Haemoflagellates Leishmaniasis & Trypanosomiasis

1. Haemoflagellates Leishmaniasis & Trypanosomiasis

2. Different stages of Haemoflagellates

3. Promastigotes of Leishmania Amastigote of Leishmania

4. The life cycle of Leishmania

6. Leishmania Parasites and Diseases

8. World distribution of Visceral Leishmaniasis

9. Sand fly

10. Amastigotes of Leishmania

11. Promastigotes of Leishmania

12. lesion

13. lesion

14. lesion

15. 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

17. 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.

18. Diffuse cutaneous leishmaniasis Leishmaniasis recidiva

19. cutaneous leishmaniasis Diagnosis: • Smear: Giemsa stain – microscopy for LD bodies (amastigotes) • Biopsy: microscopy for LD bodies or culture in NNN medium for promastigotes

20. NNN medium

21. Treatment • No treatment – self-healing lesions • Medical: • Pentavalent antimony (Pentostam), Amphotericin B • +/- Antibiotics for secondary bacterial infection. • Surgical: • Cryosurgery • Excision • Curettage

22. Pentostam ( sodium stibogluconate) for treatment of all types of leishmaniasis

23. Visceral leishmaniasis • There are geographical variations. • The diseases is called kala-azar • Leishmania infantum mainly affect children • Leishmania donovani mainly affects adults

24. Presentation • Fever • Splenomegaly, hepatomegaly, hepatosplenomegaly • Weight loss • Anaemia • Epistaxis • Cough • Diarrhoea

25. Untreated disease can be fatal After recovery it might produce a condition called post kala-azar dermal leishmaniasis (PKDL)

26. Fever 2 times a day due to kala-azar

27. Hepatosplenomegaly in visceral leishmaniasis

28. Mucocutaneous leishmaniasis

29. Visceral leishmaniasis Diagnosis • Parasitological diagnosis: METHOD Bone marrow aspirate 1. microscopy Splenic aspirate 2. culture in NNNmedium Lymph node Tissue biopsy

30. Bone marrow aspiration Bone marrow amastigotes

31. (2) Immunological Diagnosis: • Specific serologic tests: Direct Agglutination Test (DAT), ELISA, IFAT • Skin test (leishmanin test) for survey of populations and follow-up after treatment. • Non specific detection of hypergammaglobulinaem by formaldehyde (formol-gel) test or by electrophoresis.

32. DAT test ELISA test

33. Formol-gel

34. Treatment: • Pentavalent antimony- sodium stibogluconate (Pentostam) • Amphotericin B Treatment of complications: • Anaemia • Bleeding • Infections etc.

35. Post-kalazar dermal leishmaniasis (PKDL)

36. Trypanosomiases

37. African Trypanosomiasis Life cycle of Trypanosoma brucei gambiense & T. b. rhodesiense

38. African sleeping sickness Trypanosoma brucei rhodesiense: East Africa, wild and domestic animal reservoirs Trypanosoma brucei gambiense: West and Central Africa, mainly human infection

40. Animal reservoir hosts for African sleeping sickness

41. Tsetse fly

42. Pathology and clinical picture • Skin stage: chancre. • Haematolymphatic stage: generalized lymphadenopathy, anaemia, generalized organ involvement. • Central nervous system stage (CNS): Meningoencephalitis. (Development of the disease more rapid in Trypanosoma brucei rhodesiense)

43. chancre

44. Winterbottom’s stage

45. 3rd stage CNS

46. Lymph node aspirate

47. trypanosoma

48. CSF

50. AMERICAN TRYPANOSOMIASIS LIFE CYCLE OF Trypanosoma cruzi