Podcast
Questions and Answers
What is the primary method of identifying the non-motile intracellular form of Leishmania in stained specimens?
What is the primary method of identifying the non-motile intracellular form of Leishmania in stained specimens?
Which factors contribute to the failure of the leishmanin test in certain patients?
Which factors contribute to the failure of the leishmanin test in certain patients?
Which of the following is NOT a mode of transmission of Leishmania?
Which of the following is NOT a mode of transmission of Leishmania?
What main groups of drugs are primarily used to treat Leishmaniasis?
What main groups of drugs are primarily used to treat Leishmaniasis?
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How does antiretroviral treatment affect individuals co-infected with Leishmania and HIV?
How does antiretroviral treatment affect individuals co-infected with Leishmania and HIV?
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Which form of Leishmaniasis is associated with skin ulcers and nodules?
Which form of Leishmaniasis is associated with skin ulcers and nodules?
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What is the primary reservoir for Leishmaniasis in domesticated animals?
What is the primary reservoir for Leishmaniasis in domesticated animals?
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Which risk factor is least likely to be associated with the transmission of Leishmaniasis?
Which risk factor is least likely to be associated with the transmission of Leishmaniasis?
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Female phlebotomine sandflies transmit Leishmania by which mode?
Female phlebotomine sandflies transmit Leishmania by which mode?
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Which nutritional deficiency is NOT linked to increased risk for progressing to Leishmaniasis?
Which nutritional deficiency is NOT linked to increased risk for progressing to Leishmaniasis?
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Which of the following characteristics does NOT apply to the lifecycle of Leishmania?
Which of the following characteristics does NOT apply to the lifecycle of Leishmania?
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Which species of Leishmania is most commonly associated with visceral leishmaniasis?
Which species of Leishmania is most commonly associated with visceral leishmaniasis?
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In what type of environment is the risk of leishmaniasis transmission most likely to increase?
In what type of environment is the risk of leishmaniasis transmission most likely to increase?
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What is the most effective treatment option for cases that do not respond to antimony?
What is the most effective treatment option for cases that do not respond to antimony?
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Which of the following is NOT a component of effective epidemic control measures for leishmaniasis?
Which of the following is NOT a component of effective epidemic control measures for leishmaniasis?
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What initial skin manifestation is characteristic of cutaneous leishmaniasis?
What initial skin manifestation is characteristic of cutaneous leishmaniasis?
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In which region do over 90% of mucocutaneous leishmaniasis cases occur?
In which region do over 90% of mucocutaneous leishmaniasis cases occur?
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What is a common outcome of the cutaneous leishmaniasis lesions?
What is a common outcome of the cutaneous leishmaniasis lesions?
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Estimate the range of new cutaneous leishmaniasis cases that occur worldwide annually.
Estimate the range of new cutaneous leishmaniasis cases that occur worldwide annually.
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Which leishmaniasis strain is known to potentially cause dissemination to mucosal lesions years after cutaneous lesions have healed?
Which leishmaniasis strain is known to potentially cause dissemination to mucosal lesions years after cutaneous lesions have healed?
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What type of protozoan causes cutaneous and mucosal leishmaniasis?
What type of protozoan causes cutaneous and mucosal leishmaniasis?
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Which of these countries is NOT listed among the top contributors to new cutaneous leishmaniasis cases?
Which of these countries is NOT listed among the top contributors to new cutaneous leishmaniasis cases?
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What is a common appearance of classic Leishmania major lesions?
What is a common appearance of classic Leishmania major lesions?
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What is the estimated global annual incidence of new cases of Visceral leishmaniasis?
What is the estimated global annual incidence of new cases of Visceral leishmaniasis?
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Which of the following countries reported more than 90% of new VL cases to WHO in 2019?
Which of the following countries reported more than 90% of new VL cases to WHO in 2019?
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What diagnostic method is noted for being the most sensitive for Visceral leishmaniasis, despite its cost?
What diagnostic method is noted for being the most sensitive for Visceral leishmaniasis, despite its cost?
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Which method is NOT mentioned as a preventive measure for Visceral leishmaniasis?
Which method is NOT mentioned as a preventive measure for Visceral leishmaniasis?
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What is regarded as the first-line treatment for Visceral leishmaniasis in most countries?
