Genus Leishmania

• Leishmania is a genus of family

trypanosomatidea

• Including parasites responsible for

the disease Leishmaniasis

• Leishmaniasis is the collective name

for a number of diseases which have
diverse clinical manifestations
 Classification
Leishmania Genus

Leishmania Vianni Subgener

a a

L. donovani L. major L. aethopica L. tropica L. mexicana L. laisoni L. braziliensis L. complexe

guyanensis
s
CL New World
CL Old World species
L. braziliensis L. guyanensis DCL
MCL
L. tropica L. peruviana L. New
L. major New
L. killicki L. mexicana panamiensis World
L. donovani World
L.
L. chagasi amazonensis
VL Old World & New World
L. infantum L. garhani
L. archibaldi L. pifanoi
L.
venezuelensis
*CL= Cutaneous Leishmaniasis
DCL=Diffused Cutaneous Leishmaniasis
MCL=Muco-cutaneous Leishmaniasis
VL=Visceral Leishmaniasis
(Rioux et al., ‘Annls Parasitol hum comp’ 19
Species of Leishmania Associated with
Human Disease
• New World
L. amazonensis, L. chagasi, L. mexicana, L.
pifanoi,, L. braziliensis, L. guyanensis, L. lainsoni.,
L. naiffi, L. panamensis, L. peruviana, and L.
shawi

• Old Word
L. tropica, L. major, donovani, L. infantum,
 Global occurrence
• Affects 88 countries of old and new world
• 22 countries in the New World
• 66 countries in the Old World
 Transmission
Transmission is by infective bite of a
female sand fly.
Genera:

● New World
● Lutzomyia
● Brumptomyia
● Warileia

● Old World
● Phlebotomus

● Sergentomyia
 Reservoir Hosts…
• Reservoir hosts: rodents, horses, foxes,
wolves, chickens and most importantly
dogs…
 Vectors
• Sand flies
• Fly silently and can penetrate mosquito nets
• They do not fly high or far (range of only 50m from
breeding site)
• Active in evening and at night
• Lives in more barren/sandy areas
• Needs moisture for breeding
• Breed in cracks in walls or among rocks, animals burrows,
caves, holes in ground, poultry houses etc
• Phlebotomus sergenti L. tropica

• P. papatasi L. major
 Lifecycle

Anthroponotic
Infection

Zoonotic Infection
 Common forms of leishmaniasis
Over 23 different species of Leishmania exist and manifest
into one of the three common forms:
cutaneous, mucocutaneous, and visceral leishmaniasis
 Clinical Forms of
Leishmaniasis
There are three main forms
• Cutaneous: involving the skin at the site of a sandfly bite
• Mucocutaneous: involving mucous membranes of the
mouth and nose after
•Visceral: involving liver, spleen, and bone marrow
 Cutaneous Leishmaniasis
• Most common form
• Characterized by one or more lesions, papules or
nodules on the skin
• Sores can change in size and appearance over time
• Often described as looking somewhat like a volcano
with a raised edge and central crater
• Lesions are usually painless but can become painful if
secondarily infected
• Swollen lymph nodes may be present near the sores
(under the arm if the sores are on the arm or hand…)
 Cutaneous Leishmaniasis
• Most lesions develop within a few weeks of the
sandfly bite, however they can appear up to
months later

• Skin lesions of cutaneous leishmaniasis can heal

on their own, but this can take months or even
years

• Lesions can leave significant scars and be

disfiguring if they occur on the face
Dry lesions
• Ulcer diameter 1-4cm
• Dry sores (central dry crust)
• No exudates
• Heal within two years
• Incubation period: 1-3
months
Wet lesions
• Ulcer diameter 2-6cm
• Wet Sores (Ulcerated &
inflamed)
• Seropurulant Exudate
• Heal within 2-8 months
• Incubation period: 1-10
weeks
Geographical distribution of Old World cutaneous leishmaniasis due to L. tropica and
related species and L. aethiopica
 Cutaneous Leishmaniasis (CL)
in Pakistan
• 3 species endemic
• L. infantum
• cause Visceral Leishmaniasis
• L. major
• cause Zoonotic Cutaneous
Leishmaniasis (ZCL)
• L. tropica
• Causing Anthroponotic Cutaneous
Leishmaniasis (ACL)
 Mucocutaneous Leishmaniasis

• Occurs due to Leishmania species from Central and

South America
• Very rarely associated with L. tropica which is found in
the Middle East
- This type occurs if a cutaneous lesion on the face
spreads to involve the nose or mouth
- This rare mucosal involvement may occur if a skin
lesion near the mouth or nose is not treated
• May occur months to years after original skin lesion
• Hard to confirm diagnosis as few parasites are in the
lesion
• Lesions can be very disfiguring
Geographical distribution of cutaneous and mucocutaneous leishmaniasis in the New
World
 Espundia Leishmania braziliensis
• Die because of difficulty of breathing, eating and
bacterial infections.

• Can also localize in larynx loss of voice.

• Pentastam drug of choice, however most people are

not treated.

• Reconstructive surgery.
Espundia Leishmania braziliensis

Most common in Brazil

Sand flies in the genus Lutzomyia serve as
vectors
 Visceral Leishmaniasis
• Most severe form of the disease, may be fatal if left untreated

• Usually associated with fever, weight loss, and an enlarged

spleen and liver

• Anemia (low RBC), leukopenia (low WBC), and

thrombocytopenia (low platelets) are common

• Lymphadenopathy may be present

• Visceral disease from the Middle East is usually milder with less
specific findings than visceral leishmaniasis from other areas
of the world
 Visceral Leishmaniasis

• Symptoms usually occur months after sandfly

bite

• Because symptoms are non-specific, so there

is usually a delay in diagnosis

• Visceral leishmaniasis should be considered

in any chronic FEVER patient returning from
an endemic area.
Geographical distribution of visceral leishmaniasis in the Old and New
world
• Clinical picture depends on
–The host immune response,
– The number of parasites inoculated,
– Site of inoculation
–Nutritional status of the host etc
 Diagnostic approach
in Hospitals/Clinics
 Trained eye of a careful physician
 Appropriate history of exposure
 Microscopy
 Parasite culture
 Serology
Treatment
CL
• Oral (Rifampicin)
• Miltefosine (most promising new oral drug)

Treatment is toxic, so pathological confirmation is

crucial
 Treatment
Visceral Leishmaniasis

• Liposomal amphotericin-B (AmBisome®) is the drug of

choice
• Pentostam® is an alternative therapy
 Prevention
• Suppress the reservoir: dogs,
rats, gerbils, other small
mammals and rodents

• Suppress the vector: Sandfly

• Prevent sandfly bites:

Personal Protective Measures
• Most important at night
• Sleeves down
• Insect repellent w/ DEET
• Permethrin treated uniforms
• Permethrin treated bed nets