Leishmaniasis pdf - د. ناديا

LEISHMANIASIS ICD-10 B55

Dr. Nadia Aziz Nasir

C.A.B.C.M.

Department of community medicine

Baghdad medical college

Community

Objectives

1- Define LEISHMANIASIS, its types, visceral &
cutaneous.

2- identify sign & symptoms & its occurrence

3- identify the mode of transmission

4- identify the incubation period & methods of
controlling the disease.

I. CUTANEOUS AND MUCOSAL

LEISHMANIASIS ICD-10 B55.1, B55.2

A polymorphic

protozoan

disease of

skin

and

mucous membranes

caused by several species

of the genus Leishmania.
These protozoa exist as obligate

intracellular

parasites in humans and other mammalian
hosts.

CUTANEOUS AND MUCOSAL

LEISHMANIASIS

The disease starts with a

macule

then a

papule

that enlarges and typically becomes an

indolent

ulcer

Lesions may be single or multiple, occasionally non
ulcerative and diffuse.
Lesions may

heal spontaneously within weeks to

months

, or last for a year or more.

CUTANEOUS AND MUCOSAL

LEISHMANIASIS

In some individuals, certain strains can
disseminate to cause

mucosal lesions (espundia)

These sequelae, which involve

nasopharyngeal

tissues, are characterized by

progressive tissue

destruction

and often scanty presence of

parasites and can be severely disfiguring.

Diagnosis

Microscope

identification

of the nonmotile,

intracellular form (amastigote) in stained
specimens from lesions.

Culture

of the motile, extracellular form

(promastigote) on suitable media.

Diagnosis

Intradermal (Montenegro)

test with antigen

derived from the promastigotes, it is

negative

very

early lesions

immunosuppressed

patients.

Serological (IFA or ELISA)

testing for mucosal

leishmaniasis

Infectious agents

Eastern hemisphere: Leishmania tropica,

L. major, L. aethiopica

western hemisphere: L. braziliensis and

L. mexicana complexes.

Infectious agents

Members of

L. donovani

complex usually cause

visceral disease in the eastern hemisphere,

in the western hemisphere the responsible
organism is

infantum/chagasi

Occurrence

2 million new cases per year
In the eastern hemisphere,

urban

population

groups, including children, are at risk for

anthroponotic

cutaneous leishmaniasis

due to

L. tropica

rural

areas, people are at risk for

zoonotic

cutaneous leishmaniasis due to

L. major

Reservoir

Humans

(in anthroponotic cutaneous

leishmaniasis),

wild rodents

(gerbils), hyraxes,

marsupials and

domestic dogs

Mode of transmission

From the animal reservoir through

the bite of

infective female phlebotomines (sandflies).

Motile promastigotes develop and multiply in
the gut of the sandfly after it has fed on an
infected mammalian host
In

8–20

days, infective parasites develop and are

injected during biting.

Incubation period

At least a

week

, up to

many months

Period of communicability

Not directly transmitted from person to person,
but

infectious to sandflies

as long as parasites

remain in lesions in untreated cases, usually a
few months to 2 years.
Eventual

spontaneous healing

occurs in most

cases.

Susceptibility

Is probably general.

Lifelong

immunity may be present after lesions

due to L. tropica or L. major heal

Methods of control

A. Preventive measures:

Currently no vaccine available.

1) Case management:

Detect

cases systematically

and

treat

rapidly. This applies to all forms of

leishmaniasis and is one of the important
measures to prevent development of destructive

mucosal lesions

Preventive measures

2) Vector control:
Apply

residual insecticides

periodically.

Phlebotomine sandflies have a relatively

short flight

range and are highly susceptible to control by systematic
spraying with residual insecticides.
Possible breeding places of sandflies, such as stone
walls, animal houses and rubbish heaps, must be
sprayed.

Preventive measures

Insecticide-treated

bednets

are a good vector

control alternative, especially in anthroponotic
foci.

Preventive measures

3) Destroy gerbils (and their burrows)
implicated as reservoirs in local areas by deep
ploughing and removal of plants they feed on.

B. Control of patient, contacts and the

immediate environment

Specific treatment:

1- Mainly

pentavalent antimonials

, either

sodium stibogluconate, or meglumine
antimonate

B. Control of patient, contacts and the

immediate environment

Pentamidine

is used as a second line drug for

cutaneous leishmaniasis.

Imidazoles

, ketoconazole and itraconazole

Amphotericin B

for mucosal disease if this

does not respond to antimonial therapy.

II. VISCERAL LEISHMANIASIS

(Kala-azar) ICD-10 B55.0

A chronic systemic disease caused by

intracellular

protozoa

of the genus Leishmania.

The disease is characterized by

fever

hepatosplenomegaly, lymphadenopathy, anemia,
leukopenia, thrombocytopenia

and progressive

emaciation and weakness.
Untreated clinically evident disease

is usually fatal.

VISCERAL LEISHMANIASIS

Fever

is of

gradual

sudden

onset,

persistent

and

irregular

, often with

two daily

peaks

, alternating periods of

apyrexia and low-grade fever.

Post-kala-azar

dermal

lesions

may occur after

apparent cure of systemic disease.

VISCERAL LEISHMANIASIS

Leishmania/HIV co-infection

is a well-known

entity in southern Europe, and in eastern Africa
and in Asia.

Diagnosis

Culture

of the organism from a biopsy

specimen or aspirated material
2-

Demonstration of intracellular amastigotes

stained smears from bone marrow, spleen, liver,
lymph nodes or blood
3-

PCR

technique is the most sensitive but

expensive.

Diagnosis

4- Serological diagnosis is based on

IFA

and

ELISA

, tests that are expensive

5- Freeze-dried antigen (

DAT

) and

dipsticks

(k39/k26) are inexpensive, easy to use and
reliable

Infectious agents

Typically Leishmania donovani, L. infantum

and L. infantum/chagasi.

Occurrence

Visceral leishmaniasis occurs with a yearly
incidence of 500 000 cases
the disease occurs as scattered cases among

infants

children

and

adolescents

but

occasionally in epidemic waves.
Incidence is modified by the use of antimalarial
insecticides.

Reservoir

Include

humans

wild

Canidae

(foxes and

jackals) and

domestic dogs

Mode of transmission

Through bite of infected phlebotomine sandflies.
In anthroponotic visceral leishmaniasis,

humans

are the only reservoir and transmission occurs
through the sandfly bite.
In zoonotic visceral leishmaniasis,

dogs

, constitute

the main source of infection for sandflies.

Person-to-person

transmission has been reported

in intravenous drug users

Incubation period

Generally

2–6 months

, range is 10 days to

years.

Susceptibility

Kala-azar induces

lasting homologous

immunity.

Asymptomatic

and

subclinical

infections

are

common.

Malnutrition

AIDS

predisposes to

reactivation of latent infections

Treatment

Pentavalent antimonials

is the first-line drugs.

Sodium stibogluconate, and meglumine
antimonate are effective.

Amphotericin B

pentamidine

for cases not

responding to antimony (not used routinely
because of

toxicity

& its price restricts use to

industrialized countries).

Treatment

Aminosidine

(paramomycin), a good for

combination therapy with antimonials therapy.