Leishmaniasis

Obligate intra cellular parasite 2 hosts - mammalian host -insect vector( sand fly)

Classification
Depends on the clinical disease and geographical prevalance -Visceral leishmaniasis - Cutaneous & mucocutaneous leishmaniasis

Endemic Areas for Leishmaniasis

BMJ 2003;326:378

Morphology and life cycle

Humans/ mammalians- amastigote form Sand fly promastigote form

Promastigote

Amastigote

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

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

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

 Jaundiced hands of a visceral leishmaniasis patient.

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

Post Kala Azar Dermal Leishmanoid

Normally develops <2 years after recovery Recrudescence Restricted to skin Rare but varies geographically

Cutaneous leishmaniasis of the face.

A cutaneous leishmaniasis lesion on the arm.

Prevention
Treat all cases Eradication of vector sand fly Personally anti sand fly measures

INFECTION
Sub-clinical or inapparent infection

Recovery Immune to reinfection PKDL

Death Concurrent infection

Investigations and diagnosis

Demonstration of parasites a. Microscopy b. Culture c. Animal inoculation Demonstration of ab/ ag specific and non specific Non- specific serum tests

Treatment
Sodium stibogluconate IV 600mgdaily * 6 days Paromomycin14 mg/kg Im/ slow IV daily* 3-4 wks Pentamidine4mg/kg/ day IM* 10 days Amphotericin

prevention
Treat all the cases Eradicate the vector sandfly Anti sandfly measures