Cutaneous Leishmaniasis Overview
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Questions and Answers

What is the typical progression of cutaneous leishmaniasis after an amastigote infection?

  • Nodule >> ulcer >> scar >> healing
  • Ulcer >> nodule >> healing >> scar
  • Ulcer >> healing >> nodule >> scar
  • Nodule >> ulcer >> healing >> scar (correct)

    • Which method is NOT part of the direct diagnosis of leishmaniasis?

  • Scraping the margins of the ulcer
  • Aspiration from ulcer margins
  • Culture on blood agar (correct)
  • Biopsy from the bed of the ulcer

    • What is a key characteristic of the Montenegro test used in immunodiagnosis?

  • No induration is expected
  • Induration occurs within 24 hours
  • Immediate hypersensitivity reaction
  • Induration occurs 2-3 days after administration (correct)

    • How is cutaneous leishmaniasis primarily managed?

    <p>It generally heals spontaneously in 5-12 months</p> Signup and view all the answers

    Which treatment is indicated for larger or non-healing forms of cutaneous leishmaniasis?

    <p>Pentavalent antimonial sodium stibogluconate</p> Signup and view all the answers

    What is the primary mode of transmission for Leishmaniasis?

    <p>Female sand flies</p> Signup and view all the answers

    Which of the following is NOT a clinical group of Leishmaniasis?

    <p>Cerebral leishmaniasis</p> Signup and view all the answers

    Which species is associated with Visceral leishmaniasis?

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

    Who first identified visceral leishmaniasis?

    <p>William Leishman</p> Signup and view all the answers

    Which genus of sand flies is responsible for transmitting the Old World leishmanias?

    <p>Phlebotomus</p> Signup and view all the answers

    Which Leishmania species is primarily associated with Mucocutaneous leishmaniasis?

    <p>Leishmania braziliensis</p> Signup and view all the answers

    What are the general features of the genus Leishmania?

    <p>Intracellular flagellate protozoan parasites</p> Signup and view all the answers

    Which of the following regions is associated with the L. tropica complex?

    <p>Old World (Africa, Asia, Europe)</p> Signup and view all the answers

    What is the primary reservoir host for visceral leishmaniasis kala-azar?

    <p>Dogs and Cats</p> Signup and view all the answers

    In which regions is visceral leishmaniasis kala-azar endemic?

    <p>Eastern Africa</p> Signup and view all the answers

    What morphological form of the organism occurs in mammals during visceral leishmaniasis?

    <p>Amastigote</p> Signup and view all the answers

    What is the method of infection for visceral leishmaniasis?

    <p>Bite of female sand fly</p> Signup and view all the answers

    Which symptom is NOT associated with the clinical picture of visceral leishmaniasis?

    <p>Joint pain</p> Signup and view all the answers

    What happens to promastigotes after they are phagocytized by macrophages in visceral leishmaniasis?

    <p>They change to amastigotes and multiply</p> Signup and view all the answers

    Which complication can occur in severe cases of visceral leishmaniasis?

    <p>Glomerulonephritis</p> Signup and view all the answers

    Which of the following is a characteristic feature of the amastigote form of leishmaniasis?

    <p>Round or oval and non-motile</p> Signup and view all the answers

    What is the characteristic skin manifestation associated with visceral leishmaniasis?

    <p>Butterfly erythema</p> Signup and view all the answers

    Which diagnostic method is NOT used for visceral leishmaniasis?

    <p>Urine analysis for parasites</p> Signup and view all the answers

    What is the first line treatment for visceral leishmaniasis?

    <p>Sodium stibogluconate (SSG)</p> Signup and view all the answers

    Which serological test is used in the immunodiagnosis of leishmaniasis?

    <p>ELISA</p> Signup and view all the answers

    What vector is primarily responsible for transmitting cutaneous leishmaniasis?

    <p>Sand fly</p> Signup and view all the answers

    Which of these is a characteristic feature of L.major-related cutaneous leishmaniasis?

    <p>Marked inflammation and crusting</p> Signup and view all the answers

    How long can post-kala azar dermal leishmaniasis persist in patients?

    <p>20 years</p> Signup and view all the answers

    What is NOT a recommended control measure against leishmaniasis?

    <p>Prophylactic antibiotics</p> Signup and view all the answers

    Study Notes

    Leishmaniasis

    • Leishmaniasis is a zoonotic, chronic inflammatory disease affecting skin, mucous membranes, or viscera.
    • It's caused by obligate intracellular flagellate protozoan parasites.

    Objectives

    • Students will identify the general features of the Leishmania genus.
    • Students will list the causative agents of leishmaniasis.
    • Students will list the vectors responsible for transmitting leishmaniasis.
    • Students will discuss the epidemiology, habitat, life cycle, pathogenesis, and clinical aspects of leishmaniasis.
    • Students will discuss the laboratory diagnosis of leishmaniasis.
    • Students will discuss the treatment, prevention, and control of leishmaniasis.

