Leishmania Species and Transmission Quiz
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Questions and Answers

Which key group of parasites does Leishmania belong to?

  • Bacteria
  • Helminths
  • Protozoa (correct)
  • Fungi

Within the Protozoa, Leishmania is categorized under which subgroup?

  • Sporozoa
  • Flagellates (correct)
  • Amoebae
  • Ciliates

What type of organisms are classified as Metazoan Parasites?

  • Bacteria and viruses
  • Parasites with a single cell
  • Parasites with complex body systems (correct)
  • Fungi and yeasts

Which arthropod is responsible for transmitting Leishmania to humans?

<p>Sandflies (B)</p> Signup and view all the answers

What characteristic differentiates Protozoa from other parasitic groups?

<p>They are unicellular organisms (C)</p> Signup and view all the answers

What happens to mononuclear cells in blood during disease?

<p>They do not produce interferon gamma. (D)</p> Signup and view all the answers

Which test is performed first if visceral leishmaniasis is suspected?

<p>Complete blood count (CBC). (C)</p> Signup and view all the answers

What is the confirmatory test for visceral leishmaniasis?

<p>Bone marrow aspirate/biopsy. (D)</p> Signup and view all the answers

What is a disadvantage of culture methods in diagnosing visceral leishmaniasis?

<p>It takes several weeks for results to appear. (C)</p> Signup and view all the answers

What can the Buffy Coat method detect in positive cases?

<p>WBCs, platelets, and parasites microscopically. (D)</p> Signup and view all the answers

Which of the following is a method used to distinguish species of parasites during diagnosis?

<p>Isoenzyme analysis during culture. (C)</p> Signup and view all the answers

What role does interferon gamma play in the context of persistent parasites?

<p>It causes skin inflammation as a reaction. (A)</p> Signup and view all the answers

What is a significant advantage of using PCR technique for diagnosing Leishmaniasis?

<p>Results appear within days. (A)</p> Signup and view all the answers

Which of the following represents a limitation of serological tests?

<p>They can only detect antibodies, not the actual infection. (D)</p> Signup and view all the answers

Which characteristic is true regarding molecular techniques in diagnosing visceral leishmaniasis?

<p>They are primarily a research tool. (D)</p> Signup and view all the answers

Which of the following reflects a disadvantage of the PCR diagnostic method for Leishmaniasis?

<p>It is an expensive diagnostic method. (D)</p> Signup and view all the answers

What is a key indicator that a patient is infective to biting sand flies?

<p>Skin inflammation due to parasites. (D)</p> Signup and view all the answers

Which treatment method is NOT used for healing ulcers caused by Cutaneous Leishmaniasis?

<p>Topical application of antifungal cream (A)</p> Signup and view all the answers

What is an essential task for the prevention and control of Leishmaniasis from the Ministry of Health?

<p>Treatment of patients (B)</p> Signup and view all the answers

Liposomal Amphotericin B is used for the treatment of which form of Leishmaniasis?

<p>Both Cutaneous and Visceral Leishmaniasis (C)</p> Signup and view all the answers

What method is suggested for control of the sand fly vector in Leishmaniasis prevention?

<p>Using wire screens and repellents (A)</p> Signup and view all the answers

In a case of suspected visceral Leishmaniasis, what is crucial to confirm the diagnosis?

<p>Bone marrow aspirate examination (A)</p> Signup and view all the answers

What is a common symptom associated with visceral Leishmaniasis as described in the case?

<p>High fever with intermittent patterns (B)</p> Signup and view all the answers

What type of organism is recovered from the culture of an aspirate in a case diagnosed as a parasitic infection leading to a wound?

<p>Amastigote forms (B)</p> Signup and view all the answers

Which symptom is characterized by a double daily rise in fever, specific to visceral leishmaniasis?

<p>Intermittent with double daily rise (D)</p> Signup and view all the answers

What major organ is primarily affected in visceral leishmaniasis, leading to significant enlargement?

