Lecture (10 )

Leishmaniasis
Objectives:
Not given

Done by: abduallah alanzi ,Khalid alosaimi ,Fahed Alsbiea Reviewd by: Joharah Almubrad

Very important Additional information Male doctor’s notes Female doctor's notes not important
 (Leishmaniasis)

Pathogens Types Diagnosis Treatment

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 Disease Species
Leishmania tropica*
Cutaneous leishmaniasis Leishmania major*
Leishmania aethiopica
Leishmania mexicana

Mucocutaneous Leishmania braziliensis

leishmaniasis
Leishmania donovani*
Visceral leishmaniasis Leishmania infantum*
Leishmania chagasi

* Endemic in Saudi Arabia

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Morphology:
Leishmaniasis disease caused by lishmania parasites , and transmitted by sand fly bite as promastigotes (
infective stage )
inside humand they found in macrophages ( intracellular ) and tissue as Amastigotes ( diagnostic phase )
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Disease Cutaneous leishmaniasis “more common than visceral”
Type 1) Clinical types of cutaneous leishmaniasis
Protozoa important Leishmania major Leishmania tropica
transmission Zoonotic Anthroponotic
Clinical findings wet lesions with severe Dry lesions called Oriental sore (most common
reaction ) with minimal ulceration self-limited ulcer

2) Uncommon types:
a) Diffuse cutaneous leishmaniasis (DCL)
Caused by L. aethiopica, diffuse nodular non-ulcerating lesions. Low immunity to Leishmania antigens,
numerous parasites
b)Leishmaniasis recidiva (lupoidleishmaniasis):
Severe immunological reaction to leishmania antigen leading to persistent dry skin lesions, few parasites.
Diagnosis • Smear: Giemsa stain – microscopy for LD bodies (amastigotes)
• Biopsy: microscopy for LD bodies or culture in NNN medium for promastigotes .
Treatment • Pentostam ( sodium stibogluconate) for treatment of all types of leishmaniasis
• No treatment – self-healing lesions ” if it is local and not progressing “ NNN medium
• Medical:”if needed ” * Pentavalent antimony (Pentostam),
* Amphotericin B, Antifungal drugs
* +/- Antibiotics for secondary bacterial infection
• Surgical: - Cryosurgery “is the application of extreme cold to destroy abnormal or diseased tissue ”
- Excision “Surgical removal by cutting “
-Curettage “Surgical scraping, usually of the lining of a body cavity, to clean it of foreign
matter, to remove tumours or other growths or diseased tissue”
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Zoonotic = Anthroponotic
Disease Visceral leishmaniasis Also called (kala-azar) more sever than cutaneous

Protozoa important Leishmania donovan Leishmania infantum

Type Affects adults children
# Untreated disease can be fatal After recovery it might produce a condition called post kala-azar
dermal leishmaniasis (PKDL).
Fever , Splenomegaly , hepatomegaly hepatosplenomegaly , wight loss, Anemia , Epistaxis , Cough,
Presentation
Diarrhea

1)Parasitological diagnosis:
a)Bone marrow aspirate ( the best diagnosis but less sensitve ) 1. microscopy
b) Splenic aspirate ( More sensitive but very dangerous, bleeding) 2. culture in NNN medium
2) Immunological Diagnosis:
Diagnosis
• Specific serologic tests: Direct Agglutination Test (DAT), ELISA, IFAT
• rK39 antigen-based immunochromatographic test . “become more popular in some areas “

 LIMITATIONS FOR SEROLOGIC TESTS:

1)Do not diagnose relapses. , 2)In endemic areas it is sometimes +ve in healthy individuals.
Recommended treatment varies in different endemic areas:
1) Pentavalent antimony- sodium stibogluconate (Pentostam) , 2) Amphotericin B
Treatment
Treatment of complications:
1) Anaemia, 2) Bleeding , 3) Infections
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disease Cutaneous leishmaniasis Visceral leishmaniasis also called (kala-azar)
“Cutaneous is more common than visceral “more sever than cutaneous”
Types and 1.Clinical types of cutaneous leishmaniasis a)Leishmania donovan : mainly affects adults
pathogen a)Leishmania major: Zoonotic cutaneous b)Leishmania infantum : mainly affect children
leishmaniasis: wet lesions with severe reaction
b) Leishmania tropica: Anthroponotic cutaneous
leishmaniasis: Dry lesions with minimal
ulceration
2. Uncommon types:
a) Diffuse cutaneous leishmaniasis (DCL)
b) Leishmaniasis recidiva (lupoidleishmaniasis)
Diagnosis 1)Smear: Giemsa stain – microscopy for LD 1)Parasitological diagnosis:
bodies (amastigotes) • Bone marrow aspirate ( the best diagnosis but
2)Biopsy:microscopy for LD bodies or culture in less sensitve )
NNN medium for (promastigotes) • Splenic aspirate ( More sensitive but dangerous)
2) Immunological Diagnosis:
a) Specific serologic tests , b) rK39
Presentation Fever , Splenomegaly , hepatomegaly
hepatosplenomegaly , Wight loss, Anemia , Epistaxis ,
Cough, Diarrhea
Treatment 1) Medical: Pentavalent antimony (Pentostam), 1. Pentavalent antimony- sodium stibogluconate
2) Amphotericin B (Pentostam)
2. Amphotericin B

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Q1) male 52 years old come to ER with fever , diarrhea , hepatosplenomegaly , anemia and epistaxis what is the
what is the most accurate diagnosis according to symptoms ?

A) Cutaneous leishmaniasis
B) Mucocutaneous leishmaniasis
C) Visceral leishmaniasis
D)NON

Q2) Regarding to previous question what is causative organism ?

A) Leishmania donovan
B) Leishmania infantum
C) Leishmania major
D) Leishmania tropica QUESTION ANSWER
C
1
Q3) What is the best method to diagnose the pervious case ? A
A) Bone marrow aspirate 2
B) Giemsa stain
A
C) culture in NNN medium 3
D) Splenic aspirate