Leishmania spp. CLIN. PARA.

Leishmania donovani complex  Cultured tissues of blood and bone

LIFE CYCLE marrow = demonstrates promastigote
 Sandflies responsible for L. donovani forms.
transmission:  Sternal Marrow Aspirates
 Serologic tests:
o Lutzomyia sandfly o IFA (Indirect fluorescent antibody)
o Phlebotomus sandfly o ELISA (Enzyme-linked
 Primarily affects the visceral tissue of the immunosorbent assay)
infected human. o DAT (Direct agglutination test)

EPIDEMIOLOGY
Subspeci Geographic Vector Reservoir
es Distribution Hosts
L. Central Lutzomyia Dogs,
donovani America, sandfly cats,
chagasi especially foxes
Mexico,
West Indies,
South
America
L. Parts of Phlebotom India,
donovani America, us sandfly none;
donovani India, China
Thailand, dogs
Peoples
Republic of
China,
Burma, East
CLINICAL MANIFESTATIONS Pakistan
Visceral Leishmaniasis (kala-azar) L. Mediterrane Phlebotom Dogs,
donovani an Europe, us sandfly foxes,
 Incubation period: 2-8 months infantum Near East, jackals,
 The spread of parasites into the bone Africa; also porcupin
marrow, spleen, and liver. in Hungary; es
 Acute phase: twice-daily fever spikes Romania,
with accompanying chills southern
 Subacute and chronic phase: fever, region of
weakness, loss of appetite, weight loss, former
hemorrhage, and abdominal enlargement Soviet
associated with hepatosplenomegaly. Union,
 Leishmania-specific Th1 response = low northern
or absent. China,
 Post-kala azar dermal leishmaniasis southern
(PKDL) - sequela of visceral leishmaniasis Sibria

DIAGNOSTIC TESTS TREATMENT

 Montenegro skin test  Liposomal amphotericin B (Ambisome) -

 Giemsa-stained slides of blood, bone drug of choice
marrow, lymph node aspirates, and  Sodium stiboluconate (Pentosam)
biopsies of the infected areas =  Gamma interferon & pentavalent
demonstrates diagnostic amastigote antimony
forms.  Allopurinol (AIDS)

MIDTERM DESO-ACIDO, G.
Leishmania spp.
 Prophylaxis (HIV infected; for second
dose) Four categories:
 New drug combination: paramomycin and
miltefosine
PREVENTION AND CONTROL
 Repellents (sandflies)
 Protective clothing CLINICAL MANIFESTATIONS
 Screening (windows)
Leishmania mexicana complex
LIFE CYCLE
 The life cycle of the members of the L.
mexicana complex is identical to that of L.
braziliensis and L. donovani complex.
 The primary vectors are sandfly species of
the genus Lutzomyia.
 also known as "New World”
 Infective stage: promastigotes
 Diagnostic stage: amastigotes
CLIN. PARA.
 cutaneous leishmaniasis (CL),
 diffuse cutaneous leishmaniasis (DCL),
 mucocutaneous leishmaniasis (MCL), and
 visceral leishmaniasis (VL).
1. Cutaneous Leishmaniasis
 most common form of the disease
 Incubation Period: two weeks to several
months
 an erythematous papule or nodule, called
an "oriental
 button is produced at the inoculation site .
 Chiclero ulcer, usually affecting the ear.
2. Diffuse Cutaneous Leishmaniasis
 called anergic or lepromatous
leishmaniasis,
 localized, non-ulcerating papule,
eventually developing
 numerous diffuse satellite lesions that
affect the face and extremities
 initially diagnosed as lepromatous leprosy

DIAGNOSTIC TESTS
 Giemsa-stained slides preparations of
lesion biopsy material = demonstrates
amastigote forms
 NNN (Novy-MacNeal-Nicole) culture
medium = demonstrates promastigote
forms
 Serologic testing using monoclonal
antibodies
 Schizodeme analysis, zymodeme analysis,
and nuclear DNA hybridization are
available on a research basis.

 Promastigotes
- Single free flagellum
- 15 to 20 µm in length EPIDEMIOLOGY
- 1.5 to 3.5 µm in width Subspecies Geographi Vector Reservoir
c Hosts
 Amastigotes Distributio
- ovoid or rounded bodies n
- 2 to 3 µm in length L. mexicana Belize, Lutzomyi Forest
- nucleus is large Guatemal a sandfly rodents
a, Yucatan for all for all
CLINICAL MANIFESTATIONS Peninsula species species
 The wide spectrum of symptoms comprisin comprisin
manifested by leishmaniasis is often g this g this
compared to leprosy. comply complex
 CL is similar to tuberculoid leprosy; DCL is L. pifanoi Amazon
similar to lepromatous leprosy
MIDTERM DESO-ACIDO, G.
Leishmania spp. CLIN. PARA.

River CLINICAL MANIFESTATIONS

Basin, 1. Cutaneous Leishmaniasis
Brazil,  most common
Venezuela  Incubation Period: 2 weeks to several
L. Amazon months
amazonensi River  Oriental button - produce in the
s/ Basin, inoculation site
Brazil  A papule forms a violaceous ulcer after
L. gamhami Venezuela several weeks
n Andes
L. Venezuela 2. Mucocutaneous Leishmaniasis
venezuelens
is DIAGNOSTIC
 Microscopic demonstration of Leishmania
TREATMENT from lesion, aspirates, or biopsy
• Na stibogluconate-PENTOSTAM  Giemsa and hematoxylin-eosin stain
• meglumine antimoniate GLUCANTIME  Leishman skin test *Montenegro skin test
• Amphotericin B-IV
• Oral ketoconazole EPIDEMIOLOGY
 L. tropica is the causative agent of
PREVENTION AND CONTROL cutaneous leishmaniasis
● Pest control  found in the Mediterranean region, Middle
● Insect repellant East, Armenia, Caspian region,
● Mosquito net Afghanistan, India, and Kenya)
● Avoid visiting endemic areas  Vector: Female Phlebotomus sandfly for
all species comprising this complex
Leishmania tropica complex  Reservoir Hosts: Possibly dogs
LIFE CYCLE
 identical to Leishmania braziliensis TREATMENT
 transmitted through the bite of female  Sodium stibo-gluconate (Pentosam)
sandflies  Paromomycin ointment - may also be
 Infective stage: Promastigotes given to aid in healing

PROMASTIGOTES
 Size: 9-15 um long
 Appearance: long and slender PREVENTION AND CONTROL
 Nucleus: one located in or near center  use of protective clothing, repellents,
 Other features: Kinetoplast, located in and screening are essential to prevent
anterior end, single free flagellum, future L. tropica complex infections
extending from anterior end

AMASTIGOTES
 Diagnostic stage
 Size: 5 by 3 um
 Shape: round to oval
 Nucleus: one, usually off center
 Other features: Kinetoplast present,
consisting of dotlike blepharoplasty from
which emerges a small axoneme ,
parabasal body located adjacent to the
blepharoplasty

MIDTERM DESO-ACIDO, G.