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Haemoflagellates Leishmaniasis & Trypanosomiasis.

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Presentation on theme: "Haemoflagellates Leishmaniasis & Trypanosomiasis."— Presentation transcript:

1 Haemoflagellates Leishmaniasis & Trypanosomiasis

2 Different stages of Haemoflagellates

3 The life cycle of Leishmania


5 Leishmania Parasites and Diseases DiseaseSPECIES Cutaneous leishmaniasis Leishmania tropica* Leishmania major* Leishmania aethiopica Leishmania mexicana Mucocutaneous leishmaniasis Leishmania braziliensis Visceral leishmaniasis Leishmania donovani* Leishmania infantum* Leishmania chagasi * Endemic in Saudi Arabia



8 Sand fly

9 amastigotes

10 promastigotes


12 lesion



15 Clinical types of cutaneous leishmaniasis Leishmania major: Zoonotic cutaneous leishmaniasis: wet lesions with severe reaction Leishmania tropica: Anthroponotic cutaneous leishmaniasis: Dry lesions with minimal ulceration Oriental sore (most common) classical self- limited ulcer


17 Uncommon types Diffuse cutaneous leishmaniasis (DCL): Caused by L. aethiopica, diffuse nodular non- ulcerating lesions. Low immunity to Leishmania antigens, numerous parasites. Leishmaniasis recidiva ( lupoid leishmaniasis): Severe immunological reaction to leishmania antigen leading to persistent dry skin lesions, few parasites.

18 Diffuse cutaneous leishmaniasis Leishmaniasis recidiva

19 cutaneous leishmaniasis Diagnosis: Smear: Giemsa stain – microscopy for LD bodies (amastigotes) Biopsy: microscopy for LD bodies or culture in NNN medium for promastigotes

20 NNN medium

21 Treatment No treatment – self-healing lesions Medical: oPentavalent antimony (Pentostam), Amphotericin B o+/- Antibiotics for secondary bacterial infection. Surgical: oCryosurgery oExcision oCurettage


23 Visceral leishmaniasis There are geographical variations. The diseases is called kala-azar Leishmania infantum mainly affect children Leishmania donovani mainly affects adults

24 Presentation Fever Splenomegaly, hepatomegaly, hepatosplenomegaly Weight loss Anaemia Epistaxis Cough Diarrhoea

25 Untreated disease can be fatal After recovery it might produce a condition called post kala-azar dermal leishmaniasis (PKDL)

26 Fever 2 times a day due to kala-azar

27 hepatosplenomegaly

28 mucocutaneous


30 Visceral leishmaniasis Diagnosis (1)Parasitological diagnosis: METHOD Bone marrow aspirate 1. microscopy Splenic aspirate 2. culture in NNN medium Lymph node Tissue biopsy

31 Bone marrow aspiration Bone marrow amastigotes

32 (2) Immunological Diagnosis: Specific serologic tests: Direct Agglutination Test (DAT), ELISA, IFAT Skin test (leishmanin test) for survey of populations and follow-up after treatment. Non specific detection of hypergammaglobulinaem by formaldehyde (formol-gel) test or by electrophoresis.

33 DAT test ELISA test

34 Formol-gel

35 Treatment: Pentavalent antimony (Pentostam) Amphotericin B Treatment of complications: Anaemia Bleeding Infections etc.

36 Trypanosomiasis

37 African Trypanosomiasis Life cycle of Trypanosoma brucei gambiense & T. b. rhodesiense

38 African sleeping sickness Trypanosoma brucei rhodesiense: East Africa, wild and domestic animal reservoirs Trypanosoma brucei gambiense: West and Central Africa, mainly human infection



41 Tsetse fly

42 Pathology and clinical picture 1.Skin stage: chancre. 2.Haematolymphatic stage: generalized lymphadenopathy, anaemia, generalized organ involvement. 3.Central nervous system stage (CNS): Meningoencephalitis. (Development of the disease more rapid in Trypanosoma brucei rhodesiense)

43 chancre

44 Winterbottom’s stage

45 3 rd stage CNS

46 Lymph node aspirate

47 trypanosoma

48 CSF


50 Reduviid (Triatomine) bug

51 Diagnosis Blood film Serology: IFAT Xenodiagnosis: feeding bugs on a suspected cases.

52 T. cruzi causes cutaneous stage (chagoma)

53 Ocular (Romana’ sign)

54 C-shape

55 TREATMENT African trypanosomiasis For early infection pentamidine suramin For late infection eflornithine (Diflouromethylornithine- DFMO) American trypanosomiasis (Chaga’s disease) benznidazole nifurtimox

56 Trichomonas vaginalis

57 Transmission: sexual intercourse contact with contaminated objects.

58 Pathology Female: vaginitis, profuse thin yellowish discharge with bad smell Male: invasion of urethra, prostate and seminal vesicles, causing urethritis but mostly asymptomatic.

59 trophozoites

60 Diagnosis Identification of parasite by microscopy of discharge. Examination of vaginal or urethral discharge for T. vaginalis

61 Treatment: metronidazole (flagyl). Note: Treat sexual partner because infection is mostly asymptomatic in males.

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