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

What condition is characterized by low blood counts of red cells, white cells, and platelets in visceral leishmaniasis?

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

Which of the following is a potential consequence of untreated visceral leishmaniasis?

<p>Emaciation (B)</p> Signup and view all the answers

What is the primary mode of transmission for visceral leishmaniasis?

<p>Vector-borne through sand flies (D)</p> Signup and view all the answers

What type of lesion occurs after incomplete treatment of visceral leishmaniasis and is characterized by hyperpigmented skin areas?

<p>Post kala azar dermal leishmaniasis (PKDL) (A)</p> Signup and view all the answers

In which region of the world has visceral leishmaniasis been historically recorded, particularly in India?

<p>South Asia (B)</p> Signup and view all the answers

Which cells in the reticuloendothelial system are primarily infected by amastigotes of Leishmania?

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

What type of blood cells experience high counts of immunoglobulins in patients with visceral leishmaniasis?

<p>B lymphocytes (A)</p> Signup and view all the answers

Which of the following conditions results from the suppression of cell-mediated immunity due to Leishmania infection?

<p>Increased susceptibility to opportunistic infections (A)</p> Signup and view all the answers

What is the primary challenge in treating visceral leishmaniasis that contributes to the development of PKDL?

<p>Insufficient treatment duration (B)</p> Signup and view all the answers

Which of the following is NOT typically a clinical feature of visceral leishmaniasis?

<p>Skin rashes on healthy areas (A)</p> Signup and view all the answers

Which Leishmania species is primarily associated with visceral leishmaniasis cases in India?

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

What are the two developmental stages of the Leishmania parasite?

<p>Amastigote and Promastigote (B)</p> Signup and view all the answers

How does the sand fly contribute to the transmission of Leishmania?

<p>It injects Promastigotes at the site of the bite. (D)</p> Signup and view all the answers

What characterizes the pathogenesis of cutaneous leishmaniasis?

<p>Amastigotes multiply in skin macrophages. (B)</p> Signup and view all the answers

What is a common clinical feature of cutaneous leishmaniasis?

<p>An ulcer with a sharp-cut indurated margin. (B)</p> Signup and view all the answers

Which Leishmania species are known to cause skin ulcers in the Middle East?

<p>Leishmania tropica and Leishmania major (C)</p> Signup and view all the answers

What is the method used to microscopically detect amastigote stages?

<p>Microscopic examination of necrotic tissue (C)</p> Signup and view all the answers

What is the significance of the nodule formation at the site of a bite in cutaneous leishmaniasis?

<p>It represents the body’s immune response to the promastigotes. (A)</p> Signup and view all the answers

What characterizes Leishmania species causing muco-cutaneous leishmaniasis?

<p>Spread along lymphatics leading to mucous membrane erosion (D)</p> Signup and view all the answers

What happens to the Leishmania species in the human system after an infection?

<p>They may remain dormant for years before causing symptoms. (C)</p> Signup and view all the answers

How long does it typically take to obtain results from the culture of aspirates or scrapings for leishmaniasis diagnosis?

<p>Several weeks (B)</p> Signup and view all the answers

What is a major risk factor for leishmaniasis that affects certain regions?

<p>Presence of infected sand flies in ecological zones (C)</p> Signup and view all the answers

What distinguishes Leishmania aethiopica from other species?

<p>It does not heal or ulcerate. (D)</p> Signup and view all the answers

What is the primary host response observed in cutaneous leishmaniasis?

<p>Granulomatous tissue response around the parasite (A)</p> Signup and view all the answers

Which method is primarily used to determine the species of Leishmania after isolation?

<p>Isoenzyme analysis (D)</p> Signup and view all the answers

Flashcards

Leishmania species

A type of parasite that affects human blood and tissues, causing leishmaniasis.

Leishmaniasis

A disease caused by Leishmania species infection.

Protozoan Parasites

Group of parasites that have a single-celled body structure.

Flagellates

A subgroup of Protozoa; Leishmania belongs to this group.

