1. Leishmaniasis

2. Promastigotes of Leishmania
Amastigote of Leishmania

3. The life cycle of Leishmania

4. Leishmania Parasites and Diseases
SPECIES
Cutaneous leishmaniasis
Leishmania tropica*
Leishmania major*
Leishmania aethiopica
Leishmania mexicana
Mucocutaneous leishmaniasis
Leishmania braziliensis
Visceral leishmaniasis
Leishmania donovani*
Leishmania infantum*
Leishmania chagasi
* Endemic in Saudi Arabia

6. World distribution of Visceral Leishmaniasis

7. Sand fly

8. Amastigotes of Leishmania

9. Promastigotes of Leishmania

10. lesion

11. lesion

12. Clinical types of cutaneous leishmaniasis
Leishmania major: Zoonotic cutaneous leishmaniasis: wet lesions with severe reaction
Leishmania tropica: Anthroponotic cutaneous leishmaniasis: Dry lesions with minimal ulceration
Oriental sore (most common) classical self-limited ulcer

14. Uncommon types Diffuse cutaneous leishmaniasis (DCL):
Caused by L. aethiopica, diffuse nodular non-ulcerating lesions. Low immunity to Leishmania antigens, numerous parasites.
Leishmaniasis recidiva (lupoid leishmaniasis):
Severe immunological reaction to leishmania antigen leading to persistent dry skin lesions, few parasites.

15. Diffuse cutaneous leishmaniasis
Leishmaniasis recidiva

16. cutaneous leishmaniasis
Diagnosis:
Smear: Giemsa stain – microscopy for LD bodies (amastigotes)
Biopsy: microscopy for LD bodies or culture in NNN medium for promastigotes

17. NNN medium

18. Pentostam ( sodium stibogluconate) for treatment of all types of leishmaniasis

19. Visceral leishmaniasis
There are geographical variations.
The diseases is called kala-azar
Leishmania infantum mainly affect children
Leishmania donovani mainly affects adults

20. Presentation Fever Splenomegaly, hepatomegaly, hepatosplenomegaly
Weight loss
Anaemia
Epistaxis
Cough
Diarrhoea

21. Untreated disease can be fatal
After recovery it might produce a condition called post kala-azar dermal leishmaniasis (PKDL)

22. Fever 2 times a day due to kala-azar

23. Hepatosplenomegaly in visceral leishmaniasis

24. Mucocutaneous leishmaniasis

25. Visceral leishmaniasis
Diagnosis
Parasitological diagnosis:
Bone marrow aspirate microscopy
Splenic aspirate culture in NNN medium
Lymph node
Tissue biopsy

26. Bone marrow aspiration
Bone marrow amastigotes

27. (2) Immunological Diagnosis:
Specific serologic tests: Direct Agglutination Test (DAT), ELISA, IFAT
rK39 antigen-based immunochromatographic tes .
TWO LIMITATIONS FOR SEROLOGIC TESTS:
Do not diagnose relapses.
In endemic areas it is sometimes +ve in healthy individuals.

28. DAT test
ELISA test

29. Antileishmanial drugs
Pentavalent antimonials
meglumine antimoniate ,sodium stibogluconate:IM IV ,can be administered Intralesionally for the treatment of cutaneous leishmaniasis.Cardiotoxicity and sudden death are serious but uncommon side-effects.
Amphotericin B deoxycholate
Amphotericin B is a polyene antibiotic, should always be given in hospital to allow continuous monitoring of patients.
Lipid formulations of amphotericin B
Several formulations, they are similar to amphotericin B deoxycholate in their efficacy but are significantly less toxic.
Paromomycin
Paromomycin (aminosidine) is an aminoglycoside antibiotic, usually IM. A topical formulation is available for cutaneousleishmaniasis.
Pentamidine isethionate
IM or IV.Severe adverse effects—diabetes mellitus, severe hypoglycaemia, shock,
myocarditis and renal toxicity—limit its use.
Miltefosine
This alkyl phospholipid (hexadecylphosphocholine) was originally
Miltefosine is potentially teratogenic and should not be used by pregnant women
Azoles medicines: ketoconazole, fluconazole, itraconazole
These oral antifungal agents have variable efficacy in leishmaniasis treatment

30. Treatment Of Cutaneous Leishmaniasis
No treatment – self-healing lesions
Medical:
Pentavalent antimony (Pentostam), Amphotericin B
Antifungal drugs
+/- Antibiotics for secondary bacterial infection.
Surgical:
Cryosurgery
Excision
Curettage
REFERENCE :WHO (2010) Control of leishmaniasis. Report of a meeting 571 of the WHO expert committee on the control of leishmaniasis.

31. Treatment of visceral leishmanisis
Recommended treatment varies in different endemic areas:
Pentavalent antimony- sodium stibogluconate (Pentostam)
Amphotericin B
Treatment of complications:
Anaemia
Bleeding
Infections etc.
REFERENCE :WHO (2010) Control of leishmaniasis. Report of a meeting 571 of the WHO expert committee on the control of leishmaniasis.