hemoflagellates lishmania

Haemoflagellates Leishmaniasis

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Sand fly Phlebotomus & Lutzomia

Different stages of Haemoflagellates

The life cycle of Leishmania

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B

Bone marrow aspirate smear: visceral leishmaniasis

Leishmania Parasites and Diseases
Disease
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

Sand fly

amastigotes

promastigotes

promastigotes

lesion

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

Treatment
No treatment – self-healing lesionsMedical:Pentavalent antimony (Pentostam), Amphotericin B+/- Antibiotics for secondary bacterial infection.Surgical: CryosurgeryExcisionCurettage

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

mucocutaneous

PKDL

Visceral leishmaniasis
Diagnosis Parasitological diagnosis: METHOD 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 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.


DAT test
ELISA test

Formol-gel

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