Leishmania

Sandeep Pokhrel
Assistant Professor
Dept. of Microbiology
NGMC
 Learning Objectives
 At the end of this lecture you should be able to:
 Classify Leishmania
 Mention the types (clinical) of leishmaniasis
 Describe L. donovani under following headings:
 Morphology
 Life cycle
 Pathogenesis and clinical features
 Laboratory diagnosis
 Prophylaxis
 Leishmania

Classification
 Phylum: Sarcomastigophora
 Class: Zoomastigophora
 Order: Kinetoplastida
 Family: Trypanosomatidae

Genus: Leishmania
 Leishmania


Protozoan parasite,(unicellular eukaryotes) intracellular,
mainly affect Reticuloendothelial system.
 Hemo-flagellates


Zoonosis

 Transmitted by bite of sand-flies

 Leishmania species causing infection in humans

Old world leishmaniasis New world leishmaniasis

( Mediterranean, Middle East, Africa ( South and Central America)
and Asia)
 L. braziliensis complex
 L. mexicana complex
 L. donovani
 L. peruviana
 L. infantum
 L. chagasi

L. tropica
 L. major

L. aethiopica
 Leishmaniasis -Classification

1. Dermis:- Cutaneous leismaniasis

2. Naso- oropharyngeal mucosa:- Muco-cutaneous

leishmaniasis

3. Throughout the reticuloendothelial system:- Visceral

leishmaniasis
 Leishmaniasis -Classification

1. Dermis:- Cutaneous leismaniasis

2. Naso- oropharyngeal mucosa:- Muco-cutaneous

leishmaniasis

3. Throughout the reticuloendothelial system:- Visceral

leishmaniasis
 Cutaneous leishmaniasis

 Most common form

 Old world cutaneous leishmaniasis

 L. tropica, L. major, L. aethiopica and also L.infantum and L.
donovani
 New world cutaneous leishmaniasis

L. mexicana complex, L. peruviana
 Cutaneous leishmaniasis


lesions evolve from papules to
nodular plaques to ulcerative
lesions, with a raised border and
central depression, which can be
covered by crust

 some lesions persist as nodules

 Muco-cutaneous leismaniasis

 Also called espundia ( grossly

destructive change)

 A primary skin lesion followed by

secondary mucosal involvement

 Nasal mucus membrane, pharynx,

larynx and upper lip are involved

 Granuloma develops at the muco-

cutaneous junctions
 Visceral leishmaniasis/ kala-azar

 Leishmania donovani complex

Dum-Dum fever, Asian fever, Assam fever, infantile

spleenomegaly

Fatal disease without treatment

 Habitat

• Obligate intracellular parasite (Amastigote form)

 Reticuloendothelial cells of spleen
 Bone marrow
 Liver
 Intestinal mucosa
 Mesentric lymph nodes
 Leishmania donovani

 Named after the dicoverers, Leishman and Donovan (1903)

 Passes its life cycle in two host:

 Sandfly (Phlebotomus species)
 Human

 Parasite of reticulo-endothelial system

 Morphology
Promastigote
 Occurs in sand-fly
 Elongated, motile by
flagella
 Extracellular
 15-25 μm X 1.5-3.5 μm
 Kinetoplast lies
transversely at the
anterior end
Amastigote
 Occurs in humans

Intra-cellularly in cells
of R.E. System
 Non-motile, round or
oval body
 2-4 μm
 Kinetoplast lies at right
angle to the nucleus
Promastigote Amastigote
 Pathogenesis

 Incubation period: 3-6 months

 Parasite spread from site of inoculation to multiply in RE
cells
 Liver, lymph nodes, bone marrow
 Progressive enlargement of the organs involved

 Proliferation of macrophages compromising erythropoietic

and granulocytic activity – leucopenia, anemia,
thrombocytopenia

 Production of globulins is greatly increased

 Clinical features

 Fever, malaise, headache

 Progressive spleenomegaly, hepatomegaly and
Lymphadenopathy
 Skin becomes dry rough and pigmented (darkened)
 Hair tends to be brittle and falls out
 Anemia, leucopenia
 If untreated 75-95% patients die within 2 years
 Death is due to secondary infections
 Laboratory diagnosis

 Blood count
 Leucopenia (mainly neutropenia), erythrocytopenia
 Anemia
 Laboratory diagnosis

 Microscopy
 Demonstration of amastigote (LD bodies) inside
macrophages in
 Peripheral blood smear –
 Biopsy/aspiration
 Spleen (93-99%)
 Bone marrow(53-86%)
 Lymph node (53-65%)
 Laboratory diagnosis

 Culture
 NNN (Novy, McNeal, Nicolle) medium, Hockmeyer's
medium
 Promastigote form seen in culture
 PCR
 More sensitive

Restricted to reference laboratories
 Laboratory diagnosis

 Serological tests
 Non-specific and specific tests
 Non specific tests
 Aldehyde test (serum + formalin= coagulation)
 Antimony test (serum + urea stibamine= precipitate)
 Complement fixation test
 Laboratory diagnosis

 Specific test
 DAT (direct aggluination test)
 IHA (indirect heamagglutination)
 IFAT (indirect fluorescent antibody test)
 ELISA

rK39 based ICT (immunochromatographic test)
 Leishmanin skin test

Montenegro test

• 0.2 ml of Leishmania Ag (108 promastigotes in 1 ml of 0.5%

phenol saline)

• Positive test shows erythema and induration of 5 mm or larger

which heals on 14-25 days
 Prophylaxis

 Vector control
 Personal protection
 Control of reservoir hosts
 Early diagnosis and effective case management
Thank you!