By Dr Satti Abdulrahim Satti Consultant Pediatrician بسم الله الرحمن الرحيم Leishmaniasis By Dr Satti Abdulrahim Satti Consultant Pediatrician

Affects > 12 million worldwide. In tropical & subtropical regions. A group of diseases caused by : Leishmania, which is an intracellular protozoan. Affects > 12 million worldwide. In tropical & subtropical regions. As sporadic or epidemic form. 5/9/2019

Transmitted by Sandflies (The vector). Rodents & dogs are reservoirs = A zoonotic cycle . Subclinical infections occurs 5/9/2019

Pathogenesis Organism replicates & resides only within mononuclear phagocytes of the host. Entry into the macrophage. Reticuloendothelial cell hyperplasia. Granulomatous reaction . Cellular immune mechanism. 5/9/2019

Clinical Manifestations # Forms of the disease : (1) Localized cutaneous leishmaniasis. LCL or Oriental sore L. major, L. tropica & L. mexicana (2) Diffuse cutaneous leishmaniasis. DCL , which is rare. 5/9/2019

(3) Mucosal leishmaniasis . ML (Espundia) L. brazilienses . Uncommon but serious. 5/9/2019

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Visceral Leishmaniasis Called Kala-azar . Caused by L. Donovani, L. infantum & L. chagasi . Asymptomatic, oligosymptomatic or active kala-azar. High fever, weakness & loss of energy. 5/9/2019

Severe cachexia with hepatosplenomegaly. Jaundice, edema & ascitis. Anemia & Pancytopenia. Bleeding episodes e.g Epistaxis. 5/9/2019

Secondary bacterial infections . Without treatment, mortality is 90% . Splenic infarcts . Secondary bacterial infections . Without treatment, mortality is 90% . Post-kala-azar dermal leishmaniasis (PKDL) 5/9/2019

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Diagnosis Materials from splenic , bone marrow or lymph node aspirations . Tissue sections : ! Giemsa stain for amastigotes. Culture on NNN media . Hypergammaglobulinemia. 5/9/2019

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!! Indirect flluorescence assay !! Direct agglutination. ↑ liver enzymes. Serology : !! Enzyme immunoassay . !! Indirect flluorescence assay !! Direct agglutination. !! ELIZA : 100% sensitive. !! Called “Serodiagnostic tests” 5/9/2019

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Differential Diagnosis Malaria . Miliary TB . Typhoid fever. Schistosomiasis. Brucellosis . Lymphoma . Amebic liver abscess. 5/9/2019

Treatment 1. Pentavalent antimony compounds :  Sodium Stibogluconate ( Pentostam ) !! 20mg/kg/day IV or IM for 20 or 28 days. !! May need repeated courses. !! Cure rate is 80-100%  Meglumine antimoniate ( Glucantime ) 5/9/2019

 Side effects are : # Arthralgia, ↑ Liver enzymes, amylase & lipase  Side effects are : # Arthralgia, ↑ Liver enzymes, amylase & lipase. # ECG & Hematologic changes. # Cardiac toxicity with sudden death. 5/9/2019

Parenteral Paromomycin. Amphotericin B desoxycholate 2. -- 0.5-1mg/kg/d for 20 doses. -- Renal toxicity . Lipid formulation of Amphotericin B. -- 3mg/kg on days 1-5 & 10. -- Less nephrotoxic Parenteral Paromomycin. 5/9/2019

5. Recombinant human interferon- ∂  As an adjunct to antimony therapy.  Cause fever & flu-like symptoms. 6. Miltefosine PO : 50-150mg/d for 4-6 wks. GIT side effects. 5/9/2019

7. Pentamidine : For LCL . 8. Ketoconazole : Adults with LCL. 9. Allopurinol : As adjunct therapy for CL. 5/9/2019

Prevention Protect against nocturnal Sandflies. Insect repellent & mosquito netting. Insecticide spraying . Treatment of cases. Vaccination . 5/9/2019

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