Lecture -6-

Lieshmania- flagellate
 Visceral leishmaniasis

This most severe form of leishmaniasis also known as kala-azar disease, it is a life-
threatening is caused by species of the parasitic protozoa flagellate Leishmania spp. It is
which are transmitted by female sandflies. Visceral leishmaniasis causes fever, weight loss,
spleen and liver enlargement, caused by L. donovani (kala azar) (Asia, Africa and India)
progressive disease, 75-95% mortality if untreated
 Epidemiology
Visceral leishmaniasis has a wide geographic distribution.
◦ North-Eastern China, India, Middle-East, Southern Europe (Mediterranean basin).
◦ Northern Africa, Central-East Africa, Central and South America
 Types of Leishmania stages

1. Promastigote - kinetoplast anterior to

nucleus; no undulating membrane;
flagellum arising near kinetoplast and
emerging from the end of the body.

2. Amastigote - kinetoplast anterior to

nucelus; no free flagellum; usually
spheroid or subspheroid,
 Transmission of Lieshmania

Leishmania spp. transmitted to

humans through the bite of infected female
phlebotomine sandflies and in mammalian
disease can be transmitted from zoonotic
reservoir hosts, such as rodents and canids.
 Life cycle of Lieshmania spp.

1-The sandflies inject the infective stage, Promastigotes, during blood meals.
2- Promastigotes that reach the puncture wound are phagocytized by macrophages and
transform into amastigotes.
3- Amastigotes multiply in macrophages and affect different tissues. (the reason clinical
manifestations).
4- Sandflies become infected during blood meals from infected host when they ingest
macrophages infected with amastigotes.
5- The parasites differentiate into promastigotes in sandfly's midgut, which multiply and
migrate to the proboscis.
Life cycle of Lieshmania sp.
 Macrophages

A type of white blood cell that have

defensive function against pathogens
(microbes).
1- Surrounds and kills microorganisms,
2- Removes dead cells, and
3- Stimulates action the immune system
cells.
 Pathogenesis

• Infection of macrophage in spleen, liver, bone marrow and

lymph nodes.
• Since leishmaniasis is primarily a disease of the reticulo-
endothelial system, replacement of infected cells produces
enlargement of the visceral organs associated with the system
(e.g. spleen and liver).
• Decrease RBC and WBC production result that anemia and Symptoms of visceral leishmaniasis

leukopenia, facilitating secondary bacterial infection

Symptoms
• The disease typically starts off slowly with
fever, chills, and general anemia, weakness
and wasting
• Loss of appetite, pallor and weight loss
with progressive emaciation.
• Skin – Dry, thin, scaly and hair may be
lost. ...
• Anemia – develops rapidly.
• Splenomegaly – spleen enlarges rapidly.
 Diagnosis
• Detecting Leishmania parasites in tissue of the skin lesion or the bone marrow
• Serological tests (visceral disease)

Treatment
• Antimonials
• Amphotericin B (less toxic, expensive)
• Miltefosine

Control
Control reservoir (dogs, rodents, ect.)
Control vector.