Presentation on theme: "Haemoflagellates General Characters: Includes many different species:"— Presentation transcript:
1Haemoflagellates General Characters: Includes many different species: LeishmaniaandTrypanosomaGeneral Characters:1- Present in blood and tissue. 2- Move by Flagellum3- Require vector (blood sucking insect) for transmission.4- Alternate cycles & acquire 2 interchangeable stages in host & vector.5- Multiply by simple binary fission.Trypanosoma spp.Polymorphic Trypanosomes: Monomorphic Trypanosomes:1- Trypanosoma gambienseTrypanosoma cruzi2- Trypanosoma rhodesienseLeishmania spp.Leishmania tropica complex: Leishmania donovani complex:1- Leishmania tropica1- Leishmania donovani2- Leishmania major2- Leishmania infantum3- Leishmania aethiopica3- Leishmania chagasiLeishmania mexicana complex:Leishmania braziliensis complex:Leishmania mexicanaLeishmania braziliensis
2flagellum (mastigote) then invade their tissues. Blood Flagellates1- Are Protozoa that swim in the blood of patients usingخيطflagellum (mastigote) then invade their tissues.2- Transmitted to man through arthropods biteLeishmania& Trypanosoma3- Include:4- Acquire the following shapes:TrypomastigoteAmastigoteUndulating membranekinetoplastovalNo free flagellumFree FlagellumEccentric nucleusCentral nucleusPromastigoteEpimastigotekinetoplastelongatedkinetoplastFree FlagellumFree FlagellumCentral nucleusUndulating membraneCentral nucleus
3Leishmania spp. Introduction 1- Leishmania established everywhere in Forest, desert, mountains, towns, countries2- Leishmaniasis is a variety of syndromes that are wide-spread giving rise to:Cutaneous – Mucocutaneous – Visceral Leisons.3- Species variation & the cellular immune response determine the type of lesion4- Leishmania spp. are strictly obligatory intracellular parasite of macrophages/ monocyte series (Histiocytes – Epitheloid cells – Kupfer cells – R.E.Cs5- Multiply by binary fission within macrophages of : SKIN – RETICULO- ENDOTHELIAL SYSTEM & other VISCERA6- Acquire interchangeable stages:Amastigotes: in Man- Dogs –Rodents Promastigotes: in vector & culture7- Transmission of the disease is seasonal – mainly zoonotic.Exceptions are L. donovani in india & L. tropica ….. Whereas man is the onlysource of maintaining infection (Anthroponotic)8- Vector of transmission is Sandfly “Phlebotomus” (old world) and “Lutzomyia”(new world).
4Disease I- Cutaneous Leishmaniasis “Oriental Sore”: A- Old World Cutaneous Leishmaniasis (O.W.C.L.):1- Single Dry Non-Exudative Lesion L.tropica2- Multiple Wet Exudative Lesion L.major3- Disseminated Cut. Leishmaniasis L.aethiopica4- Chronic (Recidivan) Relapsing Cut. Leishmaniasis L.tropicaB- New World Cutaneous Leishmaniasis (N.W.C.L.):1- Relapsing skin Lesion (Chiclero’s Ulcer) L.mexicana2- Mucocutaneous Leishmaniasis (Espundia) L.braziliensisII- Mucocutaneous Leishmaniasis “ESPUNDIA”:L. braziliensisIII- Visceral Leishmaniasis “Kala-azar”:L. donovani - L. infantum - L. chagasi
5Leishmania Parasites and Diseases SPECIESCutaneous leishmaniasisLeishmania tropica*Leishmania major*Leishmania aethiopicaLeishmania mexicanaMucocutaneous leishmaniasisLeishmania braziliensisVisceral leishmaniasisLeishmania donovani*Leishmania infantum*Leishmania chagasi* Endemic in Saudi Arabia
7Leishmania causes leishmaniasis Disease is caused by Bite of ♀ sandflyLiverAttacks human skinOld world cutaneous leishmaniasisAttacks human visceraNew world cutaneous leishmaniasisOld world visceral leishmaniasisDifferent Leishmania speciesNew world visceral leishmaniasis
8Mode of infection of Leishmaniasis Through the bite of female sand fly (vector)Phlebotomus (OW)Lutzomyia (NW)in skin or blood of patientblock mouth & pharynxAmastigotePromastigotesDiagnostic stageInfective stageAlimentary canal of sand flyPromastigotesMultiply by binary fissionBiological transmission
9Transmission of Leishmaniasis _ by sand flies._ artificial transmission of leishmania via the sharing of contaminated syringes and needles, from one intravenous drug user to another.Rarely, Leishmaniasis is spread from a pregnant woman to her baby (Materno-fetal transplacental transmission).Blood transfusion or contaminated needles also can spread Leishmaniasis.