What is regarded as the first-line treatment for Visceral leishmaniasis in most countries?
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Which of the following is a control measure that can help reduce the population of sandflies?
Which of the following is a control measure that can help reduce the population of sandflies?
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Which of the following is NOT part of case management for Visceral leishmaniasis?
Which of the following is NOT part of case management for Visceral leishmaniasis?
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What preventive measure involves the application of residual insecticide in certain areas?
What preventive measure involves the application of residual insecticide in certain areas?
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What is the primary role of using insecticide-treated bed nets in Visceral leishmaniasis prevention?
What is the primary role of using insecticide-treated bed nets in Visceral leishmaniasis prevention?
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Which of the following is the least effective method for controlling Visceral leishmaniasis according to the control measures listed?
Which of the following is the least effective method for controlling Visceral leishmaniasis according to the control measures listed?
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What is the primary infectious agent responsible for causing visceral leishmaniasis?
What is the primary infectious agent responsible for causing visceral leishmaniasis?
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Which of the following symptoms is NOT typically associated with visceral leishmaniasis?
Which of the following symptoms is NOT typically associated with visceral leishmaniasis?
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What is the incubation period for visceral leishmaniasis?
What is the incubation period for visceral leishmaniasis?
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In which region is post-kala-azar dermal leishmaniasis (PKDL) primarily reported?
In which region is post-kala-azar dermal leishmaniasis (PKDL) primarily reported?
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Which mode of transmission is associated with visceral leishmaniasis?
Which mode of transmission is associated with visceral leishmaniasis?
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What can be said about the infectivity of visceral leishmaniasis after clinical recovery?
What can be said about the infectivity of visceral leishmaniasis after clinical recovery?
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What percentage of untreated visceral leishmaniasis (VL) cases can result in fatality?
What percentage of untreated visceral leishmaniasis (VL) cases can result in fatality?
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Which reservoir hosts are associated with visceral leishmaniasis?
Which reservoir hosts are associated with visceral 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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What is the lasting immune response after recovery from kala-azar?
What is the lasting immune response after recovery from kala-azar?
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Study Notes
Leishmaniasis Overview
- Leishmaniasis is a significant vector-borne disease caused by various Leishmania species, mostly zoonotic.
- Different Leishmania species cause diverse disease forms in humans.
- Many species cause skin ulcers and nodules. Some affect mucous membranes, potentially causing disfiguring lesions.
- Other species lead to visceral leishmaniasis, a life-threatening condition damaging internal organs.
- Domestic dogs are a crucial epidemiological factor for the disease.
- Over 90 sandfly species transmit Leishmania parasites.
Learning Objectives
- Understand different types of Leishmaniasis (Cutaneous, Mucocutaneous, Visceral)
- Identify risk factors for Leishmaniasis (Socioeconomic conditions, Malnutrition, Population mobility, Environmental changes).
- Understand Visceral Leishmaniasis (VL) (Causative agent, incubation period, reservoir, mode of transmission, occurrence, prevention and control methods)
- Understand Cutaneous Leishmaniasis (Causative agent, incubation period, reservoir, mode of transmission, occurrence, prevention and control methods)
Leishmania Morphology
- In vertebrate hosts: Amastigotes (Leishman body)
- In sandfly vectors: Promastigotes (Leptomonad)
- Leishmania promastigotes (culture form)
Life Cycle
- Sandfly stages: sandfly takes a blood meal (injects promastigote stage into skin); promastigotes divide and migrate to proboscis
- Human stages: promastigotes are phagocytized by macrophages; transform to amastigotes; amastigotes multiply in various tissues including macrophages
Risk Factors
- Socioeconomic: Poverty correlates with increased risk due to poor housing, sanitation, and access to humans.
- Malnutrition: Protein-energy deficiencies, iron, vitamin A, and zinc deficiencies increase disease progression.
- Population mobility: Migration often accompanies epidemics, exposing non-immune populations.
- Environmental changes: Urbanization and human encroachment into forested areas affect disease incidence.
- Climate change: Changes in temperature, rainfall, and humidity affect vector & reservoir host distributions/survival impacting disease.
Visceral Leishmaniasis (VL)
- Chronic systemic disease caused by intracellular Leishmania protozoa.
