1. Haemoflagellates Leishmaniasis & Trypanosomiasis

2. Different stages of Haemoflagellates

3. Promastigotes of Leishmania
Amastigote of Leishmania

4. The life cycle of Leishmania

6. 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

8. World distribution of Visceral Leishmaniasis

9. Sand fly

10. Amastigotes of Leishmania

11. Promastigotes of Leishmania

12. lesion

13. lesion

14. lesion

15. 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

17. 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.

18. Diffuse cutaneous leishmaniasis
Leishmaniasis recidiva

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

20. NNN medium

21. Treatment No treatment – self-healing lesions Medical: Surgical:
Pentavalent antimony (Pentostam), Amphotericin B
+/- Antibiotics for secondary bacterial infection.
Surgical:
Cryosurgery
Excision
Curettage

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

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

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

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

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

27. Hepatosplenomegaly in visceral leishmaniasis

28. Mucocutaneous leishmaniasis

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

30. Bone marrow aspiration
Bone marrow amastigotes

31. (2) Immunological Diagnosis:
Specific serologic tests: Direct Agglutination Test (DAT), ELISA, IFAT
Skin test (leishmanin test) for survey of populations and follow-up after treatment.
Non specific detection of hypergammaglobulinaem by formaldehyde (formol-gel) test or by electrophoresis.

32. DAT test
ELISA test

33. Formol-gel

34. Treatment:
Pentavalent antimony- sodium stibogluconate (Pentostam)
Amphotericin B
Treatment of complications:
Anaemia
Bleeding
Infections etc.

35. Post-kalazar dermal leishmaniasis (PKDL)

36. Trypanosomiases

37. African Trypanosomiasis
Life cycle of Trypanosoma
brucei gambiense & T. b. rhodesiense

38. African sleeping sickness
Trypanosoma brucei rhodesiense: East Africa, wild and domestic animal reservoirs
Trypanosoma brucei gambiense: West and Central Africa, mainly human infection

40. Animal reservoir hosts for African sleeping sickness

41. Tsetse fly

42. Pathology and clinical picture
Skin stage: chancre.
Haematolymphatic stage: generalized lymphadenopathy, anaemia, generalized organ involvement.
Central nervous system stage (CNS): Meningoencephalitis.
(Development of the disease more rapid in Trypanosoma brucei rhodesiense)

43. chancre

44. Winterbottom’s stage

45. 3rd stage CNS

46. Lymph node aspirate

47. trypanosoma

48. CSF

50. AMERICAN TRYPANOSOMIASIS
LIFE CYCLE OF Trypanosoma cruzi

51. Reduviid (Triatomine) bug

52. Diagnosis
Blood film
Serology: IFAT
Xenodiagnosis: feeding bugs on a suspected cases.

53. T. cruzi causes cutaneous stage (chagoma)

54. Ocular lesion (Romana’ sign)

55. C-shape

56. TREATMENT African trypanosomiasis For early infection pentamidine
suramin
For late infection
eflornithine (Diflouromethylornithine- DFMO)
American trypanosomiasis (Chaga’s disease)
benznidazole
nifurtimox

57. Trichomonas vaginalis
trophozoites

58. Trichomonas vaginalis

59. Trichomonas vaginalis
Transmission:
sexual intercourse
contact with contaminated objects.

60. Trichomoniasis Pathology Female:
vaginitis, profuse thin yellowish discharge with bad smell
Male:
invasion of urethra, prostate and seminal vesicles, causing urethritis but mostly asymptomatic.

61. Signs and Symptoms of Trichomoniasis in Women
Sign/Symptom
Percent of Patients
Asymptomatic
≤ 50%
Vaginal/vulvar erythema (redness)
75%
Frothy, yellow/green discharge
25%
Vulvar itching
20-50%
Strawberry cervix
< 2%
Vaginal odor
60%
pH > 5
60-90%
Dyspareunia (pain during sexual intercourse)
< 25%
Dysuria (pain during urination)

62. Signs and Symptoms of Trichomoniasis in Men
Sign/Symptom
% of Patients
Asymptomatic
> 50%
Urethral discharge
65-100%
Pruritus (itching)
98.5%
Dysuria (pain during urination)
5.5%

63. Trichomoniasis Diagnosis
Identification of parasite by microscopy of discharge.
Examination of vaginal or urethral discharge for T. vaginalis

64. Trichomonas vaginalis

65. Trichomonas vaginalis

66. Trichomoniasis Treatment: metronidazole (flagyl). Note:
Treat sexual partner because infection is mostly asymptomatic in males.