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Leishmaniasis

Leishmaniasis. Promastigotes of Leishmania. Amastigote of Leishmania. The life cycle of Leishmania. Leishmania Parasites and Diseases. World distribution of Visceral Leishmaniasis. Sand fly. Amastigotes of Leishmania. Promastigotes of Leishmania. lesion. lesion.

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Leishmaniasis

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  1. Leishmaniasis

  2. Promastigotes of Leishmania Amastigote of Leishmania

  3. The life cycle of Leishmania

  4. Leishmania Parasites and Diseases

  5. World distribution of Visceral Leishmaniasis

  6. Sand fly

  7. Amastigotes of Leishmania

  8. Promastigotes of Leishmania

  9. lesion

  10. lesion

  11. 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

  12. 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.

  13. Diffuse cutaneous leishmaniasis Leishmaniasis recidiva

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

  15. NNN medium

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

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

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

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

  20. Fever 2 times a day due to kala-azar

  21. Hepatosplenomegaly in visceral leishmaniasis

  22. Mucocutaneous leishmaniasis

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

  24. Bone marrow aspiration Bone marrow amastigotes

  25. (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.

  26. DAT test ELISA test

  27. Antileishmanial drugs • Pentavalentantimonials • meglumineantimoniate ,sodium stibogluconate:IM IV ,can be administered Intralesionally for the treatment of cutaneousleishmaniasis.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. • Pentamidineisethionate • 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

  28. 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

  29. 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

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