- Characterized by fever, hepatosplenomegaly, lymphadenopathy, anemia, leukopenia, thrombocytopenia, progressive emaciation, and weakness.
- Known as Kala-azar.
- Untreated VL is often fatal (over 95% of cases).
- Post-kala-azar dermal leishmaniasis (PKDL) is a possible sequel (rash on face, arms, trunk).
- PKDL usually occurs months to years after initial treatment but can occur sooner.
- People with PKDL are considered potential sources of infection.
- Symptoms include spleen and liver enlargement, night sweats, bouts of temperature, bleeding, skin darkening, scaly skin, cough, weakness, and substantial weight loss.
Cutaneous Leishmaniasis (CL)
- Most common form causing skin lesions (ulcers, scars).
- High incidence in the Americas, Mediterranean basin, Middle East, and Central Asia.
- Over 87% of CL new cases in 2019 were concentrated in 10 countries (Afghanistan, Algeria, Brazil, Colombia, Iran, Iraq, Libya, Pakistan, Syria, and Tunisia.)
- Approximately 600,000 to 1 million new cases worldwide annually.
Mucocutaneous Leishmaniasis
- Leads to partial or total destruction of mucous membranes (nose, mouth, throat).
- Primarily found in Bolivia, Brazil, Ethiopia, and Peru with over 90% of cases concentrated there.
Diagnosis
- VL: Demonstration of intracellular amastigotes in stained smears from bone marrow, spleen, liver, or lymph nodes; PCR is sensitive but costly. Serological diagnosis (IFA and ELISA). Urine antigen detection test. Recombinant k 39 immunochromatographic strip test
- CL: Microscopic identification of amastigotes in stained specimens. Intradermal test (Montenegro) using leishmanin. Serological testing (IFA or ELISA).
Infectious Agents
- Eastern Hemisphere: Leishmania tropica, Leishmania major, Leishmania aethiopica.
- Western Hemisphere: Leishmania braziliensis, Leishmania mexicana.
Reservoirs
- Humans, wild canids (foxes, jackals), and domestic dogs are common reservoirs. Reservoir distribution varies regionally.
Incubation Period
- Generally varies from 2-6 months to even years, ranging from 10 days to years.
Communicability
- Not usually transmitted between people. Infectious to sandflies if parasites are present in blood or skin. Infectivity may persist post-clinical recovery.
Transmission
- Leishmania is transmitted via the bite of infected female phlebotomine sandflies ( P. papatasi and P. sergenti).
- Transmission may rarely occur through blood transfusion.
Susceptibility
- General but Kala-azar induces lasting homologous immunity.
Treatment
- Antimony-containing compounds (meglumine antimoniate, sodium stibogluconate) are frequently used as first-line treatment.
- Amphotericin B or amphotericin B deoxycholate may be used for non-responding cases; liposomal amphotericin B is most effective but expensive.
Control Measures
- Case management: rapid detection and treatment.
- Vector control: applying residual insecticides, especially in breeding locations (rubbish, animal houses) and insecticide-treated bed nets. Eliminate gerbils and other reservoir animals via plowing & removing plants.
- Control of animal reservoirs (dogs, other animals).
- Environmental management: clearing overgrown areas.
- Preventative measures: Although vaccination is in development, no current vaccines exist.
Epidemic Measures
- Case detection and treatment.
- Vector control using indoor residual spray, insecticide-treated bed nets.
- Control of animal reservoirs.
- Surveillance and program monitoring
Leishmania-HIV Coinfection
- HIV increases the chance of developing full-blown leishmaniasis, relapses, and mortality
- Treatment of HIV reduces disease development, delays relapses, and improves survival in co-infected patients.
- Brazil, Ethiopia, and the Bihar region of India have significant rates of this co-infection.
Summary
- Leishmaniasis has 3 forms (visceral, cutaneous, mucocutaneous).
- It is a zoonotic disease mostly transmitted by sandfly bites.
- It disproportionately affects impoverished populations linked to malnutrition, displacement, poor housing, immune weakness, and lack of resources.
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Description
This quiz covers the essential aspects of Leishmaniasis, including its various forms and transmission factors. You will learn about cutaneous, mucocutaneous, and visceral leishmaniasis, as well as risk factors and prevention methods. Test your understanding of this significant vector-borne disease caused by Leishmania species.
