Leishmaniasis

Dr.Anusuya devi.D
Asst prof
 Leishmaniasis
• Leishmaniasis is a disease caused by genus
Leishmania and is transmitted by the bite of sand
fly.

• This disease is also known as kala azar, black fever,

sandfly disease, Dum-Dum fever.

• Human infection is caused by about 21 of 30

species that infect mammals.
 The Parasite
• Phylum Sarcomastigophora

• Order Kinetoplastida

• Family Trypanosomatidae

• Genus Leishmania

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 Leishmania Parasites and Diseases
SPECIES Disease
Leishmania tropica*
Leishmania major* Cutaneous leishmaniasis
Leishmania aethiopica
Leishmania mexicana
Leishmania braziliensis Mucocutaneous leishmaniasis

Leishmania donovani*
Leishmania infantum* Visceral leishmaniasis
Leishmania chagasi

* Endemic in Saudi Arabia

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Classification of Leishmania
(L.tropica
(Dry sore or Urban C.L.)

L.major
Old world C.L. (Wet sore or Rural C.L.)

(L. aethiopica)
Diffuse C.L.
Cutaneous L.-L. mexicana Complex
New world C.L. ( Chiclero ulcer)
Muco-cutaneous L.- L. braziliensis
( Espundia )
 Vector

• female sandfly
♀
– Old world Phlebotomus
Phlebotomus papatasi 

– New world Lutzomyia

♀ ♂

Lutzomyia mignoei  Vector of L infantum 

CAKIR: LEISHMANIASIS 2014-2015

Visceral Leishmaniasis (VL)
Kala azar
Dum Dum fever
 History
• 1900 – Sir William
Leishman
discovered
L. donovani in
spleen smears of a
soldier who died of
fever at Dum-
Dum,kolkatta
India.

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 Charles Donovan
• Charles Donovan also
recognized these
parasites in other
kala-azar patients.

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 Geographical distribution
• Endemic- india,china,africa
• India- Assam,bengal, bihar, orissa, chennai

• Habitat
• intracellular, R.E system

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Different stages of Haemoflagellates
Morphology of leishmania parasites

*in vertebrate hosts * in sandfly vectors

Amastigote Promastigote
(Leishman body) (Leptomonad)
 Life cycle
• Definitive host - man,dog,other mammals
• Vector - female sandfly
• Infective form - promastigote

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 mode of transmission
• Bite of infected sandfly vector

– Blood transfusions,
– Transplacental route
– Accidental inoculation in lab

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Life cycle

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 Pathogenesis
• Infections range from asymptomatic to progressive,
fully developed kala-azar.

• Incubation period is usually 2 – 4 months.

• Symptoms – Begins with low-grade fever and

malaise, followed by progressive wasting,protrusion
of the abdomen from enlarged liver and spleen.

• Fatal after 2 – 3 years if not treated.

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 Pathogenesis
• Spleen– most affected organ
• soft,friable- chocolate color on cut section
• Liver– enlarged, nutmeg appearance
• Bone marrow,
• lymphnode- involved

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 Clinical feature
• Fever
• Splenomegaly, hepatomegaly, lymphadenopathy
• Weight loss
• Anaemia
• Epistaxis
• Dry, rough ,darkly pigmented skin
• Diarrhoea
 Post Kala-azar Dermal
Leishmaniasis
• PKDL- Leishmania donovani invades skin
cells, resides and manifests as dermal
leisions.
• India,east africa- 3-10% develop this after
2 years treatment.
• non-ulcerative skin lesion.

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 Post Kala Azar Dermal
Leishmaniasis
• Normally develops <2 years after recovery

• Recrudescence

• Restricted to skin

• Rare but varies geographically

 Cutaneous Leishmaniasis
• Most common form
• Characterized by one or more sores, papulesor
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
• Sores 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 sores develop within a few weeks of thesandfly
bite, however they can appear up to months later

• Skin sores of cutaneous leishmaniasis can heal on their

own, butthis can take months or even years

• Sores can leave significant scars and be disfiguring if

they occur on the face

• If infection is from L. tropica it can spread to

contiguous mucous membranes (upper lip to nose)
 Mucocutaneous Leishmaniasis
• Occurs with Leishmania species from Central andSouth
America
• Very rarely associated with L. tropica which is found inthe
Middle East
- This type occurs if a cutaneous lesion on theface
spreads to involve the nose ormouth
- This rare mucosal involvement may occur if a
skin lesion near the mouth or nose is not
treated
• May occur months to years afteroriginal skin lesion
• Hard to confirm diagnosis as few parasites are in thelesion
• Lesions can be very disfiguring