طفيليات leishmania

1. 1
Medical Protozoology
Blood Flagellates
Some species of Leishmania and Traypanosoma are
parasites of human.
Devlepmental forms of Trypanosoma and Leishmania:
Parasitology

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Blood Flagellates
1- Amastigote:
Oval, intracellular, 2-3 u and contains a
nucles and kinetoplast (parabasal body,
blepharoplast) form which arises axoneme.

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Blood Flagellates
2- Promastigote:
Spindle shape, 10-15 u. the kinetoplast at
the anterior end form which arises a free
flagellum. It is found in culture and in the
insect.

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Blood Flagellates
3- Epimastigote:
Spindle shape 10-20 u. the kinetoplast in
the middle, anterior to the nucleus, with free
flagellum and short undulating membrane. It
is found in culture and in the insect.

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Blood Flagellates
4- Trypomastigote:
Spindle shape 20-30 u. The kinetoplast at
the posterior end from which arises a flagellum
that from undulating membrane and project
anteriorly as a free flagellum. It occurs in
blood, lymphatic and CNS.

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Leishmania
There are 2 types of diseases caused by
leishmania:
1- Cutaneous leishmaniasis.
2- Visceral Leishmaniasis.

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Morphology:
 1- Amastigote form ( in human and
animal reservoir host). Amastigote
– Mammalian stage
– Non-motile
– Intracellular

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Morphology:
 2- Promastigote form ( in insect and culture ).
Promasitogte
– Insect
– Motile
– Midgut

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Life cycle:
1- Sand fly bites human it inoculates the promastigotes
into the skin.
2- Promastigotes proliferate as amastigotes in the
macrophages and the endothelium of the capillaries
and other small blood vessels of the immediate.
3- It become transformed into amastigotes in phagocytic
cells where they multiply.
4- Amastigotes are taken by sand fly through blood meal
from infected person.
5- Amastigotes transform into promastigotes which
multiply in the midgut of the insect and migrate
forward to the mouthparts.

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Cutaneous Leishmaniasis
1- Old world cutaneous leishmaniasis ( owcl )
It is caused by 3 species of leishmania.
a- Leishmania tropical ( Oriental sore ):
Distribution: Mediterranean region, Middle East,
Asia and Central Africa.
Reservior host: Human and dogs.
Vector: Sand fly ( Phlebotomus).

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Cutaneous Leishmaniasis
1- Old world cutaneous leishmaniasis ( owcl )
It is caused by 3 species of leishmania.
b- Leishmania major ( Rural, acute, moist lesion ):
Distribution: Middle East, Asia and Africa.
Reservoir host: Rodents.
Vector: Sand fly.

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Cutaneous Leishmaniasis
1- Old world cutaneous leishmaniasis (
owcl )
It is caused by 3 species of leishmania.
c- Leishmania aehiopica.

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Cutaneous Leishmaniasis
2- New world cutaneous leishmaniasis ( nwcl )
It is caused by :
a- leishmania braziliensis complex.
b- leishmania Mexicana complex.
Distribution: Central and South of America.
Reservoir host: Rodents and dogs.
Vector: Sand fly ( Lutzomyia species ).

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a- leishmania braziliensis complex
The parasites are seen in the reticulo-endothelial
cells of the oro- nasal mucosa producing ulcers
in the mucocutaneous areas. There is erosion of
the nasal septum or larynx with oedema, tissue
destruction and secondary bacterial infection
(Espundia). Leishmania peruviana causes a dry
skin nodule that resembles a warty growth.

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b- leishmania Mexicana complex
The disease is found commonly on the ears
of the chicle plantation workers which result
in marked deformity and destruction of
cartilage of the ear. The lesion is single.
Painless and heals spontaneously within 6
month.

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Diagnosis
1- Clinically.
2- Demonstration of organisms:
- Aspiration or scraping the active edge of
the ulcer.
- Culture on NNN (Novy Macenel and Nicolle)
medium.
- Permanent stain with iron haematoxylin or
trichrome.
3- Leishmania test (Montenegro test).
4- Biopsy: Bone marrow, Spleen and liver.

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Treatment:
1- Local Treatment:
a- Early non-inflamed or non-ulcerated lesion:
Intra-lesional injection of pentavalent antimony or 5%
mepacrine 1-3 times at 3-5 days interval.
b- Ulcerated lesion:
- Surgical excision, curettage and application of heat.
- Using 2% chlorpromazine and 2% clotrimazole as
tropical methods.
- Antibiotics for secondary infection.

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Treatment:
 1- Systemic treatment:
a- Pentavalent: antimony as sodium gluconate or
pentostam 10 mg / kg I.M. daily for 10 days.
b- Pentamidine: 4 mg / Kg I.M. daily for 15 days.
c- Amphotericne B.

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Control
 Vector control
 Reservoir control
 Treatment of active cases
 Vaccination

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Visceral Leishmaniasis
Visceral leishmaniasis is caused by L. donovani complex.
Disease: Kala azar, dum dum fever or black sickness.
Definative host: Human.
Reservoir host: Rodents and Dog.
Vector: Lutzomyia Sand fly.
Habitat: Inside reticulo-endothelial cells (RECs).
A- L. donovani: In India and parts in Africa. Common in young
adult (10-25).
B- L. infantum: In the Mediterranean countries and parts in
Africa. Common in children.
C- L. chagasi and L. amazonensis: In central and South
America. Common below the age of four.

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Clinical Picture
1- Intermittent fever with double daily rise.
2- Diarrhoea or dysentery.
3- Hepatosplenomeegaly and lymph node
enlargement.
4- Pancytopenia: Thrombocytopenia, anaemia,
leucopenia with relative monocytosis and
lymphocytosis.
5- Depigmented skin nodul.

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Diagnosis
1- Cinical picture in endemic area.
2- Demonstration of organism:
a- Blood film.
b- Splenic, liver, lymph node or bone marrow
punctures.
c- Culture on N.N.N.
d- Animal incubation.
3- Serological test:
a- Montenegro test.
b- IFA, ELISA and CFT.
c- PCR.

26. Treatment:
1- Pentavalent antimony: 10 mg kg I.M. daily
for one month.
2- Pentamidine: 4 mg Kg I.M. daily for 15
day.
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