    Leishmaniasis Description

    • Leishmaniasis is a zoonotic chronic inflammatory disease of the skin, mucous membranes, or viscera.
    • Caused by obligate intracellular flagellate protozoan parasites.

    History

    • William Leishman identified visceral leishmaniasis in Dum-Dum village, Calcutta, India (1903) - also known as Dum-Dum fever.
    • Charles Donovan (1903) identified the parasite and named the Leishmania-Donovan (LD body)

    Transmission

    • Leishmaniasis is transmitted by female sand flies.
    • New World leishmaniasis is transmitted by Lutzomyia sand flies.
    • Old World leishmaniasis is transmitted by Phlebotomus sand flies.

    Classification

    • Visceral leishmaniasis (kala-azar) from the L. donovani complex—includes species infecting Africa, Asia, and Europe.
      • L. donovani, L. infantum, L. chagasi.
    • Cutaneous leishmaniasis from the L. tropica complex—affects Africa, Asia, and Europe.
      • L. tropica minor, L. tropica major
    • Mucocutaneous leishmaniasis from L. braziliensis complex affects South America.
      • L. braziliensis
    • L. mexicana complex affects South America.
      • L. mexicana

    Visceral Leishmaniasis (Kala-azar) Description

    • The L. donovani complex causes visceral leishmaniasis in the old world.
    • The primary reservoirs are dogs and cats.
    • Transmission occurs through the bite of female sandflies of the genus Phlebotomus.
    • The parasite develops from promastigote to amastigote.
    • Amastigotes multiply in macrophages.
    • The main endemic area in Sudan is in the eastern part of the country, stretching from the western part of the White Nile to the Sudanese-Ethiopian border in the east.

    Life Cycle

    • The parasite has two forms:
      • Intracellular, non-flagellated amastigotes (Leishman-Donovan bodies). These are found in mammals
      • Promastigotes
    • Sand flies transmit the infective promastigote stage.
    • Promastigotes transform into amastigotes after phagocytosis by macrophages.
    • Amastigotes reproduce and fill the macrophages' cytoplasm.

    Promastigote

    • Found in the insect midgut. Its elongated, motile, and flagellated form.

    Amastigote

    • Found in the mammalian reticuloendothelial system.
    • Round or oval in shape. Non-motile.
    • Thin cell membrane and a dense nucleus.
    • A rod-shaped kinetoplast within the cytoplasm.

    Visceral Leishmaniasis Pathogenesis & Clinical Picture

    • Leishmanioma, often seen in African cases.
    • Intermittent fever, hepatosplenomegaly, generalized lymphadenopathy, and diarrhea.
    • Bone marrow depletion and pancytopenia.
    • Secondary infections contribute to loss and death.
    • Reverse albumin/globulin ratio (hypergammaglobulinemia)
    • Glomerulonephritis due to immune complex deposition.

    Visceral Leishmaniasis Kala-Azar Skin

    • Hyperpigmentation (black fever).
    • Butterfly erythema on the nose and cheeks.
    • Post kala-azar dermal leishmaniasis: Maculopapular hypo-pigmented areas starting on the face.
    • Response to antimony treatment and immune-mediated factors increased amastigotes, making patients reservoirs.

    Diagnosis

    • History and clinical picture (e.g., typical ulcer).
    • Direct diagnosis by aspiration or biopsy from ulcer margins. Amastigotes are found in macrophages.
    • Culture (NNN media) yields promastigotes.
    • Immunodiagnosis using Montenegro leishmanin test (intradermal test, induration in 2-3 days).
    • Serology (ELISA, IFA).
    • PCR

    Treatment

    • First-line treatment for visceral leishmaniasis: Pentavalent antimonial drug --Sodium stibogluconate (SSG)—effective in Sudan.
    • Amphotericin B deoxycholate or pentamidine.
    • Allopurinol in AIDS cases.
    • Splenectomy for recurrent cases.

    Management of Cutaneous Leishmaniasis

    • Single lesions heal spontaneously in 5-12 months.
    • Treat with antibiotics, if the ulcer is secondarily infected.
    • Larger or non-healing cutaneous forms require pentavalent antimonials (e.g., sodium stibogluconate).

    Control

    • Treat all cases.
    • Control animal reservoirs.
    • Control sandfly populations.

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    Leishmaniasis Lecture Notes PDF

    Description

    Test your knowledge about cutaneous leishmaniasis, including its progression after infection, diagnostic methods, and management strategies. Explore key aspects such as the Montenegro test and treatment options for varying forms of this infection.

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