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

2. 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.

3. 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)

4. b)Reservoirs of infections
Dogs.jackels,foxes,rodents,other mammals.
Indian kala-azar is considered as non-zootic.

5. 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.

6. 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.

7. 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.

8. 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.

9. 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.

10. 3.Muco-cutaneous leismaniasis
Ulcer similar to the oriental sore,around the
mouth and nose.

11. 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.

12. 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.

13. 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)

14. 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.

15. .
2)Sandfly Control.
3)Personal prophylaxis.

16. 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