Cutaneous Leishmaniasis Overview

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Questions and Answers

Which species of Leishmania is more commonly associated with densely populated areas?

  • Leishmania braziliensis
  • Leishmania major
  • Leishmania donovani
  • Leishmania tropica (correct)

What is the primary vector responsible for transmitting Leishmania amastigotes?

  • Phlebotomus sand fly (correct)
  • Aedes mosquito
  • Anopheles mosquito
  • Culex mosquito

What type of lesions are commonly caused by Leishmania tropica and L.major?

  • Warts or fibromas
  • Dry papules that develop into ulcers (correct)
  • Hemorrhagic pustules
  • Raised, itchy mound-like structures

What is the incubation period of Leishmaniasis usually described as?

<p>A few days to several months (D)</p> Signup and view all the answers

What typically happens to the lesion caused by Leishmania infection over time?

<p>It can develop secondary infections (D)</p> Signup and view all the answers

Which of these statements is true regarding the differences between Leishmania tropica and L.major?

<p>L.tropica lesions persist longer before ulcerating compared to L.major (A)</p> Signup and view all the answers

What facilitates the infection process when a sand fly bites a mammalian host?

<p>Presence of vasodilators in sand fly saliva (C)</p> Signup and view all the answers

In diagnosing Leishmaniasis, what specifically facilitates the diagnosis?

<p>Detection of amastigotes during examination (D)</p> Signup and view all the answers

What primary lesion occurs after inoculation by a sand fly's bite?

<p>A small, red papule (A)</p> Signup and view all the answers

Which species serves as a vector for Leishmania braziliensis?

<p>Lutzomyia (C)</p> Signup and view all the answers

What is a significant secondary complication of mucocutaneous leishmaniasis?

<p>Respiratory infections (C)</p> Signup and view all the answers

What staining methods are used to visualize Leishmania in affected patients?

<p>Wright's or Giemsa's stain (A)</p> Signup and view all the answers

Which term is NOT associated with Leishmania braziliensis infections?

<p>Visceral leishmaniasis (A)</p> Signup and view all the answers

How long can the primary lesion caused by L. braziliensis take to heal?

<p>6 to 15 months (B)</p> Signup and view all the answers

What is the result of the invasion of Leishmania into the nasal system and buccal mucosa?

<p>Deformation of soft tissues (A)</p> Signup and view all the answers

What method is primarily used to confirm the diagnosis of leishmaniasis?

<p>L-D bodies identification (C)</p> Signup and view all the answers

What is the primary method by which L. donovani parasites damage the reticuloendothelial (RE) system?

<p>They are engulfed and kill successive macrophages. (A)</p> Signup and view all the answers

Which of the following is a common symptom during the late stages of L. donovani infection?

<p>Protrusion of the abdomen (B)</p> Signup and view all the answers

What is the typical incubation period for L. donovani infections in humans?

<p>2-4 months (B)</p> Signup and view all the answers

What diagnostic method is primarily used to confirm L. donovani infection?

<p>Detection of L-D bodies in tissues (C)</p> Signup and view all the answers

Which of the following symptoms is associated with severe cases of L. donovani infection?

<p>Breathing difficulty (C)</p> Signup and view all the answers

What distinguishes L. donovani from other diseases with similar symptoms during diagnosis?

<p>Detection of specific L-D bodies (A)</p> Signup and view all the answers

Which treatment is commonly administered for L. donovani infections?

<p>Injections of antimony compounds (B)</p> Signup and view all the answers

What role do neutrophils and eosinophils play in L. donovani infections?

<p>They have little effect on disease outcome. (D)</p> Signup and view all the answers

What is the primary treatment for espundialike conditions?

<p>Antimonial compounds (A)</p> Signup and view all the answers

Which organism is primarily associated with visceral leishmaniasis?

<p>Leishmania donovani (D)</p> Signup and view all the answers

Why is it challenging to control espundialike conditions?

<p>Primarily a sylvatic disease (B)</p> Signup and view all the answers

What happens to Leishmania donovani when ingested by a sand fly?

<p>It transforms into promastigotes (D)</p> Signup and view all the answers

What is a common characteristic of amastigotes of Leishmania donovani?

