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Leishmaniasis

Leishmaniasis. Leishmania donovani (complex) (VL) Leishmania tropica (CL) Leishmania major (CL) Leishmania aethiopica (CL) Leishmania mexicana (Complex) (CL) Leishmania brazilliensis (complex) (MCL) Leishmania peruriana. Phylum Order Family Genus. Sarcomastigophora Kinetoplastida

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Leishmaniasis

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  1. Leishmaniasis Leishmania donovani (complex) (VL) Leishmania tropica (CL) Leishmania major (CL) Leishmania aethiopica (CL) Leishmania mexicana (Complex) (CL) Leishmania brazilliensis (complex) (MCL) Leishmania peruriana

  2. Phylum Order Family Genus Sarcomastigophora Kinetoplastida Trypanosomatidae Leishmania The Parasite

  3. Promasitogte Insect Motile Midgut Amastigote Mammalian stage Non-motile Intracellular Morphology Digenetic Life Cycle

  4. Promastigote Amastigote Morphology Flagella Kinetoplast Golgi Nucleus Cytoskeleton

  5. Promastigote

  6. Amastigotes (*) of Leishmania donovani in the cells of a spleen.  The individual amastigotes measure approximately 1 µm in diameter. 

  7. Amastigote

  8. Amastigotes of Leishmania in a macrophage from a lymph node of a dog. 

  9. Leishmania (Leishman-Donovan or LD bodies). Lying in macrophage cells from liver. Giemsa. ×12000. Enlarged by 9.6.

  10. A macrophage filled with Leishmania amastigotes.

  11. Life cycle • The organism is transmitted by the bite of several species of blood-feeding sand flies (Phlebotomus) which carries the promastigote in the anterior gut and pharynx. It gains access to mononuclear phagocytes where it transform into amastogotes and divides until the infected cell ruptures. The released organisms infect other cells. The sandfly acquires the organisms during the blood meal, the amastigotes transform into flagellate promastigotes and multiply in the gut until the anterior gut and pharynx are packed. Dogs and rodents are common reservoirs.

  12. Rodents Gerbils Hyraxes Bats Porcupines Opossums Sloths Primates Dogs Foxes Anteaters . . . . . Mammalian Hosts

  13. Vectors Phlebotomine Sandflies 6 genera world wide distribution Phlebotomus & Lutzomia 500 species Females Haematophagus Males sap feeders

  14. Visceral Fatal (90% untreated) Liver Spleen Bone marrow Cutaneous Generally Self- healing Skin Mucous membranes Clinical Disease SPECTRUM OF DISEASE

  15. Initial Infection • Similar in all species • Inoculation of promastigotes • Inflammation & chemotaxis • Receptor mediated phagocytosis Promastigote Amasitgote Transformation

  16. Parasite Spread Macrophage lysis & parasite release Lymphatic spread Blood spread Target organs Skin/lymph nodes/spleen/liver/ bone marrow

  17. 1903 1920 1931 William Leishman Pentavalent antimony Experimental transmission Visceral Leishmaniasis Leishmania donovani (Complex) L.d. archibaldi - L.d.chagasi - L.d.donovani - Ld.infantum

  18. VL - Clinical Manifestation Variable - Incubation 3-100+ weeks Lowgrade fever Hepato-splenomegaly Bone marrow hyperplasia Anemia, Leucopenia & Cachexia Hypergammaglobulinnemia Epistaxis , Proteinuria, Hematuria

  19. Profile view of a teenage boy suffering from visceral leishmaniasis. The boy exhibits splenomegaly, distended abdomen and severe muscle wasting. 

  20. A 12-year-old boy suffering from visceral leishmaniasis. The boy exhibits splenomegaly and severe muscle wasting.

  21. Jaundiced hands of a visceral leishmaniasis patient. 

  22. Enlarged spleen and liver in an autopsy of an infant dying of visceral leishmaniasis.

  23. Post Kala Azar Dermal Leishmanoid Normally develops <2 years after recovery Recrudescence Restricted to skin Rare but varies geographically

  24. Cutaneous leishmaniasis of the face. 

  25. A cutaneous leishmaniasis lesion on the arm.

  26. INFECTION Sub-clinical or inapparent infection RecoveryDeath Immune to reinfection Concurrent infection PKDL

  27. Diagnosis Clinical signs & symptoms Hypergammaglobulinemia ELISA/Formol gel Bone marrow biopsy Spleen or liver biopsy Culture & Histology

  28. Speciation • Similar morphology • Isoenzyme profiles - Zymodemes • Monoclonal antibodies • DNA hybridisation - PCR

  29. Treatment Good nursing Diet Antibiotics Pentavalent antimony Pentamidine New drugs - New delivery

  30. Control • Vector control • Reservoir control • Treatment of active cases • Vaccination

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