2. Leishmaniasis are group of protozoal diseases caused
by parasite Leishmania, and transmitted to humans by
the bite of female phlebotomine sandfly.
Leishmaniasis exists in many temperate and tropical
countries of the world. The disease is most common in
India, Bangladesh, Nepal, Sudan, Ethiopia,
Afghanistan, Algeria…
3. Three forms of the disease are known:
1)Visceral leishmaniasis, better known as kala-
azar, caused by Leishmania donovani.
2) Cutaneous Leishmaniasis
3) Mucocutaneous Leishmaniasis
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9. PKDL is a condition when Leishmania donovani
invades skin cells, resides and develops there and
manifests as dermal leisions.
Some of the kala-azar cases manifests PKDL after a
few years of treatment.
10. Recurrent fever
loss of appetite, pallor and weight loss
weakness
Skin - dry, thin and scaly and hair may be lost
persons show grayish discolouration of the skin of
hands, feet, abdomen and face which gives the Indian
name Kala azar meaning "Black fever”
11. Primary prevention
◦ Control of vector (Sand flies) – spraying DDT
◦ Control of reservoir – rodents
◦ Avoid sleeping on the floor to avoid sand fly bites
◦ Health education
Secondary prevention
◦ Early diagnosis and treatment
12. The currently used drugs for treatment of VL
are:
1. Sodium stibogluconate (SSG)
(or Meglumine
2. Amphotericin B (AMB)
3. Miltefosine
4. Paromomycin
13. 1. Sodium stibogluconate (SSG):
It has been the standard first line drug for VL in most
parts of the world achieving > 90% cure rate
SSG is a water soluble pentavalent antimonial, the
supplied solution contains 10% (100 mg/ml) antimony
14. Recent evidence indicates that a specific reductase
enzyme, present in leishmania amastigots
reduces pentavalent-Sb of SSG to the toxic trivalent
form
which then promotes efflux of glutathione and other
reduced thiols from the parasite residing within
macrophages
exposing them to oxidative damage
15. Sod. stibogluconate is rapidly absorbed from the site of
i.m. injection and excreted unchanged in urine within
6–12 hrs.
A small fraction enters tissues and remains stored for
long periods.
Repeated doses are cumulative.
16. Though, antimonials are toxic drugs, but the
pentavalent compounds (particularly SSG) are better
tolerated
Nausea, vomiting, metallic taste, cough, abdomen pain
and stiffness of injected muscle
Sterile abscesses, and mental symptoms often occur.
Pancreatitis, liver and kidney damage,
myelosuppression are possible
Q-T prolongation may cause arrhythmias.
Few cases of shock and death are on record
17. This antifungal antibiotic is available in two types of
preparations. The older and less expensive one is
formulated with deoxycholate (AMB-DOC), while in
the newer one it is incorporated in liposomes (L-AMB),
and is very expensive.
Like fungi, leishmania has high percentage of
ergosterol and is susceptible to this antibiotic which has
high affinity for ergosterol and acts by binding to it.
18. Presently, AMB is the drug with highest cure rate in
kala-azar: up to 99% clinical and parasitological cure
has been reported
However, high toxicity and need for prolonged
hospitalization, monitoring and repeated slow i.v.
infusions limit its application.
19. It is a derivative of alkyl phosphocholine with potent
antileishmania activity
was approved as the first orally active drug for kala-
azar.
A 4 week course of miltefosine has achieved >95%
cure rate in India and 90% in Ethiopia.
20. Not known, but it may be interfering with lipid
metabolism of the parasite or prevent synthesis of some
critical cell surface anchor molecules, or alter signal
transduction.
Leishmania can develop resistance to miltefosine and
this may be due to mutation limiting transport of the
drug into the parasite cell.
21. This aminoglycoside antibiotic is use in VL by the i.m.
route.
Found to be effective in SSG-resistant cases.
The WHO recommends 21 day paromomycin treatment
as an alternative to miltefosine.
22. Though paromomycin produces ototoxicity (in 2%
recipients), reversible elevation of serum transaminase
and injection site pain, but renal toxicity is rare.