<p>They have a large nucleus and kinetoplast (C)</p> Signup and view all the answers

What kind of immunity is typically acquired after curing an infection by L. donovani?

<p>Lifelong immunity (D)</p> Signup and view all the answers

What is the method for diagnosing occult infections related to leishmaniasis?

<p>Skin tests (A)</p> Signup and view all the answers

What is a significant complication associated with mucocutaneous lesions of leishmaniasis?

<p>They are resistant to standard chemotherapy (D)</p> Signup and view all the answers

Flashcards

Cutaneous Leishmaniasis

A type of leishmaniasis characterized by skin sores, typically known as oriental sore, cutaneous leishmaniasis, Jericho boil, Aleppo boil, and Delhi boil.

Leishmania tropica and L.major

The parasitic protozoa responsible for cutaneous leishmaniasis, found in West Central Africa, the Middle East, and Asia Minor.

Amastigotes

Small, round parasites found within infected cells, responsible for causing cutaneous leishmaniasis.

Phlebotomus

Sandflies of the Phlebotomus genus are the intermediate hosts and vectors of cutaneous leishmaniasis.

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Incubation period

The incubation period for cutaneous leishmaniasis can range from a few days to several months, with an initial red papule at the bite site.

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Ulcer progression

The papule usually progresses into a spreading ulcer, which can coalesce with other ulcers to form a large sore. The ulcer typically heals within months, leaving a scar.

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Secondary infections in cutaneous leishmaniasis

Secondary infections, such as yaws and myiasis, can occur, leading to complications and potential disfigurement.

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Differences between L.tropica and L.major

Leishmania tropica is found in densely populated areas, characterized by a dry, persistent lesion with numerous amastigotes. L.major, found in sparsely populated regions, quickly ulcerates and contains fewer amastigotes.

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Mucocutaneous Leishmaniasis

Leishmaniasis caused by Leishmania braziliensis, characterized by skin sores that can spread to the mucous membranes of the nose and mouth.

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Primary Lesion

A small, red, itchy bump that appears at the site of a sand fly bite, marking the initial infection with Leishmania braziliensis.

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Secondary Lesion

A sore that develops months after the primary lesion, often on the nose, mouth, or other parts of the body, marking the spread of Leishmania braziliensis infection.

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Espundia

A severe form of mucocutaneous leishmaniasis caused by Leishmania braziliensis that can cause extensive disfigurement of the face.

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Lutzomyia

A type of sand fly that serves as the vector for transmitting Leishmania braziliensis.

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Promastigote

The stage of the Leishmania parasite that lives inside the sand fly.

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Dissemination

The spread of Leishmania braziliensis infection from the primary lesion to other parts of the body.

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Visceral Leishmaniasis

A condition caused by the protozoan parasite Leishmania donovani, characterized by fever, enlarged spleen and liver, and often leading to anemia and weight loss.

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Leishmania donovani

The scientific name for the parasite causing visceral leishmaniasis, discovered by Leishman and Donovan in 1900 and 1903, respectively, in India.

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Reticuloendothelial (RE) System

A group of tissues and organs, including the spleen, liver, and lymph nodes, involved in the immune response, specifically targeted by Leishmania donovani.

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Occult infection

A type of infection where the parasite is present but symptoms are not noticeable, meaning the infection is not fully active.

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Parasite Multiplication

The process of multiplying in large numbers within a host's body, a characteristic of parasites.

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Amastigotes of L. donovani

Small, round parasites found within infected macrophages, dividing by binary fission and causing the death of host cells.

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Incubation Period of L. donovani

The incubation period for visceral leishmaniasis can range from a few days to a year, but typically lasts two to four months.

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Symptoms of Visceral Leishmaniasis

Early symptoms of visceral leishmaniasis may include low-grade fever, malaise, and weight loss. Later stages involve enlarged liver and spleen, anemia, and potential death if untreated.

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Diagnosing Leishmania donovani infection

Diagnosis of visceral leishmaniasis typically involves finding amastigotes in tissues or secretions. Blood, spleen, bone marrow, and nasal smears are examined for parasites.

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Antimony Compounds for Treating L. donovani

Treatment for visceral leishmaniasis involves injecting various antimony compounds, similar to treatments for cutaneous leishmaniasis.

