand).
23. Epidemiology of common form of
Leishmaniasis in Iran
A) Anthroponotic Cutaneous Leishmaniasis:
-It is common in man and endemic cities.
-Cuasative agent: L.tropica; smaller than L.major P. sergenti
-Transmition ways: 1) man to man by sand fly vector
2)contact infection (inoculable & oinoculable)
3)Mechanical transmitionfrom an open
ulcer( by stable fly:Stomoxys)
-Reservior host: Mainly; man occasionally dog
24. Epidemiology of common form of
Leishmaniasis in Iran
B) Zoonotic Cutaneous Leishmaniasis:
- Rural Oriental sore is a zoonosis with human
infections occuring only sporadically.
- Causative agent : is L. major
- Reservior host: the principal reservior host in Iran is
:
the gerbil Rhobomys opimusm, a grounddwelling
rodent.Secondary reservior are Meriones lybicus
erythrourus,Tatera indica , Nesokia indica and
Meriones hur rianea .
- The principal vector in Iran is Phlebotomus papatasi,
other vectors are P.caucasicus, P.ansarii,P.m
ongolensis
25. Geographical varieties of
visceral leishmaniasis
( Dum Dum fever , Kala-azar )
1) Indian kala-azar
Cuasative agent
(L.donovani complex)
L.donovani donovani
2) Mediterranean kala-azar
L.(d.) infantum
3) African kala-azar
L.(d.) archibaldy
4) American kala-azar
L.(d.)
cha gasi
26. Clinical Features of
visceral leishmaniasis
Persons who have visceral leishmaniasis usually have
fever, weight loss, and an enlarged spleen and liver
(usually the spleen is bigger than the liver).
Some patients have swollen glands.
Certain blood tests are abnormal. For example, patients
usually have low blood counts, including a low red blood
cell count (anemia), low white blood cell count, and low
platelet count.
Some patients develop post kala-azar dermal
leishmaniasis. Visceral leishmaniasis is becoming an
important opportunistic infection in areas where it coexists
with HIV.
28. Epidemiology of
Visceral Leishmaniasis in Iran
Mediterranean Kala-azar:
- Causative agent is L. infantum
- Reservior host: involving canine such as Dog, Jackal and
other wild carnivorouses.
- The probably main vector in Iran is Phlebotomus major,
other vectors are P.keshishiani, P.wenyoni,…….
- Age distribution: the disease occure in children from 1 to
4 years of age.
29. Distribution of Leishmaniaiasis
in the Iran
- Incidence rate of C.L. is: 0.28 (thousands)
- The most cases related to Isfahan and Bushehr
provinces : 1.66 (thousands)
-The least cases related to Mazandaran province :
0.22 (thousands)
-Annually 20,000 cases of C.L.is repoted from
different regions of Iran(1989, Azmoodae)
31. Laboratory Diagnosis
Examination of Giemsa-stained slides
of the relevant tissue is still the
technique most commonly used to
detect the parasite
32. Diagnostic findings
Microscopy
• Isolation of the organism in culture (diphasic NNN medium)
• Inoculation in experimental animals (hamsters) constitutes
another method of parasitilogic confirmation of the
diagnosis, and in addition can provide material for further
investigations (e.g., isoenzyme analysis).
• Antibody detection can prove useful in visceral
leishmaniasis but is of limited value in cutaneous disease,
where most patients do not develop a significant antibody
response.
• Other diagnostic techniques exist that allow parasite
detection and/or species identification using biochemical
(isoenzymes), immunologic (immunoassays), and molecular
(PCR) approaches. Such techniques, however, are not
readily available in general diagnostic laboratories.
34. Treatment
•
Physicians may consult CDC to obtain
information on how to treat leishmaniasis.
The drug sodium stibogluconate is available
under an Investigational New Drug protocol
from the CDC Drug Service. Also, see
recommendations in The Medical Letter
(Drugs for Parasitic Infections).
35. Number cases of
Cutaneous Leishmaniasis
in Abarkooh city from 1376 to 1383
390
400
350
300
290
255
250
192
200
180
150
114
83
100
95
50
0
1376
1377
1378
1379
1380
1381
1382
1383
36. Number cases of
Cutaneous Leishmaniasis
in Ardakan city from 1376 to 1383
992
1000
900
800
700
600
500
417
400
300
213
191
204
200
164
166
100
100
0
1376
1377
1378
1379
1380
1381
1382
1383
37. Number cases of
Cutaneous Leishmaniasis
in Bafgh city from 1376 to 1383
300
268
261
250
200
150
100
50
7
0
1376
2
1377
1
1378
7
1379
3
1380
1
1381
1382
1383
38. Number cases of
Cutaneous Leishmaniasis
in Taft city from 1376 to 1383
80
72
70
60
50
39
40
33
30
19
20
11
11
10
0
5
1376
1377
1378
1379
4
1380
1381
1382
1383
39. Number cases of
Cutaneous Leishmaniasis
in Khatam city from 1376 to 1383
238
250
200
167
150
100
44
50
0
0
1376
0
1377
0
1378
40
0
1379
1380
1381
1382
1383
40. Number cases of
Cutaneous Leishmaniasis
in Meyboad city from 1376 to 1383
160
143
140
120
100
80
60
44
31
40
20
0
10
1376
22
21
1377
1378
1379
30
16
1380
1381
1382
1383
41. Number cases of
Cutaneous Leishmaniasis
in Yazd city from 1376 to 1383
467
500
443
450
400
350
300
250
266
241
244
218
209
180
200
150
100
50
0
1376
1377
1378
1379
1380
1381
1382
1383
42. Numbf er cases o
Cutaneous Leishmaniasis
in Yazd province from 1376 to 1383
2500
2174
2000
1500
1295
1027
1076
1000
760
642
1133
1382
1383
570
500
0
1376
1377
1378
1379
1380
1381
