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Leishmaniasis. Promastigotes of Leishmania. Amastigote of Leishmania. The life cycle of Leishmania. Leishmania Parasites and Diseases. World distribution of Visceral Leishmaniasis. Sand fly. Amastigotes of Leishmania. Promastigotes of Leishmania. lesion. lesion.
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Promastigotes of Leishmania Amastigote of Leishmania
Clinical types of cutaneous leishmaniasis • Leishmania major:Zoonotic cutaneous leishmaniasis: wet lesions with severe reaction • Leishmania tropica:Anthroponotic cutaneous leishmaniasis: Dry lesions with minimal ulceration Oriental sore (most common) classical self-limited ulcer
Uncommon types • Diffuse cutaneous leishmaniasis (DCL): Caused by L. aethiopica, diffuse nodular non-ulcerating lesions. Low immunity to Leishmania antigens, numerous parasites. • Leishmaniasis recidiva (lupoid leishmaniasis): Severe immunological reaction to leishmania antigen leading to persistent dry skin lesions, few parasites.
Diffuse cutaneous leishmaniasis Leishmaniasis recidiva
cutaneous leishmaniasis Diagnosis: • Smear: Giemsa stain – microscopy for LD bodies (amastigotes) • Biopsy: microscopy for LD bodies or culture in NNN medium for promastigotes
Pentostam ( sodium stibogluconate) for treatment of all types of leishmaniasis
Visceral leishmaniasis • There are geographical variations. • The diseases is called kala-azar • Leishmania infantum mainly affect children • Leishmania donovani mainly affects adults
Presentation • Fever • Splenomegaly, hepatomegaly, hepatosplenomegaly • Weight loss • Anaemia • Epistaxis • Cough • Diarrhoea
Untreated disease can be fatal After recovery it might produce a condition called post kala-azar dermal leishmaniasis (PKDL)
Visceral leishmaniasis Diagnosis • Parasitological diagnosis: Bone marrow aspirate 1. microscopy Splenic aspirate 2. culture in NNNmedium Lymph node Tissue biopsy
Bone marrow aspiration Bone marrow amastigotes
(2) Immunological Diagnosis: • Specific serologic tests: Direct Agglutination Test (DAT), ELISA, IFAT • rK39 antigen-based immunochromatographic tes . TWO LIMITATIONS FOR SEROLOGIC TESTS: • Do not diagnose relapses. • In endemic areas it is sometimes +ve in healthy individuals.
DAT test ELISA test
Antileishmanial drugs • Pentavalentantimonials • meglumineantimoniate ,sodium stibogluconate:IM IV ,can be administered Intralesionally for the treatment of cutaneousleishmaniasis.Cardiotoxicity and sudden death are serious but uncommon side-effects. • Amphotericin B deoxycholate • Amphotericin B is a polyene antibiotic, should always be given in hospital to allow continuous monitoring of patients. • Lipid formulations of amphotericin B • Several formulations, they are similar to amphotericin B deoxycholate in their efficacy but are significantly less toxic. • Paromomycin • Paromomycin (aminosidine) is an aminoglycoside antibiotic, usually IM. A topical formulation is available for cutaneousleishmaniasis. • Pentamidineisethionate • IM or IV.Severe adverse effects—diabetes mellitus, severe hypoglycaemia, shock, • myocarditis and renal toxicity—limit its use. • Miltefosine • This alkyl phospholipid (hexadecylphosphocholine) was originally • Miltefosine is potentially teratogenic and should not be used by pregnant women • Azoles medicines: ketoconazole, fluconazole, itraconazole • These oral antifungal agents have variable efficacy in leishmaniasis treatment
Treatment Of Cutaneous Leishmaniasis • No treatment – self-healing lesions • Medical: • Pentavalent antimony (Pentostam), Amphotericin B • Antifungal drugs • +/- Antibiotics for secondary bacterial infection. • Surgical: • Cryosurgery • Excision • Curettage REFERENCE :WHO (2010) Control of leishmaniasis. Report of a meeting 571 of the WHO expert committee on the control of leishmaniasis. http://whqlibdoc.who.int/trs/WHO_TRS_949_eng.pdf
Treatment of visceral leishmanisis • Recommended treatment varies in different endemic areas: • Pentavalent antimony- sodium stibogluconate (Pentostam) • Amphotericin B Treatment of complications: • Anaemia • Bleeding • Infections etc. REFERENCE :WHO (2010) Control of leishmaniasis. Report of a meeting 571 of the WHO expert committee on the control of leishmaniasis. http://whqlibdoc.who.int/trs/WHO_TRS_949_eng.pdf