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Leishmania donovani Immunity

Immunity to Leishmania donovani infections is not lifelong, and reinfection is possible. Long-term immune responses are variable and not fully understood.

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The Role of the Reticuloendothelial System

The Reticuloendothelial system (RES) plays a critical role in host defense, but Leishmania parasites can significantly damage it by killing macrophages.

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Study Notes

Cutaneous Leishmaniasis

  • Caused by Leishmania tropica and L. major
  • Produces skin ulcers (oriental sore, cutaneous leishmaniasis, Jericho boil, Aleppo boil, Delhi boil)
  • Found in West Central Africa, the Middle East, and Asia Minor into India
  • Different reservoir and intermediate hosts for L. tropica and L. major
  • Lesion severity varies by age and other factors
  • Differentiated by biochemical means

Morphology and Life Cycle

  • Amastigotes of L. tropica and L. major are similar to other leishmanias
  • Intermediate hosts and vectors are sand flies of the genus Phlebotomus
  • Parasites multiply in the midgut of the sand fly, then move to the pharynx
  • Inoculated into mammalian victim, multiply in reticuloendothelial system and lymphoid cells of the skin
  • Sand flies must feed near infection site to become infected
  • Sand fly saliva contains low molecular weight compounds and peptides that facilitate infection

Pathogenesis

  • Incubation period ranges from a few days to several months
  • Initial symptom is a small red papule at the bite site
  • Papule often crusts over and ulcerates
  • Uncomplicated cases heal in 2-12 months, leaving a scar
  • Secondary infections (yaws, myiasis) are common

Diagnosis

  • Amastigotes are found in scrapings from the ulcer edge, stained with Wright's or Giemsa's stain
  • Useful in endothelial cells and monocytes
  • Cultures can be made if amastigotes aren't detected in smears
  • Differentiate between L. tropica & L. major by lesion characteristics

Leishmania braziliensis

  • Causes espundia, uta, or mucocutaneous leishmaniasis
  • Found in Central Mexico to Northern Argentina
  • Life cycle similar to L. donovani and L. tropica
  • Promastigotes reproduce in sand fly hindgut; Lutzomyia species are vectors
  • Lesion begins as a red papule, ulcerates, and heals in 6 to 15 months; secondary lesions are possible
  • Secondary lesions involve nasal system, buccal mucosa; may cause necrosis and infection.
  • Commonly affects lips, palate, and pharynx; disfigurement possible
  • Infection may last many years
  • Death from secondary infection or respiratory complications is possible

Diagnosis and Treatment

  • L bodies identified in affected tissues
  • Similar treatment to kala-azar and tropical sore: antimonial compounds applied/injected
  • Secondary bacterial infections treated with antibiotics
  • Mucocutaneous lesions often require extensive chemotherapy
  • Relapse is possible, but lifelong immunity is usual once cured
  • Control is difficult given sylvatic nature

Visceral Leishmaniasis

  • Caused by Leishmania donovani
  • Discovered in 1900 by Sir William Leishman in spleen samples
  • Also called Dum-Dum fever or kala-azar
  • Leishman-Donovan bodies are the amastigote forms

Morphology and Life Cycle

  • Amastigotes cannot be distinguished from other Leishmania spp.
  • Ovoid or rounded shape, 2-3 µm
  • Found in cells of the reticuloendothelial system (spleen, liver, lymph nodes)
  • Life cycle similar to L. tropica, but predominantly visceral
  • Amastigotes multiply in the midgut, reaching the esophagus and buccal cavity to be injected

Pathogenesis

  • Infections range from asymptomatic to progressive kala-azar
  • Incubation in humans from 10 days to a year
  • Typical symptoms: slow onset, low-grade fever, malaise, wasting, splenomegaly, hepatomegaly
  • Death in untreated cases in 2-3 years
  • Some cases have acute onset, with high fever, vomiting
  • Death within 6-12 months with complications

Diagnosis and Treatment

  • Diagnosis relies on finding L-D bodies in tissues or secretions
  • Spleen punctures, blood smears, bone marrow examination
  • Antibody tests (ELISA, IFA) to differentiate from other diseases
  • Treatment involves injections of antimony compounds
  • Secondary infections require antibiotics
  • Nursing care is essential

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