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Leishmaniasis Overview and Pathogenesis
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Leishmaniasis Overview and Pathogenesis

Created by
@BonnyWalnutTree

Questions and Answers

What is a common clinical feature seen in patients with Kala-azar?

  • Improved skin condition
  • Weight gain
  • Increased white blood cell count
  • Massive splenomegaly (correct)

    • Which laboratory finding is frequently associated with the pancytopenia observed in Kala-azar?

  • Leucopenia with neutropenia (correct)
  • Hypereosinophilia
  • Elevated hemoglobin levels
  • Increased platelet count

    • Which type of skin lesion is associated with Post Kala-azar Dermal Leishmaniasis (PKDL)?

  • Scaly patches
  • Irritated blisters
  • Depigmented macules (correct)
  • Sore ulcers

    • How does the immune response change in patients affected by leishmaniasis?

    <p>Cell mediated immunity is suppressed</p> Signup and view all the answers

    What is a typical outcome if untreated patients with Kala-azar do not receive treatment?

    <p>Death due to intercurrent disease</p> Signup and view all the answers

    Where is Post Kala-azar Dermal Leishmaniasis mainly observed?

    <p>India and East Africa</p> Signup and view all the answers

    Which of the following is NOT a prominent feature of Kala-azar?

    <p>Elevated blood pressure</p> Signup and view all the answers

    What type of antibodies are produced in excess during leishmaniasis?

    <p>Polyclonal IgG/IgM</p> Signup and view all the answers

    What type of staining is commonly used for microscopy in the diagnosis of visceral leishmaniasis?

    <p>Leishman, Giemsa, or Wright's stains</p> Signup and view all the answers

    Which body fluid is considered most valuable for the diagnosis of visceral leishmaniasis?

    <p>Splenic aspirate</p> Signup and view all the answers

    What is the sensitivity and specificity of the RDT(ICT) method for antibody detection in visceral leishmaniasis?

    <p>98% sensitivity and 90% specificity</p> Signup and view all the answers

    What type of anemia is typically seen in a full blood count for a patient with visceral leishmaniasis?

    <p>Normocytic normochromic anemia</p> Signup and view all the answers

    In which condition is lymph node aspiration not useful for diagnosis of visceral leishmaniasis?

    <p>Indian Kala-azar</p> Signup and view all the answers

    What are the potential negative implications of performing splenic aspirate for diagnosis?

    <p>It can cause dangerous bleeding</p> Signup and view all the answers

    Which diagnostic test is currently not used routinely in endemic areas for visceral leishmaniasis?

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

    What is the role of immunodiagnosis in the diagnosis of post-kala-azar dermal leishmaniasis (PKDL)?

    <p>It has no role in diagnosis</p> Signup and view all the answers

    What happens to the promastigotes once they are in the sandfly's midgut?

    <p>They begin to multiply and migrate to the mouth.</p> Signup and view all the answers

    What is the primary organ affected by L. donovani in visceral leishmaniasis?

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

    How does visceral leishmaniasis primarily affect the liver?

    <p>Kupffer cells and vascular endothelial cells are heavily parasitized.</p> Signup and view all the answers

    What contributes to severe anemia in patients with kala-azar?

    <p>Infiltration of bone marrow and destruction of red blood cells.</p> Signup and view all the answers

    What characteristic appearance can be seen in the liver of a kala-azar patient?

    <p>A nutmeg appearance due to fatty degeneration.</p> Signup and view all the answers

    What type of immune response is involved in the pathology of L. donovani infection?

    <p>Cell-mediated immune response leading to tissue infiltration.</p> Signup and view all the answers

    What is the main consequence of the 'blockade' of the reticuloendothelial system?

    <p>Marked proliferation and destruction of reticuloendothelial tissue.</p> Signup and view all the answers

    Which cells are primarily phagocytosing the released daughter cells from macrophages?

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

    What is the primary mode of transmission for amastigotes in cutaneous leishmaniasis?

    <p>Bite of infected sandflies</p> Signup and view all the answers

    What type of lesions are primarily associated with the anthroponotic urban type of cutaneous leishmaniasis?

    <p>Painless dry ulcerating lesions</p> Signup and view all the answers

    Which species causes the zoonotic rural type of cutaneous leishmaniasis?

    <p>L. major</p> Signup and view all the answers

    How long does the incubation period typically last for zoonotic rural type cutaneous leishmaniasis caused by L. major?

    <p>Less than 4 months</p> Signup and view all the answers

    What is the primary pathological process seen in cutaneous leishmaniasis?

    <p>Inflammatory granulomatous reaction</p> Signup and view all the answers

    Which vector is primarily associated with the transmission of L. tropica in cutaneous leishmaniasis?

    <p>Sandflies, specifically P. sargenti</p> Signup and view all the answers

    What type of lesions usually develop in the early stages of cutaneous leishmaniasis?

    <p>Raised papules</p> Signup and view all the answers

    How do the healing times for lesions caused by L. major compare to those caused by L. tropica?

    <p>L. major heals more quickly than L. tropica</p> Signup and view all the answers

    Which vector is most important for the spread of leishmaniasis in the context provided?

