1. Supercourse وزارة الصحة

2. eishmaniasis is a protozoal disease caused by Leishmania parasite, which is transmitted by the sand fly. Leishmaniasis is of three types ; cutaneous leishmaniasis, muco-cutaneous and the visceral (Kala-azar )

3. 1 5 4 3 2 6 7 8 Sand fly takes a blood meal (Injects promastigote stage into the tissue) Promastigotes are Phagocytized by macrophages Promastigotes transfer into amastigotes inside macrophages Amastigotes multiply in cells (Including macrophages) of Various tissues Sand fly takes a blood meal (ingest macrophages Infected with amastigotes ) Ingestion of Parasitized cell Amastigotes transform Into promastigote stage in midgut Divide in midgut and migrate to proboscis id i d Infective stage Diagnostic stage

4. Sand fly bite Others (nfected blood transfusion and,Pregnancy in (VL),physical contact in CL)

5. Sand Flies are vector of the disease. More than 500 species and subspecies in the world.Of which,only 35 types are known to transmit the disease,Phlebotomus in OCL,and Lutzomia in NCL. There are more than 21 Leishmanial species.

6. Leishman test: Intradermal injection of leishmanial antigen causes a delayed tuberculin type of reaction. Clinical features. Smear from the base of the ulcer stained with Wright‘s stain detects round or ovoid parasite in the cytoplasm of macrophages.

7. The dogs in the Mediterranean countries The man in the Middle East The wild rodents in Asia and Africa

8. Cutaneous Leishmaniasis Visceral Leishmaniasis > 12 Million people infected in 88 countries > 350 Million people are risk Mucocutaneous Leishmaniasis Our focus of presentation Annually,0.5M (VL)80,000 Deaths,1.5M(CL)

9. Death, 90% in Bangladesh, Brazil, India, Nepal,and in Sudan * Fever * Hepatosplenomegaly * Weight loss Skin ulceration, 90%Afghanistan,Syria,Iran,Iraq,Brazil,Peru, and Saudi Arabia Might be fatal. 90% in Bolivia, Brazil and Peru * Skin and mucus membranes affection

10. It is known in the Kingdom back to 1950. Ministry of Health has established the leishmaniasis unit in the 1980 Under The precautionary medicine to follow-up the disease in the Saudi cities

11. There are VL and CL. VL caused by L.Donovani LON 42,and the Rattus rattus is the reservoir. 2 types of CL(ZCL and ACL) In the Riyadh and Eastern province,ZCL transmitted by P.Papatasi and caused by L.Major LON4

12. CL in Southern region is ACL transmitted by P.Sergenti and caused by L.Tropica LON 72

13. There are 20 types of Sand Flies in the KSA.7 are Phlebotomous and 13 are of Sergentomyia type.

14. Riyadh Northern Al-jouf Tabouk Medina Makkah Baha Aseer Jazan Eastern Najran Affected area

16. utaneous leishmaniasis has many local names

17. The peak of cutaneous leishmaniasis is in August, October, December, January and February. The least number of cases are reported in May and June.

18. Riyadh Qaseem Northern Al-jouf Hail Tabouk Medina Makkah Baha Aseer Jazan Eastern Najran Alhsa only 41.2 % 7.6 % 8.4 % 18.2 % 9.6 %

19. Riyadh Qaseem Northern Al-jouf Hail Tabouk Medina Makkah Baha Aseer Jazan Eastern Najran Alhsa 20.9% 18.5 % 9.1 % 26.6% 4.1 %

23. Leishmaniasis usually affects children more than other age groups.

24. Mucosal Hyperkeratotic Nodules Lymphangitis after Pentostam treatment

25. Erysipeloid Plaque Recidivans Lupoid/Disseminated