It has proven to be an effective, less expensive and
easier to use alternative to AMB in kala-azar
23. combination therapy with 2 effective drugs has several
advantages in the treatment of VL. These are:
• Limiting risk of development of drug Resistance
• Attaining higher efficacy and cure rate.
• Shortening of duration of therapeutic regimen;
better compliance and convenience.
• Reduction of overall dose; lower toxicity and cost.
24. a. L-AMB (5 mg/kg i.v. single dose) +
Miltefosine (oral) daily × 7 days
b. L-AMB (5 mg/kg i.v. single dose) +
Paromomycin (i.m.) daily × 10 days
c. Miltefosine (oral) daily × 10 days +
Paromomycin (i.m.) daily × 10 days.
Each of these combinations yielded 98–99% cure rate.
25. 1. Sodium stibogluconate: Infiltrate 2 ml of the solution
(100 mg antimony/ml) round the sore.
Paromomycin (15%) ointment: applied topically on the
sore, twice daily for 20 days
Multiple sores and severe cases should be treated by
systemic drugs as for kala-azar.
26. Filariasis (or philariasis) is a parasitic disease caused by
an infection with roundworms
These are spread by blood-feeding black flies and
mosquitoes. This disease belongs to the group of
diseases called helminthiasis.
27. These are divided into three groups according to the
niche they occupy in the body:
Lymphatic filariasis is caused by the
worms Wuchereria bancrofti, Brugia malayi,
and Brugia timori. These worms occupy the lymphatic
system, including the lymph nodes; in chronic cases,
these worms lead to the syndrome of elephantiasis.
28. Subcutaneous filariasis is caused by Loa loa (the eye
worm), Onchocerca volvulus. These worms occupy
the subcutaneous layer of the skin, in the fat layer. L.
loa causes Loa loa filariasis,
Serous cavity filariasis is caused by the
worms Mansonella perstans and Mansonella ozzardi,
which occupy the serous cavity of the abdomen.
29.
30. The most spectacular symptom of lymphatic filariasis
is elephantiasis – edema with thickening of the skin and
underlying tissues—which was the first disease
discovered to be transmitted by mosquito bites.
Elephantiasis results when the parasites lodge in
the lymphatic system
31.
32. Fever
Skin abnormalities due to bacterial infection.
Elephantiasis Swelling of limbs and genitalia
Male: Enlargement of scrotum, penis retracted under
skin, spermatic cords thickened
Female: Long tumorous mass covered by thickened
ulcerated skin develops on the vulva
33. It is the first drug for filariasis caused by the nematodes
Wuchereria bancrofti (90% cases) and Brugia malayi.
Diethylcarbamazine is microfilaricidal.
A dose of 2 mg/kg TDS clears Mf of W. bancrofti and
B. malayi from peripheral blood in 7 days.
The most important action of DEC appears to be
alteration of organelle membranes of the Mf promoting
cell death.
34. 1. Filariasis:
DEC 2 mg/kg TDS is a first line drug produces rapid
symptomatic relief; Mf disappear from blood and
patient becomes noninfective to mosquitoes in 7 days.
Yearly treatment with a combination of DEC (6 mg/kg)
and albendazole (400 mg) single dose on mass scale
has brought down transmission of filariasis by reducing
microfilaraemia.
35. Congener of mebendazole: retains the broad-spectrum
activity and excellent tolerability of its predecessor
Has the advantage of single dose administration in
many infestations
M/A:
It inhibits the polymerization of microtubules, hence
glucose uptake is inhibited, leading to death
36. It is an extremely potent semisynthetic derivative of the
antinematodal principle obtained from Streptomyces
avermitilis.
Ivermectin is the drug of choice for single dose
treatment of onchocerciasis and strongyloidosis,
Certain insects, notably scabies and head lice are killed
by ivermectin
37. Treating the infection:
DEC (6 mg/kg per day) for 12 days in bancroftian
filariasis and for 6 days in brugian filariasis, repeated at
1-6 monthly intervals if necessary
Ivermectin
Albendazole
Side effects : headaches, fever, myalgia,
lymphadenopathy and occasionally rash, itching
