Leishmaniasis

Promastigotes of Leishmania Amastigote of Leishmania

The life cycle of Leishmania

Leishmania Parasites and Diseases SPECIES 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

World distribution of Visceral Leishmaniasis

Sand fly

Amastigotes of Leishmania

Promastigotes of Leishmania

lesion

lesion

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

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.

Diffuse cutaneous leishmaniasis Leishmaniasis recidiva

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

NNN medium

Pentostam ( sodium stibogluconate) for treatment of all types of leishmaniasis

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

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

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

Fever 2 times a day due to kala-azar

Hepatosplenomegaly in visceral leishmaniasis

Mucocutaneous leishmaniasis

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

Bone marrow aspiration Bone marrow amastigotes

(2) Immunological Diagnosis: Specific serologic tests: Direct Agglutination Test (DAT), ELISA, IFAT rK39 antigen-based immunochromatographic tes . TWO LIMITATIONS FOR SEROLOGIC TESTS: Do not diagnose relapses. In endemic areas it is sometimes +ve in healthy individuals.

DAT test ELISA test

Antileishmanial drugs Pentavalent antimonials meglumine antimoniate ,sodium stibogluconate:IM IV ,can be administered Intralesionally for the treatment of cutaneous leishmaniasis.Cardiotoxicity and sudden death are serious but uncommon side-effects. Amphotericin B deoxycholate Amphotericin B is a polyene antibiotic, should always be given in hospital to allow continuous monitoring of patients. Lipid formulations of amphotericin B Several formulations, they are similar to amphotericin B deoxycholate in their efficacy but are significantly less toxic. Paromomycin Paromomycin (aminosidine) is an aminoglycoside antibiotic, usually IM. A topical formulation is available for cutaneousleishmaniasis. Pentamidine isethionate IM or IV.Severe adverse effects—diabetes mellitus, severe hypoglycaemia, shock, myocarditis and renal toxicity—limit its use. Miltefosine This alkyl phospholipid (hexadecylphosphocholine) was originally Miltefosine is potentially teratogenic and should not be used by pregnant women Azoles medicines: ketoconazole, fluconazole, itraconazole These oral antifungal agents have variable efficacy in leishmaniasis treatment

Treatment Of Cutaneous Leishmaniasis No treatment – self-healing lesions Medical: Pentavalent antimony (Pentostam), Amphotericin B Antifungal drugs +/- Antibiotics for secondary bacterial infection. Surgical: Cryosurgery Excision Curettage REFERENCE :WHO (2010) Control of leishmaniasis. Report of a meeting 571 of the WHO expert committee on the control of leishmaniasis. http://whqlibdoc.who.int/trs/WHO_TRS_949_eng.pdf

Treatment of visceral leishmanisis Recommended treatment varies in different endemic areas: Pentavalent antimony- sodium stibogluconate (Pentostam) Amphotericin B Treatment of complications: Anaemia Bleeding Infections etc. REFERENCE :WHO (2010) Control of leishmaniasis. Report of a meeting 571 of the WHO expert committee on the control of leishmaniasis. http://whqlibdoc.who.int/trs/WHO_TRS_949_eng.pdf