Podcast
Questions and Answers
Which form of leishmaniasis is characterized by affecting the mucous membranes and may cause disfiguring lesions of the nose?
Which form of leishmaniasis is characterized by affecting the mucous membranes and may cause disfiguring lesions of the nose?
What are the primary species responsible for the transmission of Leishmania to humans?
What are the primary species responsible for the transmission of Leishmania to humans?
What is NOT considered a risk factor for the development of leishmaniasis?
What is NOT considered a risk factor for the development of leishmaniasis?
What is the primary form of the Leishmania parasite found in vertebrate hosts?
What is the primary form of the Leishmania parasite found in vertebrate hosts?
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What environmental factor is likely to increase the risk of leishmaniasis?
What environmental factor is likely to increase the risk of leishmaniasis?
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Which symptom is NOT typically associated with Visceral Leishmaniasis?
Which symptom is NOT typically associated with Visceral Leishmaniasis?
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Which of the following best describes the epidemiological role of dogs in leishmaniasis?
Which of the following best describes the epidemiological role of dogs in leishmaniasis?
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Visceral Leishmaniasis is also known by what other name?
Visceral Leishmaniasis is also known by what other name?
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How does climate change potentially influence leishmaniasis transmission?
How does climate change potentially influence leishmaniasis transmission?
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What systemic symptoms can characterize chronic systemic leishmaniasis?
What systemic symptoms can characterize chronic systemic leishmaniasis?
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Which of the following statements regarding Post-kala-azar dermal leishmaniasis (PKDL) is accurate?
Which of the following statements regarding Post-kala-azar dermal leishmaniasis (PKDL) is accurate?
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What are the main infectious agents responsible for visceral leishmaniasis?
What are the main infectious agents responsible for visceral leishmaniasis?
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Which of these countries reported the highest concentration of new visceral leishmaniasis cases in 2019?
Which of these countries reported the highest concentration of new visceral leishmaniasis cases in 2019?
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How is visceral leishmaniasis primarily transmitted to humans?
How is visceral leishmaniasis primarily transmitted to humans?
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What is the approximate incubation period for visceral leishmaniasis?
What is the approximate incubation period for visceral leishmaniasis?
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Which of these methods is identified as the most sensitive technique for diagnosing visceral leishmaniasis?
Which of these methods is identified as the most sensitive technique for diagnosing visceral leishmaniasis?
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In which method of control are insecticide-treated bed nets primarily employed?
In which method of control are insecticide-treated bed nets primarily employed?
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Which of the following conditions particularly affects the skin and mucous membranes and may lead to life-long scars?
Which of the following conditions particularly affects the skin and mucous membranes and may lead to life-long scars?
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What is the recommended first-line treatment for visceral leishmaniasis in most countries?
What is the recommended first-line treatment for visceral leishmaniasis in most countries?
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Which of the following measures is NOT generally part of the control strategies for leishmaniasis?
Which of the following measures is NOT generally part of the control strategies for leishmaniasis?
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What is the typical appearance of Post-kala-azar dermal leishmaniasis (PKDL)?
What is the typical appearance of Post-kala-azar dermal leishmaniasis (PKDL)?
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Which species is primarily responsible for the transmission of Leishmania to humans?
Which species is primarily responsible for the transmission of Leishmania to humans?
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Which of the following organisms is NOT typically considered a reservoir for Leishmania?
Which of the following organisms is NOT typically considered a reservoir for Leishmania?
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What is the predominant method for diagnosing visceral leishmaniasis based on sensitivity?
What is the predominant method for diagnosing visceral leishmaniasis based on sensitivity?
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What is the primary form of the Leishmania parasite when it is in sandfly vectors?
What is the primary form of the Leishmania parasite when it is in sandfly vectors?
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Which of these factors is least likely to contribute to the transmission of leishmaniasis?
Which of these factors is least likely to contribute to the transmission of leishmaniasis?
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During which time period does Post-kala-azar dermal leishmaniasis typically manifest after kala-azar treatment?
During which time period does Post-kala-azar dermal leishmaniasis typically manifest after kala-azar treatment?
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Which symptom is most closely associated with visceral leishmaniasis?
Which symptom is most closely associated with visceral leishmaniasis?
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Which vector control method is recommended for managing leishmaniasis?
Which vector control method is recommended for managing leishmaniasis?
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Which of the following statements about the incidence of visceral leishmaniasis (VL) is correct?
Which of the following statements about the incidence of visceral leishmaniasis (VL) is correct?
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What is the significant consequence of untreated visceral leishmaniasis?
What is the significant consequence of untreated visceral leishmaniasis?
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What is the characteristic symptom of visceral leishmaniasis?
What is the characteristic symptom of visceral leishmaniasis?
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Which demographic factor can significantly increase the risk of leishmaniasis?
Which demographic factor can significantly increase the risk of leishmaniasis?
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What type of Leishmaniasis is characterized by the presence of skin ulcers?
What type of Leishmaniasis is characterized by the presence of skin ulcers?
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In the control of leishmaniasis, what is a crucial aspect of epidemic measures?
In the control of leishmaniasis, what is a crucial aspect of epidemic measures?
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Which treatment is considered the first line for visceral leishmaniasis in most countries?
Which treatment is considered the first line for visceral leishmaniasis in most countries?
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Which nutritional deficiency is particularly associated with an increased risk of severe leishmaniasis infection?
Which nutritional deficiency is particularly associated with an increased risk of severe leishmaniasis infection?
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What ecological factor is integral to the transmission of visceral leishmaniasis?
What ecological factor is integral to the transmission of visceral leishmaniasis?
