‘Old world Leishmaniasis New wortd Leishmaniasis Cutaneous Visceral Mucocutaneous (Oriental Sore) (Kala azar ~ Black dumdum Fever) (Espundia) c/P ‘Simple Localized form at site of bite (Nodule - Ulcer — Scar) Both heal by fibrosis —> ‘Scar & Liable for 2ry bact. Infection io shy nai eee oe Start at face then spread allover the body (disfigurement) Both are rare, NOT Uleerate & dificult to be cured Disseminated nodules in “mmunosupprestion Nodes ful of amastigotes Intradermal tect is negative L. Major L. Tropica ~ L. Aethiopica L Donovan ~L. Infantum | Brazliensis ~ L. Mexicana [Geographies Alia, mile east & south Asia af, south Europe & south sa dla Centra & south America obitat Intracellular : RES cells of sin~skin & mucous membrane = Internal cere Def. host Man Vector Phiebotomus sand fly Phiebotomus sand fly [.tutazomyia sand fly Infistage_| Promastigote joni: vec" The kintoplast is between Nucleus & ant. end, 30 No undulating membrane ™ - Das stage | Amstigote tomer) "rounded, The Kntoplasis sil detectable & No Flagela™ wor Bite of Sand fly ¥ Moderate to severe Fever 2. Spleen -* Splenomegaly (1'sign) 3-Liver > Hepatomegaly ‘Asaitos(Jafbumin) & bleeding tendency de ce over dysfunction, 4-L.Ns = generalized lymphadenopathy SBME anemia, leucopenia & thrombocytopenia 6- Dark discoloration of skin of face & hands ‘henoe name kale azar-or black over 7-intestine = Dysentery £8: Vague general pain & edema 9- Post kala azar dermal Leishmaniasis» ‘inadequate tesiment of ala azar © change the nature of parasite o be demonic: 0, rates fom intemal sca io skin ' dissominaiod shin nodhios. FSH MOLED [> Starts simply in Face as a cutaneous leishmaniasis thatif untreated o> spread by blood & lymph to mucosa of: ‘Mouth - Nose — Lips ~ Pharynx- Larynx causes sever deformity if not treated Destruction in lips & nose ‘The Montenegro skin tests positiveCutaneous Lesion Visceral Lesion cell-mediated immunity ‘Strong 1 Suppressed {ve & become +ve months after tt nomunly ia saree “ Death of parasite + recovery of cell-mediated Tumoral immunity gM & 1g6) Weak late t Strong Antibodies Present Ai Fistory ar G aboratory investigation 1 Direct ton te a tons] Tas Tomcisia Sample rom skin, i [eins Stain = Amastigote Direct | bone marrow, LN-or | The Antigen (Ae) [it [Inoculation inte Hamster | — Amastigote blood 231 ulture on NNN media = Promastigote Diagnosis fan 2 indirect (Serological) 1 ELISA: to demonstrate Antibodies (Ab in blood 2 PCR 3- Speci (intradermal Montenegro test) Delayed hypersensitivity reaction (within 2 days) using (antigenic not toxigenic) promastigote “dead or live -attenuate’ ‘to test presence of Antibodies in blood. Negative (-ve) with VL & become positive (4ve) after ttt ‘Treatment | Pentostam 1.M. or |.V.: For all types of Leishmaniasis. 1- Personal protection from Sand fiy bite: by protective cloths, repellents & mosquito nets. 2- Insecticides spraying of breeding places of sands. Control | 3- Destruction of stray dogs (reservoir hosts for MCL). 4- Treatment of cases. '5- Vaccination in endemic areaOpportunistic - produce sever fata cisease in immunosuppressed patios. ‘American Trypanosoma - CHAGAS’ disease ‘Trypanosoma Cruzi Habitat RES, blood, brain & muscles of heart & intestine Def. host Reser. host ‘Man ‘Domestic animals, dogs, cats, pigs - wild animals, armadilios & rodents ..so, it's a Zoonotic disease Vector “Friatoma bug = Reduviid winged bug = kissing bug as t attack face: Infect. stage Metacyclic Trypomastigote ( stage after Epimastigote ) Diag. stage | long undul Blood stream trypomastigote (not replicate) & Tissue amastigote (replicate) ‘Trypomastigote: present in blood only —C or $ shaped ~ post. Kinetoplast & 1g membrane Amastigote: present intracellularly in RES or heart ~ actively divided by Binary fission _— 1- Direct contamination of wound by stool of bug... |e, Posterior station 2 Congenital Transplacental ‘3 Organ transfusion 4. Blood Transfusion 5+ Accidental in Labs (rare) A) Acute Stage: In Skin: Chagoma “ Painless nodule at ste of bite” jomana’s sign ~* unilateral conjunctivitis, Periorbital edema & iymphadentis, atigue , lymphadenopathy , myocarditis ,hepatosplenomegaly B) Chronic Stage: ‘May not appear for years or even decades. It include i + Cardiomyopathy ( Dilated floppy heart ) ‘Most Serious manifestation lervous system —* dementia + Mega-colon & Mega-esophagus (Dilated ) Y 3) G) Laboratory investigation: 4 Direct: mainly in Acute stage Blood film (thin or thick) stained by Geimsa Buty coat of centrifuged heparinized blood ~* motile trypomastigote psy from LN. oF muscles to detect Amastigote culture of blood on NNN media Xeno-diagnoss: uninfected triatoma bug are fed on patient's blood then examine the bug after 4 weeks 2- Indirect: mainly in Chronic stage 1 IHAT 2-Complement fixation 3. Immunoblot 4 PCR Treatment 1-Acule = Benzonidazole or nifurtimox _(Usvalyescive tis sage) 2-Chronic symptomatic tttonly (not affective) | Control 1 Insecticides to kill bugs 2- sereening of blood for CHAGAS’ disease in blood transfusion 3- No Vaccine nor drugs are available for prevention of CHAGAS’ diseaseT. cruzi ‘Trypomastigote form