Leishmaniasis Lecture Notes PDF

Leishmaniasis By Prof/ Samia Sadig Moh. Ismail PhD &MD of Clinical Microbiology PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 1  Objectives  After taking this unit the student will be...

Leishmaniasis By Prof/ Samia Sadig Moh. Ismail PhD &MD of Clinical Microbiology PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 1  Objectives  After taking this unit the student will be able to:  Identify the general feature of the Genus Leishmania  List the causative agents  List the vector responsible for transmission  Discuss the epidemiology, habitat, life cycle, pathogenesis and clinical aspects  Discuss the laboratory diagnosis  Treatment, prevention & control PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 2 Leishmaniasis: zoonotic Chronic inflammatory disease of skin, mucus membrane or viscera caused by obligate intracellular flagellate protozoan parasites. PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 3 History:  William Leishman 1903 the first identification of visceral leishmaniasis in Dum-Dum village in Calcata India (Dum-Dum fever) PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 4  Charles Donovan 1903 also Identify the parasite so the name : (Leishmania- Donovan {LD} body) PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 5  Leishmaniasis Leishmaniasis is a zoonosis. Transmitted among mammalian hosts by female sand flies. PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 6 CLASSIFICATION: Three Clinical Groups:- (1)Visceral leishmaniasis (kala-azar) (2) Cutaneous leishmaniasis (3) Mucocutaneous or Naso-oral leishmaniasis PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 7 CLASSIFICATION Visceral leishmaniasis kala- azar L.donovani complex:old world ( Africa , Asia , Europe ) L.donovani donovani ,L. donovani infantum ,L. donovani chagasi PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 8  Cutaneous leishmaniasis:  L.tropica complex: old world ( Africa , Asia , Europe )  L.t.minor L.t.major PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 9 Mucocutaneous or Naso-oral leishmaniasis  L.braziliensis complex: new world (South America)  L.b.Braziliensis,  L.mexicana complex: new world  (South America)  L.m.mexicana, PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 10  Transmission The New World forms are all carried by sand flies of the genus lutzomyia. Old World leishmanias are transmitted by sand flies of the genus phlebotomus. PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 11 Visceral leishmaniasis kala- azar  L.donovani complex:old world  ( Africa , Asia , Europe )  L.donovani donovani  ,L. donovani infantum  Reservoir host: Dogs & Cats  Mod of Infection:bite of female Sand fly (genus phlebotomus ).Inculating promastigotes  Habitat:Amastigote in macrophage &other RECs PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 12 Visceral leishmaniasis kala-azar:- In Sudan Leishmaniasis is endemic in several parts  It is endemic in Gadarif, Sinar, Upper Nile, Blue Nile.North Darfor, and South Kordofan.  The main endemic area is in the eastern part of country.  stretches from western part of white nile to Sudanese Ethiopian border in the east.  and in the north from upper reaches Atbara River.  PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 13   Life Cycle  The Organism has 2 morphological forms  1- intracellular non flagellated amastigote  (Leishman-Donovan [LD] body) occurs in mammals  2- The sand fly transmits the infective promastigotes after bite the host.  The promastigotes rapidly change to amastigotes after phagocytosis by macrophages, and then multiply, filling the cytoplasm of the macrophages.  PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 14 PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 15  1- Promastigote : found in side the insect mid gut elongated motile (flagellated) form PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 16  2- Amastigote : the mammalian stage found intracellularly in the reticuloendothelial System, round or oval in shape , non motile. with a thin cell membrane , dense nucleus and arod-shaped kinetoplastid in the cytoplasm PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 17 Visceral leishmaniasis kala- azar  Pathogenesis & Clinical picture: 1. LEISHMANIOMA(Seen in Africans ) 2. Intermittent fever, Hepatosplenomegaly &generalised lymphadenopathy(Diarrhea) 3. Bone marrow depletion:  Pancytopenia 2ry infection +Wt. loss=death in sever cases  Reverse albumin /globulin ratio(hyper gamma glopulineamia) 4. Glomerulonephritis : >> Immune complex deposition PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 18 Visceral leishmaniasis kala- azar 5. Skin : 1.Hyperpigmentation (black fever) 2.Butterfly Erethema on nose & cheeks 3.Post kal-Azar dermal leishmaniasis: Maculopapular hypo pegiented areas start at face >>Sudan & India >> Response to antimony ttt +immune- mediated >increased Amastigotes in lesions for 20 yers (Pts act as Reservoir of infection) PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 19 Visceral leishmaniasis kala- Diagnosis:- azar A.Histo:hepatosplenomegaly +Butterfly ERETHEMA B.CBC :Pancytopenia C.Direct diagnosis: 1-Giema stained bone marrow aspirate ,spleen , liver or LN biopsy or Buffy coat film >> Amastigotes 2- Buffy coat Culture>>>promastigote - Schneider´s or NNN media. PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 20 Visceral leishmaniasis kala- Immunodiagnosis: azar Serology :-ELISA..IFA Skin Test:- Motenegro/Leishmainen Test: +ve after Successful TTT. PCR PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 21  First Line Treatment for Visceral  Leishmaniasis : Sodium stibogluconate SSG (Pentostam)  Sodium stibogluconate (SSG) is apentavalent antimony compound.  This drug introduced in Sudan in 1940s & still is the drug of choice.  It is very effective in treatment of VL in Sudan.  Given only Parenterally.  Amphotericin B deoxycholate /pentamidine  Allopurinol in AIDS  Splenectomy in Recurrent cases. PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 22 CONTROL  Treatment of cases  Animal reservoir control  Sandy fly control PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 23  1-Cutaneous leishmaniasis..  / L. Tropica complex..old world:  1/L. Tropica :1/ In big cities 2/ Oriental sores /Bagdad boil 3/ Dry/ urban Cutaneous leishmaniasis.4/ R.H : Dogs 5/ On FACE 6/ ulcer with little inflammation & raised edges 7/ chronic..heal with in year  2/ L. major:  1/ Wet / rural Cutaneous leishmaniasis 2/ R.H: Rodent.3/ on exposed parts..4/ marked inflammation & crusting 5/ acute heals in 4-6 months..6/ long lasting immunity. PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 24  1-Cutaneous leishmaniasis..L. Tropica complex..old world:  It transmitted mainly by the females of sand flies phlebotomus.IS: promastigote..Ds:Amastigots  Cutaneous forms of the disease normally produce skin ulcers on the exposed parts of the body such as the face, arms and legs. The disease can produce a large number of lesions.  PATHOGENESIS: Amastigote multiply inside macrophage at site of bite e>>Nodule>>ulcer >>healing >>scar. PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 25 L.tropica L. major L. aethiopica L. braziliensis L. mexicana Samia Sadig PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 26  Diagnosis -1/ History  2/ clinical picture : typical ulcer  3/ Direct diagnosis: 1/ Aspiration or scraping or biopsy  -From margins of ulcer. - bed of ulcer no organism found. -amastigote found in macrophages 2/ Culture :- NNN media >>promastigote IMMUNODIAGNOSIS: 1/ Montenegro / leishmanin intra dermal test Delay reaction >>induration 2-3 days. 2/ serology PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 27  Management of cutaneous leishmaniasis :  It generally heels spontaneously in 5-12 months.  Single lesions may be cleaned, curetted, treated with antibiotics if secondarily infected, and then covered and left to heal.  For larger or non healing forms, pentavalent antimonial.. sodium stibogluconate …Pentostam.  Prevention & control:….. PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 28 PROF/SAMIA SADIG MOHAMED ISMAIL 17/12/24 29