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Which of the following best describes the presence of Leishmania in vertebrate hosts?
Which of the following best describes the presence of Leishmania in vertebrate hosts?
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What role do socioeconomic conditions play in the risk of contracting leishmaniasis?
What role do socioeconomic conditions play in the risk of contracting leishmaniasis?
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Study Notes
Leishmaniasis: A Detailed Overview
- Definition: Leishmaniasis is a vector-borne parasitic disease caused by Leishmania species (over 20). It is primarily zoonotic and different species cause various disease manifestations. Domestic dogs are important reservoir hosts.
Types of Leishmaniasis
- Cutaneous Leishmaniasis (CL): Characterized by skin ulcers and nodules; potentially disfiguring nasal lesions.
- Mucocutaneous Leishmaniasis: Affects mucous membranes, causing disfiguring lesions.
- Visceral Leishmaniasis (VL): Damages internal organs; a life-threatening condition, fatal if untreated in over 95% of cases.
Transmission
- Vector: Transmitted by the bite of infected female phlebotomine sandflies (over 90 species known).
Morphology
- Human hosts: Amastigote (Leishman body) form.
- Sandfly vectors: Promastigote (Leptomonad) form.
Risk Factors
- Socioeconomic: Poverty, poor housing, poor sanitation increase sandfly breeding and human exposure.
- Malnutrition: Deficiencies in protein-energy, iron, vitamin A, and zinc increase disease severity.
- Population Mobility: Movement of non-immune populations contributes to disease outbreaks.
- Environmental Change: Urbanization and human encroachment on forested areas impact disease incidence.
- Climate Change: Alterations in temperature, rainfall, and humidity impact vector and reservoir host distribution and survival.
Visceral Leishmaniasis (VL)
- Description: Chronic systemic disease—intracellular protozoa. Characterized by fever, hepatosplenomegaly, lymphadenopathy, anemia, leukopenia, thrombocytopenia, wasting, and weakness; also known as kala-azar.
- Severity: Fatal if untreated in over 95% of cases.
- Post-Kala-azar Dermal Leishmaniasis (PKDL): Skin rash (macular, papular, or nodular) usually affecting the face, upper arms, trunk, and other body parts, typically appearing months to years after apparent VL treatment, mainly in East Africa and the Indian subcontinent; 5-10% of VL patients.
- Infectious Agents: Primarily Leishmania donovani, L. infantum, and L. infantum/chagasi.
- Reservoir Hosts: Humans, wild canids (foxes, jackals), and domestic dogs.
- Incubation Period: Generally 2-6 months, with a range of 10 days to years.
- Communicability: Not usually transmitted person-to-person, infectious to sandflies, infectivity can persist after clinical recovery. Person-to-person transmission, rare, mainly among co-infected HIV-positive IV drug users.
- Susceptibility: General susceptibility but VL induces lasting homologous immunity.
- Transmission Mode: Bite of infected female phlebotomine sandflies. Person-to-person is rare, (HIV and IV drug use).
Cutaneous and Mucosal Leishmaniasis
- Synonyms: Baghdad boil, Delhi boil, oriental sore (other regions). Espundia, Uta-and Chiclero ulcer (Americas).
- Definition: Polymorphic protozoan disease of the skin and mucous membranes, caused by various Leishmania species; obligate intracellular parasites in humans and mammals.
- Symptoms: Progresses from maculae to papules, enlarging, and forming ulcers (absence of bacterial infection). Lesions can be single or multiple, occasionally non-ulcerative and diffuse. Heal spontaneously in weeks/months or persist for a year or more. Some strains (especially Western Hemisphere) can disseminate to mucous membranes even years after initial healing.
- Prevalence: Most common form; primarily in the Americas, Mediterranean basin, Middle East, and Central Asia. Over 95% of cases occur in the Americas.
Occurrence of Leishmaniasis
- VL: Primarily in Brazil, East Africa, and India. 50,000–90,000 new cases annually, reported to WHO by 25–45%. In 2019, over 90% of new cases in 10 countries.
- CL: Primarily in the Americas(95%), Mediterranean basin, Middle East, and Central Asia. 600,000–1,000,000 new cases annually in 2019, 87% in 10 countries.
Diagnosis
- VL: Microscopy (intracellular amastigotes). PCR. Serology (IFA, ELISA). Urine antigen test. Recombinant k39 immunochromatographic strip test.
- CL: Visual inspection. Microscopic confirmation of intracellular amastigotes.
Control and Treatment
- Prevention: No vaccine currently available, but candidate vaccines in development.
-
Control measures: Vary based on reservoir and vector habits. Include:
- Case management: Rapid diagnosis and treatment of all forms
- Vector control: Periodic residual insecticide spraying (stone walls, animal houses, rubbish heaps); Insecticide-treated bed nets.
- Environmental control: Eliminate breeding sites, reservoir control (dogs, gerbils).
- Patient/Contact Management: Reporting to health authorities, isolation, concurrent disinfection, quarantine of contacts, contact/source investigation.
- Treatment: Pentavalent antimonials (first line); amphotericin B and liposomal amphotericin B for antimony-resistant cases.
Epidemic Measures
- Effective control—understanding local ecology, transmission, reduce mortality, stop transmission, prevent geographical expansion.
- Key measures: Case detection & treatment, Vector control (indoor residual spray, nets, reservoir control), Surveillance.
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Description
Explore the different forms of leishmaniasis, including cutaneous, mucocutaneous, and visceral types. Learn about the transmission, risk factors, and morphology of this parasitic disease caused by Leishmania species.
