Leishmaniasis

Leishmania donovani (complex) (VL)

Leishmania tropica (CL)
Leishmania major (CL)
Leishmania aethiopica (CL)
Leishmania mexicana (Complex) (CL)
Leishmania brazilliensis (complex) (MCL)
Leishmania peruriana
 The Parasite

Sarcomastigophora
• Phylum

Kinetoplastida
• Order

Trypanosomatidae
• Family

Leishmania
• Genus
 Morphology
Digenetic Life Cycle

• Promasitogte • Amastigote
• Insect • Mammalian
• Motile stage
• Midgut • Non-motile
• Intracellular
 Morphology

• Promastigote • Amastigote
Flagella

Kinetoplast

Golgi

Nucleus

Cytoskeleton
Promastigote
• Amastigotes (*)
of Leishmania
donovani in the
cells of a
spleen.  The
individual
amastigotes
measure
approximately 1
µm in
diameter. 
Amastigote
• Amastigotes of
Leishmania in a
macrophage from
a lymph node of
a dog. 
• Leishmania
(Leishman-
Donovan or LD
bodies). Lying in
macrophage cells
from liver.
Giemsa. ×12000.
Enlarged by 9.6.
• A macrophage
filled with
Leishmania
amastigotes.

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 Life cycle
• The organism is transmitted by the bite of several
species of blood-feeding sand flies (Phlebotomus)
which carries the promastigote in the anterior gut and
pharynx. It gains access to mononuclear phagocytes
where it transform into amastogotes and divides until
the infected cell ruptures. The released organisms infect
other cells. The sandfly acquires the organisms during
the blood meal, the amastigotes transform into flagellate
promastigotes and multiply in the gut until the anterior
gut and pharynx are packed. Dogs and rodents are
common reservoirs.

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1
 Mammalian Hosts

• Sloths
• Rodents
• Primates
• Gerbils
• Dogs
• Hyraxes
• Foxes
• Bats
• Anteaters
• Porcupines
• .•. .Opossums
..

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 Vectors

Phlebotomine Sandflies
6 genera world wide distribution
Phlebotomus & Lutzomia
500 species
Females Haematophagus
Males sap feeders

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1
 Clinical Disease

• Visceral • Cutaneous
• Fatal (90% • Generally Self-
untreated) healing
• Liver • Skin
• Spleen • Mucous membranes
• Bone marrow

SPECTRUM OF DISEASE

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 Initial Infection

• Similar in all species

• Inoculation of promastigotes
• Inflammation & chemotaxis
• Receptor mediated phagocytosis

Promastigote Amasitgote
Transformation

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 Parasite Spread

Macrophage lysis & parasite release

Lymphatic spread
Blood spread
Target organs
Skin/lymph nodes/spleen/liver/
bone marrow

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 Visceral Leishmaniasis

• 1903 William Leishman

• 1920 Pentavalent antimony
• 1931 Experimental transmission

Leishmania donovani (Complex)

L.d. archibaldi - L.d.chagasi - L.d.donovani - Ld.infantum

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VL - Clinical Manifestation

Variable - Incubation 3-100+ weeks

Lowgrade fever
Hepato-splenomegaly
Bone marrow hyperplasia
Anemia, Leucopenia & Cachexia
Hypergammaglobulinnemia
Epistaxis , Proteinuria, Hematuria

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• Profile view of a
teenage boy suffering
from visceral
leishmaniasis. The boy
exhibits splenomegaly,
distended abdomen
and severe muscle
wasting. 

2
• A 12-year-old boy
suffering from visceral
leishmaniasis. The
boy exhibits
splenomegaly and
severe muscle
wasting.

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• Jaundiced hands of
a visceral
leishmaniasis
patient. 

2
• Enlarged spleen and
liver in an autopsy of
an infant dying of
visceral leishmaniasis.

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Post Kala Azar Dermal
Leishmanoid

Normally develops <2 years after

recovery
Recrudescence
Restricted to skin
Rare but varies geographically

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Cutaneous leishmaniasis of
the face. 

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A cutaneous leishmaniasis
lesion on the arm.

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 INFECTION
Sub-clinical or inapparent infection

Recovery Death
Immune to reinfection Concurrent infection
PKDL

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 Diagnosis

Clinical signs & symptoms

Hypergammaglobulinemia
ELISA/Formol gel

Bone marrow biopsy

Spleen or liver biopsy
Culture & Histology

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 Speciation

• Similar morphology
• Isoenzyme profiles - Zymodemes
• Monoclonal antibodies
• DNA hybridisation - PCR

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 Treatment

Good nursing
Diet
Antibiotics
Pentavalent antimony
Pentamidine

New drugs - New delivery

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 Control

• Vector control
• Reservoir control
• Treatment of active cases
• Vaccination