    <p>P.papatasi</p> Signup and view all the answers

    What type of leishmaniasis is characterized by diffuse cutaneous lesions and is difficult to treat?

    <p>Diffuse cutaneous leishmaniasis</p> Signup and view all the answers

    What laboratory method is considered definitive for diagnosing leishmaniasis?

    <p>Microscopy of Giemsa stained smears</p> Signup and view all the answers

    Which factor is NOT suggested as part of the prophylaxis for leishmaniasis?

    <p>Increased humidity exposure</p> Signup and view all the answers

    In children under 10 years of age from endemic areas, a positive leishmanin test indicates which condition?

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

    What is the usual treatment for antimony-resistant diffuse cutaneous leishmaniasis?

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

    What is the characteristic of the lesions produced in diffuse cutaneous leishmaniasis?

    <p>Non-ulcerative and widely distributed</p> Signup and view all the answers

    Where are amastigote forms of the parasite typically found?

    <p>Inside macrophages.</p> Signup and view all the answers

    Study Notes

    Leishmaniasis Overview

    • Leishmaniasis is caused by various species of the Leishmania parasite, transmitted primarily through sandfly bites.
    • The different forms include visceral leishmaniasis (kala-azar), cutaneous leishmaniasis, and post-kala-azar dermal leishmaniasis (PKDL).

    Pathogenesis of Visceral Leishmaniasis (Kala-Azar)

    • Caused by Leishmania donovani, leading to reticuloendotheliosis; phagocytic cell proliferation occurs.
    • Parasites infect macrophages, disseminating throughout various organs, especially the spleen, liver, and bone marrow.
    • Spleen enlargement (splenomegaly) is prominent, and liver function remains largely unaffected despite Kupffer cells being heavily parasitized.
    • Bone marrow infiltration results in severe anemia, leukopenia, and hypersplenism, contributing to hemolysis through auto-antibodies.

    Clinical Features of Kala-Azar

    • Continuous, intermittent fever is common.
    • Massive splenomegaly, hepatomegaly, and lymphadenopathy.
    • Skin exhibits dry, rough pigmentation; patients may experience cachexia and brittle hair.
    • Untreated patients face a high mortality rate, usually within two years.

    Post Kala-Azar Dermal Leishmaniasis (PKDL)

    • Occurs in 3-10% of individuals recovering from VL, predominantly in India and East Africa.
    • Characterized by non-ulcerative skin lesions, including:
      • Depigmented macules resembling leprosy.
      • Erythematous patches, especially on the face in a 'butterfly pattern.'
      • Painless nodular lesions may develop, containing parasites.

    Immune Response

    • Cell-mediated immunity is significantly suppressed, allowing parasite proliferation.
    • Increased production of antibodies, including polyclonal IgG/IgM, is observed.
    • Circulating immune complexes can be detected in serum.

    Diagnosis

    • Direct Methods:

      • Microscopy to visualize amastigotes in tissue smears from blood, bone marrow, spleen, or lymph nodes.
      • Splenic aspirates are more reliable but risky; bone marrow aspirate is most common.
      • Culture using NNN medium can isolate promastigotes.

    • Indirect Methods:

      • ELISA and PCR for antigen detection.
      • Rapid Diagnostic Tests (RDTs) for antibody detection.
      • Full blood count typically reveals normocytic normochromic anemia, leukopenia, and thrombocytopenia.

    Diagnosis of PKDL

    • Biopsy of nodular lesions reveals amastigotes.
    • Culture and animal inoculation may be utilized for confirmation; immunodiagnosis is not applicable.

    Cutaneous Leishmaniasis Types

    • Anthroponotic urban type (L. tropica): Painless dry ulcers; common in Middle East and India.
    • Zoonotic rural type (L. major): Moist, inflamed ulcers; seen in Asia and Africa with rapid healing.
    • Diffuse cutaneous leishmaniasis (L. aethiopica): Rare, widespread nodular lesions, characterized by poor immune response and lengthy duration.

    Laboratory Diagnosis for Cutaneous Leishmaniasis

    • Definitive diagnosis includes demonstration of amastigotes in smears from lesions.
    • Culture of aspirate in NNN medium can provide promastigotes.
    • Skin test for leishmaniasis is indicative in children from endemic regions; negative in diffuse cases.

    Treatment and Prophylaxis

    • Treatments for cutaneous and visceral leishmaniasis align; alternatives exist for drug-resistant cases.
    • Prophylactic measures involve sandfly control via insecticides, personal protective clothing, and reservoir elimination.

    Geography of Leishmaniasis

    • L. braziliensis and L. mexicana are primarily associated with new world leishmaniasis found in Central and South America.
    • These species inhabit skin and mucous membranes, with transmission facilitated by specific sandfly vectors such as Lutzomia.

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    Description

    Explore the various forms of Leishmaniasis, including visceral leishmaniasis, cutaneous leishmaniasis, and post-kala-azar dermal leishmaniasis. Understand the pathogenesis of visceral leishmaniasis (kala-azar) and its clinical features. This quiz will enhance your understanding of this parasitic disease.

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