major/tropica/aethiopica Leishmania major/tropica/aethiopica By Sarah Chilmeran

Review… Transmitted by the bite of a sandfly Forms cutaneous or mucocutaneous sores Leishmania major: Cutaneous Leishmaniasis Found in sparsely inhabited regions. Papule ulcerates quickly, has a short duration, contains few amasigotes Most likely type to be found in canines

Review… Leishmania tropica: Leishmania aethiopica: Cutaneous Leishmaniasis Found in more densely populated areas It’s lesion is dry Persist’s for month’s before ulcerating Leishmania aethiopica: Old World Leishmania (Kenya, Ethiopia)

Distribution Of the 500 000 new cases of Visceral Leishmaniasis which occur annually, 90% are in five countries: Bangladesh, Brazil, India, Nepal and Sudan. 90% of all cases of Mucocutaneous Leishmaniasis occur in Bolivia, Brazil and Peru. 90% of all cases of Cutaneous Leishmaniasis occur in Afghanistan, Brazil, Iran, Peru, Saudi Arabia and Syria, with 1-1.5 million new cases reported annually worldwide.

Scientific (or non-scientific) Historical Accounts Skin lesions and facial abnormalities were found on pre-Inca potteries from Ecuador and Peru dating back to the 1st century AD!

Historical Development of Leishmania Originally referred to as “Alleppo boil” when first diagnosed/discovered by Alexander Russell in 1756. His description… "After it is cicatrised, it leaves an ugly scar, which remains through life, and for many months has a livid colour. When they are not irritated, they seldom give much pain."

Culture Practice Promoting Transmission of Leishmania HIV co-infection may reactivate latent leishmanial infections, increase the level of transmission of leishmania by phlebotomine sand flies, and facilitate artificial transmission of leishmania, via the sharing of contaminated syringes and needles, from one intravenous drug user to another.

“Infrastructure” in a broad sense and how it affects prevalence and spread of the parasite As 71.1% of co-infected patients in south-western Europe are intravenous drug users, transmission of Leishmania has occurred through the sharing of syringes in this population group. In France, Italy, Portugal, and Spain the outbreak of HIV infection has changed the epidemiology of VL from a disease predominantly found in children to one more common in adults.

Historical Movements of Leishmania The proposals for migration of Leishmania include… African origin, with migration to the Americas. Another migration from the Americas to the Old World about 15 million years ago, across the Bering Strait land bridge.

Historical Movements of Leishmania Palaearctic origin: Such migrations would entail migration of vector and reservoir or successive adaptations along the way.

How the Health Care Community Responds to the Parasitic Disease Treatments of Leishmania include… Pentamidine: More toxic and difficult to administer. “Orphan drug” by the FDA. Amphotericin B: Current alternative treatment of choice. Intravenously administered. Miltefosine: Only effective oral treatment Drawbacks are… the medicines are usually too expensive for infected persons where the disease is endemic (i.e. Africa, Brazil, India)

Anthropogenic environmental changes that have influenced the prevalence and spread of the disease The geographic spread of Leishmania-endemic regions is due to factors related mostly to development. These include massive rural-urban migration and agro-industrial projects that bring non-immune urban dwellers into endemic rural areas. Man-made projects with environmental impact, like dams, irrigation systems and wells, as well as deforestation, also contribute to the spread of leishmaniasis.

Spread of the disease continued… During deforestation, the smaller patches left after fragmentation often do not have sufficient prey for top predators, resulting in local extinction of predator species and a subsequent increase in the density of their prey species. Logging and road building in Latin America have increased the incidence of cutaneous and visceral leishmaniasis, which in some areas has resulted from an increase in the number of fox reservoirs and sandfly vectors that have adapted to the peridomestic environment.

Sites http://www.who.int/mediacentre/factsheets/fs116/en/ http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1247383 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=9145744 http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0102-311X2001000500023&lng=es&nrm=iso&tlng=en http://en.wikipedia.org/wiki/Leishmania

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