Leishmaniasis is caused by protozoan parasites of the genus Leishmania and transmitted via the bite of infected female phlebotomine sandflies. It presents in various forms including visceral leishmaniasis (kala-azar), cutaneous leishmaniasis, and muco-cutaneous leishmaniasis. The life cycle involves vertebrate hosts such as dogs, rodents, and humans that serve as reservoirs, as well as insect vectors. Transmission is influenced by environmental, host, and parasite factors. Clinical features and diagnosis depend on the infecting species and form of the disease. Treatment involves antileishmanial drugs while control relies on reservoir and vector control.

2. • List of protozoal
diseases cause by
parasites of genus
leismania and
transmitted to man by
the biite of female
phlebotomine sandfly.
LEISHMANIASIS

3. VARIOUS SYNDROMES:
Kala-azar or visceral leismaniasis.(VL)
Cutaneous leismaniasis.(CL) or oriental sore.
Muco-cutaneous leismaniasis.
Anthroponotic cutaneous leismaniasis.
Zoonotic cutaneous leismaniasis.
Post kala-azar dermal leismaniasis.
Most of leismaniasis are zoonoses involving wild or domestic mammals
(rodents,canines). Some forms (indian kala-azar) are considered as non-zoonotic
infections.
*zoonoses=diseases which can be transmitted from animals(vertebrate) to
human.eg:Rabies,anthrax(splenic fever),cysticercosis etc
For more information:infonet-biovision.org/HumanHealth/Examples-zoonoses.

4. EPIDEMIOLOGICAL DETERMINANTS
a)Agents
Leismania are intracellular parasites i.e. they infect and divide
within macrophages . Atleast 19 diff. leismania parasites have
been associated with human infections.
L. donovani ----- kala-azar(VL)
L. tropica ----- Cutaneous leismaniasis (oriental sore)
L.Brazilliensis --- Muco-cutaneous leismaniasis.
Life cycle of these agents are completed in two different hosts
.Vertebrates( amastigote form or leismania body)
.Insects ( promastogote forms, flagellated)

5. RESERVOIRS OF INFECTIONSDogs.jackels,foxes,rodents,other mammals.
Indian kala-azar is considered as non-zootic.

6. HOST FACTORS
a) Age
Kala-azar can occur in all age grops including infants below the age of one year. In india (can be
consider as a reference for Nepal as well) peak age is 5-9 years.
b) Sex
Male are more affected than female(2:1)
c)Population movement
Migrants,labours,tourists between endemic and non-endemic areas can results in the apread of
infections.
d) Socio-economic status
Poor are more affected.
e) Occupation
Farming parasites,forestry,mining,fishing,animal husbandary
f) Immunity
Recovery from kala-azar and oriental sore gives a lasting immunity.During active phase of kala-
azar,there is impairment of of cell mediated immunity,this is reflected in negative skin rteaction to
leismanin test.

7. ENVIRONMENTAL FACTOR
1. Altitude---- 2000feet(600m)
2. Season ---- after rain (november and march –april)
3. Vectors: P. argentipes ---kala-azar
P.sergenti and P.papatasi--- cutaneous leismaniasis.
4. Developments projects: Forest clearing,cultivation projects,large water
resources schemes,colonization and resettlement programmes.

8. MOT
Female phlebotomine sandfly,P.argentipes (anthrophilic).
P.sergenti and P.papatasi
Extrinsic incubation period :6 to 9 days.(this is the time required for the
development of the parasites in the insect vector)
Incubation period:1 to 4 months;range is 10 days to 2 years.

9. CLINICAL FEATURES
1.KALA-AZAR (VL,BLACK-SICKNESS, DUM-
DUM FEVER)
Fever,splenomegaly,hepatomegaly,accompanied by anaemia,weight loss.Darkenig
of skin of face, hands,feet and abdomen.
Lymphadenopathy may also occur.
If not treated, it has high mortality rate.
PKDL(Post-Kala-azar Dermal Leismaniasis)is caused by L. donovani , it appears
one to several years after apparent cure of Kala-azar. The lesions consists of
multiple nodular infiltrations of the skin,usually without ulceration.

10. 2. CUTANEOUS LEISMANIASIS
Several forms of leimaniasis:
Anthroponotic or urban Uutaneous Leismaniasis(ACL),
Zoonotic or rural Cutaneous Leismaniasis (ZCL),Diffuse
Cutaneous Leismaniasis(DCL) etc.
The disease may be mistaken for leprosy.The agent is
restricted to the skin.Its is characterised by painful ulcers in
the part of the exposed body part to the sandfly.

11. 3.MUCO-CUTANEOUS LEISMANIASIS
Ulcer similar to the oriental sore,around the mouth and nose.

12. LABORATORY DIAGNOSIS
1. Parasitological diagnosis
The demonstration of the parasite LD bodis in the aspirates of the spleen,
liver, bone marrow, lymph nodes or in then skin ( in then case of CL) is the
only way to confirm VL or CL conclusively. The parasites must be isolated
in culture to confirm the identity of the parasite.

13. 2.ALDEHYDE TEST
1 to 2 ml of sample of serum is isolated from patients blood(venous) and a drop
of formalin is added.
If the sample converted into boiled egg like structure within 2 to 20 mins than it
is cosidered as strong positive test if not then it is said to be negative.
This is not good for diagnosis but good for surveillance because test become
positive 2 to 3 months after onset of disease, and reverts to negative 6 months
after cure.

14. OTHER TESTS
3.Serological tests (ELISA,DAT,IFAT)
4.Leismanin (Montenegro) test :base on skin reaction
5.Haematological findings;ESR increased,progressive
leucopenia,anamia,reversed albumin-globulin ratio with greatly increased
IgG. WBC:RBC=1:1500(2000) (normal 1:750)

15. CONTROL MEASURE
1.Control of reservoir.
In Nepal man is the only reservoir of kala-azar. Awareness and treatment can control the reservoir.
a)First line of drugs-short form
->SSG(sodium stibogluconate)
->Amphotericin B
b)First line drug-long term
->Miltefosine
->SSG IV or IM
c)Second line of drug
SSG failure ->Amphotericine B with increase dose
SSG and Miltefosine failure -> Liposomal Amphotericine B(repeated)
Infected Zoones control programmes.

16. .
2)Sandfly Control.
3)Personal prophylaxis.

17. FACTS
Leishmaniasis is a blood borne parasite in all of it’s forms
It is not known why some forms visceralize and some normally do not
Leishmaniasis can remain dormant in a healthy person for up to twenty years
Leishmaniasis can live in stored blood for up to thirty days
Leishmaniasis is normally transmitted by the bite of an infected female sandfly
Leishmaniasis is also transmittable sexually, congenitally, and by blood transfusion or sharing needles.
There is NO Sterile cure for leishmaniasis
Leishmaniasis has been at epidemic levels in various parts of Afghanistan and Iraq for the duration of the wars
There is a one year ban on blood donations from persons having been to Iraq or Afghanistan
Leishmaniasis is a very variable bug and there is still much we do not know about it
Cutaneous species are showing signs of visceralizing