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Key Groups of Parasites (for humans)

Categories of parasites grouped by their structural characteristics and mode of infection.

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Sand Fly

A type of insect that transmits Leishmania parasites to humans through bites.

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Amastigote

The intracellular stage of Leishmania, found within the host's cells, such as macrophages.

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Promastigote

The extracellular stage of Leishmania, found in the gut of the sand fly. This is the infectious form transmitted to humans.

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How does Leishmania infection spread?

Infected sand flies ingest amastigotes from humans, which develop into promastigotes in the fly's gut. The fly then transmits these infectious promastigotes to new hosts via bites.

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Cutaneous Leishmaniasis

A skin infection caused by Leishmania parasites, characterized by ulcers and lesions.

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Visceral Leishmaniasis

A severe form of leishmaniasis that affects internal organs, particularly the liver, spleen, and bone marrow.

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Nodule

A small, hard lump that forms at the site of a Leishmania infection, often developing into an ulcer.

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Leishmania tropica

A species of Leishmania that causes dry ulcers, typical of the Oriental Sore.

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Leishmania major

A species of Leishmania that causes wet ulcers, a common type of cutaneous leishmaniasis.

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Leishmania aethiopica

A species of Leishmania that causes nodular lesions that do not heal or ulcerate, especially in immunocompromised individuals.

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Mucocutaneous Leishmaniasis

A severe form of Leishmaniasis caused by some Leishmania species, affecting mucous membranes, such as the nose and mouth.

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Laboratory Diagnosis of Cutaneous Leishmaniasis

Analyzing tissue samples for the presence of Leishmania parasites, typically by microscopic examination, culture, or molecular techniques.

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Amastigote Detection

Microscopic identification of the amastigote stage of Leishmania in tissue samples taken from the edge of the ulcer.

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Leishmania Culture

Growing Leishmania parasites from a sample in a suitable laboratory medium to obtain the promastigote stage.

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PCR for Leishmaniasis

A diagnostic method that detects Leishmania DNA in patient blood or tissue using PCR (polymerase chain reaction).

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PCR Advantages

PCR for Leishmaniasis is fast (results in days), sensitive, and identifies the specific Leishmania species.

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PCR Disadvantages

PCR for Leishmaniasis is expensive and requires specialized lab equipment.

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Sodium Stibogluconate

A drug used to treat leishmaniasis, given intramuscularly.

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Liposomal Amphotericin B

A newer drug for leishmaniasis, given intravenously (into the vein).

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Treatment of Cutaneous Leishmaniasis

Involves not only drug treatment (sodium stibogluconate, liposomal amphotericin B), but also ulcer care through methods such as injection, paste, freezing or even surgery.

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Prevention & Control: Ministry of Health

The Ministry of Health plays a role in leishmaniasis control by treating patients, controlling sand fly populations, and promoting vaccination in endemic areas.

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Prevention & Control: Individuals

Individuals can protect themselves from leishmaniasis using protective measures, such as insect repellents, mosquito nets, and wire screens.

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Interferon Gamma in Leishmaniasis

A protein produced by immune cells (mononuclear cells) during the recovery phase of Leishmaniasis. Its presence indicates the body is fighting the infection and is associated with inflammation in the skin.

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Infective Stage of Leishmaniasis

The point in the disease where the patient can transmit the Leishmaniasis parasite to another person. This is connected to the presence of interferon gamma and skin inflammation.

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Complete Blood Count (CBC)

A standard blood test that measures the number of red blood cells, white blood cells, and platelets. It's often the first step in diagnosing Visceral Leishmaniasis.

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Bone Marrow Aspirate/Biopsy

A medical procedure where a sample of bone marrow is taken for examination. This is used to find the Leishmania parasite itself (amastigotes) to confirm Visceral Leishmaniasis.

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Culture for Leishmaniasis

A lab technique where blood or tissue samples are grown on special media to identify Leishmania parasites. This method allows for seeing the promastigotes stage of the parasite.

