Leishmaniasis Types & Treatments PDF

TYPES OF LEISHMANIASIS Cutaneous leishmaniasis Visceral leishmaniasis, which which causes skin sores. affects several internal organs (usually spleen, liver, and bone marrow)...

TYPES OF LEISHMANIASIS Cutaneous leishmaniasis Visceral leishmaniasis, which which causes skin sores. affects several internal organs (usually spleen, liver, and bone marrow) Mucosal leishmaniasis cause sores in the mucous membranes of the nose (most common location), mouth, or throat. 2024-7-8 61  Visceral leishmaniasis (kala-azar) https://www3.paho.org/hq/index.php?option=com_content&view=article&id=6420:2012-leishmaniasis-visceral&Itemid=39347&lang=en#gsc.tab=0 2024-7-8 62 Introduction Visceral leishmaniasis (VL) is a parasitic disease found in tropical and subtropical areas. It is a chronic systemic disease that mainly affects children under five years of age; It may be associated with malnutrition and other conditions of immunosuppression such as HIV-AIDS. If adequate treatment is not initiated in a timely manner, it can progress to death in 90% of cases. The species commonly found in East Africa and the Indian subcontinent is L. donovani the species found in Europe, North Africa, and Latin America is L. infantum, also known as L. chagasi. 2024-7-8 63  Leishmania donovani The natural habitat of L.donovani in man is the reticuloendothelial system of the viscera. The amastigote multiplies by simple binary fission until the host cells are destroyed After destruction, new macrophages are parasitized. The amastigote stage appears as an ovoidal or rounded body, measuring about 2-3μm in length 2024-7-8 64 Pathogenesis In visceral leishmaniasis, the organs of the reticuloendothelial system (liver, spleen and bone marrow) are the most severely affected organs. Reduced bone marrow activity, coupled with cellular distraction in the spleen, results in anaemia, leukopenia and thrombocytopenia. This leads to secondary infections and a tendency to bleed. The spleen and liver become markedly enlarged, and hypersplenism contributes to the development of anaemia and lymphadenopathy also occurs. Increased production of globulin results in hyperglobulinemia, and reversal of the albumin-to-globulin ratio. 2024-7-8 65  The incubation period can range from 10 days to 24 months, with an average of 2-6 months The classic manifestations of VL include; fever splenomegaly (enlargement of the spleen, manifested in the great majority of patients) hepatomegaly (enlargement of liver) pallor (caused by severe anemia) leucopenia (low white blood cell count) weight loss and cachexia 2024-7-8 66  Other signs and symptoms include respiratory problems or gastrointestinal disturbances such as vomiting and diarrhea; In severe cases there is malnutrition and lower limb edema, which may progress to anasarca (extreme generalized edema). Other important signs are bleeding from the nose or mouth, jaundice and fluid buildup in the abdomen. In these patients, death is usually determined by bacterial infection or bleeding. 2024-7-8 67 Laboratory Diagnosis Parasitological tests are performed by detecting parasites in infected tissues, mainly i n t h e b o n e m a r r o w, t h r o u g h d i r e c t examination or isolation in culture (in vitro). Molecular tests detect Leishmania DNA through the PCR method. The immunological test currently available at the primary level is the rapid immunochromatographic test based on recombinant rK39 antigen 2024-7-8 68  Treatment and prevention Treatment The drug of choice is sodium stibogluconate, a pentavalent antimonial compound. Alternative approaches include the addition of allopurinol and the use of pentamidine or amphotericin B. Prevention Prompt treatment of human infections and control of reservoir hosts. Protection from sand flies by screening and insect repellents (DEET (N,N-diethylmetatoluamide)). 2024-7-8 69  Cutaneous leishmaniasis 2024-7-8 70