16Leishmania spp.Sand flyAmastigotePromastigotes of Leishmania
17Pathogenesis & Clinical Picture of Cutaneous Leishmaniasis Noduleforms at the site of bite due to multiplication of Leishmania in skin macrophages& granulomatous reaction around them.Inflammatory cellsPromastigotesAmastigotesSkin macrophageforms with sharp-cut edges with raised indurated marginAn ulcerIn about 1 yearHealing occurs leavinga disfiguring scarThe patient develops solid immunity
18Leishmania species causing ulcer in the Old World In the Middle East1- L. tropicaالقرحة الشرقية2- L. majorOriental soreالمدنالريفUrbanRuraldry chronicwet acuteIn Ethiopia & Kenya3- L. aethiopicaAffects patients producing diffuse cutaneous lesions resembling lepromatous leprosy.In patients with deficient cell-mediated immunityDue to some characteristics of parasite species
19I-Cutaneous Leishmaniasis “Oriental Sore”(O.W.C.L) 1- Single Dry Non-Exudative LesionCaused by L. tropica URBAN type1- Present in towns & cities (common in Saudi Arabia).2- Long incubation Period (months to years).3- Lesions develop in exposed parts such as (face –limbs)4- Lesions are slowly progressive.5- Ulcer heals “self-limiting infection” scar tissue form6- C.M.I. curtails the infection leading to resistance to reinfectionAppear as follows: single-small-Dry-painless nodule-nonexudative-delayed ulceration-small scar- non pruritic- uncommon 2ry bacterial infection.2- Multiple Wet Exudative LesionCaused by L. major RURAL type1- Found in villages at edge of deserts(common in KSA).2- Relatively short incubation period (2-6 weeks).3- Lesions are more severe than L.tropica – big Ulcers4- Lesions are rapidly progressive.5- Dense nodules ulcerate & Coalesce big ulcersAppear as follows: Multiple-Big-Wet-painless nodule-Exudative2ry bacterial delay healing –Big disfiguring scar- pruritic.
20I-Cutaneous Leishmaniasis “Oriental Sore”(O.W.C.L) 3- Chronic (Recidivan) Relapsing Cut. LeishmaniasisCaused by L. tropicaFew cases following primary skin lesion become hyper-Sensitive to parasite antigen --- vigorous immune responsePersistent chronic infection (over years)The Lesions appear as follows:.1- Papules develop around the healed skin & scar tissue2- Ulcerate & heal by SCAR tissue formation3- Appear as Tuberculoid skin lesion “Lupus Vulgaris”.N.B: Montengro’s Test (is strongly +ve), while smear & culture for parasite is –ve ????4- Diffuse Cut. Leishmaniasis (D.C.L.)L. aethiopica (also L. amazonensis)Inefficient cellular immune response limited cellular infiltration around infected macrophages failure of immune response to abort infection spread of amastigoteThe Lesions appear as follows:.1- Multiple nodules with abundant parasite – Rarely ulcerate.2- Skin becomes thick due to hyperplasia & hypertrophy.3- The lesion appear as “Lepromatous Leprosy”.
21I-Cutaneous Leishmaniasis “Oriental Sore”(O.W.C.L) somewhat like a volcano with a raised edge and central crater
22Areas where Cutaneous Leishmaniasis exists L.tropicaL.majorIn the Old WorldL.aethiopicaL.infantum
23Leishmania species causing ulcer in the New World L.peruvianaL.braziliensis(Espundia)Dry ulcer(Uta)spread along lymphatics to mucous membrane producing erosion of nasal septum, palate & larynxLeishmania pifanoiDiffuse lesion resembles lepromatous leprosy (does not heal or ulcerate).
24Leishmania species causing ulcer in the New World Leishmania mexicana:single ulcer affects the ear causing destruction of the cartilage.(Chiclero’s ulcer or Bay sore)L.braziliensis
25I-Mucocutaneous Leishmaniasis “Espundia” Caused by L. braziliensis present in hot humid forest of central & south America1- Vector of transmission is Lutzomyia.2- majority of cases primarily present with Cutaneous Lesion3- M.L. may develop 2-10 years following primary C.L..4- Deficient C.M.I Spread of infection either directly or haematogenously to involve soft tissues of the Oronasal & Pharyngeal mucosa (NOSE-PHARYNX-LARYNX –UPPER LIP)5-Lesion may be hypertrophy or severely destructive:Hypertrophy mainly NOSE & MOUTH.Destructive Mouth –Pharynx- Nasal (mucosa/cartilageSeptum) nasal obstruction – bleeding – erosionmassive destruction, severe pain & great deformity.N.B: only non-visceral Leishmaniasis lesion that may cause death from (Pneumonia- Septicemia as superimposed 2ry bacterial infection – malnutrition – Deficient C.M.I.)