Clinical Spectrum of Leishmaniasis Cutaneous Leishmaniasis (CL) most common form, relatively benign self-healing skin lesions (aka, localized or simple CL) Mucocutaneous Leishmaniasis (MCL) simple skin lesions that metastasize to mucosae (especially nose and mouth region) Visceral Leishmaniasis (VL) generalized infection of the reticuloendothelial system, high mortality

William Boog LEISHMAN (1865-1926) Leishmania donovani Causative agent of _____________________________________, or visceral leishmaniasis Identified by William Leishman in 1900 from a soldier who died of fever in Dum-Dum, India. Charles Donovan identified the parasites in the spleen of an infected person in 1903. Parasite is named in honor of these two men.                                                               William Boog LEISHMAN (1865-1926) Charles DONOVAN (1863-1915)

Amastigote: oval, 2-5 microns by 1 - 3 microns Amastigote: oval, 2-5 microns by 1 - 3 microns. Most likely seen inside macrophages. Promastigote: rarely seen in clinical samples, most likely recovered from gut of sand fly: 14 - 20 microns by 1.5 - 4 microns, similar in size & appearance to trypanosomes

Diagnosis geographical presence of parasite demonstration of parasite in skin lesion or bone marrow(NNN medium)Giemsa stain delayed hypersensitivity skin test (cutaneous forms) serological tests For Visceral Leishmaniasis: enzyme liked immunosorbent assay (ELISA) direct agglutination test (DAT) indirect fluorescent antibody test (IFAT)

Treatment pentavalent antimonials (pentostam) amphotericin B (less toxic, expensive) miltefosine (phase IV, no hospitalization

Sand fly Phlebotomus & Lutzomia

Amastigotes

Promastigotes

Amastigoites in macrophages macrophage from a lymph node of a dog.  Leishman-Donovan or LD bodies). Lying in macrophage cells from liver. Giemsa

Diffuse cuetaneous leishmaniasis

macrophage filled with Leishmania amastigotes.

hepatosplenomegaly

mucocutaneous

NNN medium