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Buffy Coat Method

A laboratory technique for detecting Leishmania parasites in blood. It separates the blood into plasma, a dense layer of red blood cells, and a 'buffy coat' containing white blood cells and parasites.

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Serological Tests for Leishmaniasis

Blood tests that look for antibodies (proteins that fight infection) specifically against Leishmania parasites. They help to detect past or current infection.

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Molecular Techniques for Leishmaniasis

Specialized lab methods used to study the DNA or RNA of the Leishmania parasite. They help to identify the specific type of parasite present.

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What is Leishmaniasis?

A disease caused by Leishmania parasites, which are protozoa that infect macrophages, the body's immune cells.

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Which species causes visceral leishmaniasis?

The Leishmania species responsible for visceral leishmaniasis varies depending on the geographical location. In the Americas, Leishmania chagasi is the main cause, while in the Old World (Europe, Asia, and Africa), Leishmania donovani predominantly causes the disease.

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What is the vector for Leishmaniasis?

Leishmaniasis is transmitted through the bite of infected female sandflies. These flies pick up the parasites during a blood meal from an infected animal or human and then transmit them to another host.

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What is the lifecycle of Leishmania?

Leishmania parasites have two main stages in their lifecycle: promastigotes and amastigotes. Promastigotes are found in the sandfly and are mobile, while amastigotes are the non-mobile stage found inside the host's macrophages.

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What is the most prominent symptom of visceral leishmaniasis?

Hepatosplenomegaly, an enlargement of the liver and spleen, is a hallmark symptom of visceral leishmaniasis. This occurs because the parasites multiply within macrophages that accumulate in these organs.

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Why is Visceral Leishmaniasis called Kala Azar?

Kala Azar, meaning 'black fever' in Hindi, refers to the darkening of the skin that can occur in patients with visceral leishmaniasis due to the accumulation of melanin. This symptom is not always present but is a characteristic feature of the disease.

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Why is visceral leishmaniasis dangerous?

Visceral leishmaniasis can be life-threatening if left untreated. The parasite can cause severe damage to vital organs, leading to organ failure and death. Additionally, the disease weakens the immune system, making the patient susceptible to other infections.

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What is the 'Dum-Dum fever'?

Dum-Dum fever, named after a town in Calcutta, India, is another name for Visceral Leishmaniasis, reflecting the cyclical, spiking fever pattern often seen in the disease due to the parasite's multiplication.

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What is Post Kala Azar Dermal Leishmaniasis (PKDL)?

PKDL is a form of leishmaniasis that develops after treatment of visceral leishmaniasis. People with a weakened immune system or incomplete treatment are more likely to develop PKDL.

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What is the connection between PKDL and Interleukin-10?

High levels of Interleukin-10 (IL-10) in the blood of visceral leishmaniasis patients are a predictor for developing PKDL. IL-10 suppresses the immune response, making it easier for the parasite to persist and cause PKDL later.

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What are the specific locations where Leishmania amastigotes are found in the body?

Amastigotes, the non-motile stage of Leishmania, are found mainly in the macrophages of the reticuloendothelial system (RES) which includes organs like the liver, spleen, and bone marrow.

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How does Leishmania affect red blood cells?

Leishmania infection can cause aplastic anemia, a condition where the bone marrow fails to produce enough red blood cells. This is due to the parasite's impact on the bone marrow, where red blood cell production takes place.

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Why does Leishmaniasis lead to an increase in immunoglobulin levels?

The immune system's response to Leishmania infection involves producing high levels of antibodies, which are also known as immunoglobulins. This is a way to try to fight off the infection, but it can sometimes be ineffective against intracellular parasites like Leishmania.

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Why does Leishmaniasis cause enlarged lymph nodes?

Lymph nodes are part of the lymphatic system, which helps to filter out waste and fight infection. When the body is infected with Leishmania, the lymph nodes become enlarged as they try to combat the parasite's spread.

