LEISHMANIA

Leishmania
• Haemoflagellate
• Obligate intracellular parasite
• Reticuloendothelial system
• 2 hosts –
 vertebrate host – man
 invertebrate host – insect vector – sandfly
Classification : Leishmania spp and Diseases
 Leishmania donovani
• Sir William Leishman (1990) → Observed in Spleen smears
of a soldier who died of “Dum Dum Fever” or “Kala Azar”
contracted at Dum Dum, Calcutta. He reported this finding
from London in 1903,

• in which year Donovan also reported the same parasite in

Spleen Smears of patients from Madras.

• Geographical Distribution : Endemic in many places in

India, China, Africa, Southern Europe, South America &
Russia
Morphology: The parasite exists in 2 stages

1) Amastigote stage - Occurs in Man

2) Promastigote Stage - Occurs in

- Gut of Insect (Sand Fly)
- Artificial culture
Cultivation: in NNN -Novy ,Mac.Neal,Nicolle medium
amastigotes
promastigote
LIFE CYCLE
Sand fly
The life cycle of Leishmania
PATHOGENESIS
 KALA - AZAR
• Visceral leishmaniasis was first characterized
in India, where it was known under the names
•Kala-Azar (Black Sickness)
•Dum Dum fence
•Burdwan fever
•Tropical Splenomegaly
• Incubation Period: 3 – 6 months
 CLINICAL FEATURES
• Pyrexia
• Splenic Enlargement
• Liver Enlargement
• Lymphadenopathy
• Anemia & Emaciation
• If untreated 75-95% die within 2 years
• Death due to secondary infections
hepatosplenomegaly
 Lab diagnosis of Kala Azar

Direct evidence Indirect evidence

Demonstration of L.donovani

Peripheral Blood Blood Culture Biopsy

•Amastigote form •Promastigote

Material obtained by

Lymph node Sternal/Iliac crest Splenic

Biopsy Puncture(marrow) puncture

Aldehyde test Antimony test Complement Fixation test

 Leishmanin/ Montenegro test
• Killed culture injected intradermally 

• Read after 72 hours

• Erythema and induration of 5mm or more

• + ve reaction produced in Kala azar cases 6 – 8

wks after recovery & represents a delayed
hypersensitivity reaction accompanied by CMI
TREATMENT

The specific chemotherapeutic drugs

1.Antimony compounds: Drugs of choice, include

Sodium stibogluconate

2.Synthetic non metallic compounds: Pentamidine

isethionate
 POST KALA AZAR DERMAL LEISHMANIASIS
• A type of non ulcerative cutaneous lesion prevalent in
endemic areas of Kala azar in India (Bengal, Madras &
Assam)
• Develops 1 – 2 years after treatment for kala-azar
• Clinical manifestations
- Deep pigmented macules
- Erythematous patches (Butterfly erythema)
- Yellow pink nodules
• Diagnosis: Biopsy from nodular lesion –
amastigote form

• Treatment: Administration of pentavalent

compound
Cutaneous Leishmaniasis
 CUTANEOUS LEISHMANIASIS
• New World Disease

Refers to the America

Etiological agents: L.mexicana complex & L.major, L.chagasi

• Old World Disease

Rest of the world

L.tropica, L.major, L.aethiopica, L.infantum & L.donovani
 Leishmania tropica
• Geographical Distribution
Mediterranean
Central & Western India (drier pats)
Central Africa

• Morphology: Amastigote form → in Man

Promastigote form → in Cultures & Sandflies
 CLINICAL FEATURES
• Oriental Sore (tropical sore) / Delhi boil (slow healing
open ulcer/sore)
• It ulcerates having clean cut margin with a railed
indurated edge, surrounded by erythema
• Has tendency to heal spontaneously but slowly, taking
6 months.
• The ulcer is filled up by granulomatous tissues, a
depressed white scar is often left
lesion
 Lab diagnosis
• Skin lesion – indurated edge
• Giemsa/ Wright stain – amastigote forms
• Culture
• Leishmanin test
 Treatment
• Sodium stibogluconate
• Cover cutaneous lesions to prevent secondary
infection