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CUTANEOUS LEISHMANIASIS

CUTANEOUS LEISHMANIASIS. Anam Saghir 12-10007. Cutaneous Leishmaniasis. Infectious disease Skin Popular names:         “Oriental Sore”, "Bay sore," or “Delhi Boil”. Epidemiology and Importance in Pakistan. 1.5 million Afghanistan, Iran, Iraq, Algeria, Saudi Arabia, Peru, and Pakistan.

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CUTANEOUS LEISHMANIASIS

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  1. CUTANEOUS LEISHMANIASIS Anam Saghir 12-10007

  2. Cutaneous Leishmaniasis • Infectious disease • Skin Popular names:         “Oriental Sore”, "Bay sore," or “Delhi Boil”.

  3. Epidemiology and Importance in Pakistan • 1.5 million • Afghanistan, Iran, Iraq, Algeria, Saudi Arabia, Peru, and Pakistan. • endemic in 88 countries,72 developing countries,350 million (WHO)

  4. Hindukush and Karakoram sub mountain range (Chitral, Dir and Gilgit) • Himalayan sub mountain range (Mansehra, Abbottabad, Rawalpindi) • Kirthar and Suleman sub mountain range (Lasbela, Khuzdar,D.G.Khan, Rajanpur, Jacobabad, Larkana) • Toba Kakar sub mountain range (Quetta, Qila Abdullah, Pishin, Qila Saifullah) KPK and FATA

  5. Causative Organism protozoa of genus Leishmania Leishman and Donovan  (1903) 20 species---------- human infecions

  6. Cutaneous leishmaniasis causing organism Leishmania tropica major Leishmania tropica minor Leishmania aethiopica Leishmania mexicana

  7. VECTOR Sand fly (Phlebotomus and Lutzomyia) • 30  species • tiny • no noise • unnoticeable bite

  8. lesions (a small reddish blue sore ) • Size and appearance

  9. PATEINTS RESPONSES • ANERGIC RESPONSE: • formation of small papule • nodular plaque • no ulcer formation 2.  HYPERSENSTIVE RESPONSE: • papule appears • raised borders and ulcer in the centre • 3-4 months • secondary infection • healing 90% • hyperpigmented and irregular scar

  10. Promastigote and amastigote

  11. LIFE CYCLE

  12. DIAGNOSTIC TEST Clinical diagnosis: • history of origin specifying the endemic area of residence at the time of development of symptoms • morphology of the lesions • character of the lesions parasitalogical, immunological and molecular tests

  13. PARASITLOGICAL TEST • direct microscopic examination • culture • hamster inoculation

  14. Skin biopsy specimen • Skin biopsy • Excision biopsy • Incisional biopsy • Shave / tangential biopsy • Punch biopsy • Curettings • Fine Needle Aspiration touch prepations, smears, histopathology, cultures in different media (NMN, BHI, EMTM etc., )

  15. SLIT SKIN SMEAR: • margin of the lesion contains amastigotes • area is punctred • syringe is injected • aspirated is taken • examined microscopically or cultured CUTANEOUS SCRAPPING: • proper cleaning and drying • centre and margins of ulcered lesions • multiple slides • +VE or -VE

  16. IMMUNOLOGICAL TEST: Montenegro skin test ELISA Indirect Fluorescence Antibody Test (IFAT) Direct Agglutination Test (DAT) MOLECULAR TEST: PCR DNA hybridization kinetoplast DNA MOLECULAR AND IMMUNOLOGICAL TESTS:

  17. TREATMENT No treatment – self-healing lesions Medical: Pentavalent antimony (Pentostam), Amphotericin B Topical paromomycin Surgical: Cryosurgery Excision Curettage

  18. PREVENTION • usage of  insect repellents such as DEET • cover the exposed skin • staying on higher floors of buildings in the evening or at night • usage of fans • insecticidal sprays • Insecticide-treated bed nets, sheets and window curtains • pumping of insecticides in rodent burrows to kill rodents • treatment can also be considered a preventive measure Vaccines.......

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