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Why is Leishmaniasis called 'Pancytopenia'?

In visceral leishmaniasis, there's a reduction in all blood cell types - red blood cells, white blood cells, and platelets. This is called pancytopenia. This happens because the parasite affects the bone marrow, where these cells are produced.

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Study Notes

Leishmania Species

  • Leishmania is a parasite affecting human blood and tissues.
  • Leishmania is a protozoan parasite, belonging to the group termed Protozoa.
  • Leishmania species belong to flagellates.
  • Leishmania species are transmitted to humans by the bite of an infective female sand fly ( Phlebotomus papatasii or Lutzomyia).

Leishmania Stages

  • Leishmania has two developmental stages:
    • Amastigote: develops inside the patient's body.
    • Promastigote: develops outside the patient's body.
  • Leishmania differentiates via isoenzyme analysis, molecular methods, or monoclonal antibodies.

Transmission

  • Sand flies transmit Leishmania infection.
  • When a sandfly bites an infected person, it ingests amastigotes.
  • Inside the sandfly, amastigotes develop into promastigotes.
  • The bite injects the promastigotes into a healthy person.

Types of Leishmaniasis

  • Cutaneous Leishmaniasis: Leishmania attacks human skin.
    • A nodule develops at the site of the bite due to Leishmania multiplication and a granulomatous reaction.
    • An ulcer forms with a sharp margin, healing to leave a disfiguring scar in about a year.
    • Patients develop permanent immunity to the infecting Leishmania species.
  • Visceral Leishmaniasis:Leishmania attacks human viscera (internal organs).
    • Affected organs include bone marrow, lymph nodes, liver, and spleen.

Geographic Distribution

  • Leishmaniasis is prevalent in the Middle East and Africa, and parts of South America and Central America.
    • Various species of Leishmania are associated with different regional types of skin ulcers.
  • Globally, 12 million people are infected and 350 million people are at risk.
  • Geographical regions with high incidences of Leishmania infections are highlighted on a global map.

Diagnosis of Cutaneous Leishmaniasis

  • Clinicians look for ulcers with sharp, hard, and rough margins.
  • Laboratory diagnosis involves microscopic examination of the lesion edge for amastigotes.
  • Tissue samples can be obtained via aspiration, scraping, or biopsy for diagnosis. The sample can then be stained with Giemsa to view the amastigotes.
  • Cultures of the aspirate can be grown to detect the promastigotes and identify the infecting species using isoenzyme analysis.
  • This takes several weeks for results to appear.

Diagnosis of Visceral Leishmaniasis

  • Blood tests (Complete Blood Count) are performed.
  • If red blood cells, white blood cells, or platelets are low, bone marrow biopsy (or liver, lymph node, or spleen biopsy) is performed. This confirms the presence of Leishmania amastigotes.
  • Leishmania diagnosis can also be determined by culture, buffy coat method or serological testing.
  • Molecular techniques such as PCR can detect parasite DNA in the patient's blood or tissue.

Treatment

  • Cutaneous and Visceral Leishmaniasis can be treated with sodium stibogluconate (Pentostam).
  • Liposomal Amphotericin B (AmBisome) is a newer treatment option.
  • Other treatment for ulcer includes: intralesional injection of pentostam, paste, heating, freezing with nitrogen and plastic surgery.

Prevention

  • Individuals can protect themselves from sand fly bites through using wire screens, repellents, and bed nets.
  • Health ministries should treat patients, control sand flies, and vaccinate in endemic areas.

Quiz Questions and Answers

  • Quiz Question (page 19): What is recovered in the culture?
  • Answer (page 19): Promastigote forms
  • Quiz Question (page 37): What is the site of parasite location in patient's body?
  • Answer (page 37): Reticuloendothelial cells

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Description

Test your knowledge on Leishmania species, their life cycle, and modes of transmission. This quiz covers the stages of the parasite, including amastigote and promastigote, as well as types of leishmaniasis. Perfect for students studying parasitology or infectious diseases.

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