1. Leishmaniasis Leishmania donovani (complex) (VL)
Leishmania tropica (CL)
Leishmania major (CL)
Leishmania aethiopica (CL)
Leishmania mexicana (Complex) (CL)
Leishmania brazilliensis (complex) (MCL)
Leishmania peruriana

2. The Parasite Phylum Order Family Genus Sarcomastigophora
Kinetoplastida
Trypanosomatidae
Leishmania

3. Morphology Promasitogte Amastigote Digenetic Life Cycle Insect Motile
Midgut
Amastigote
Mammalian stage
Non-motile
Intracellular

4. Morphology Promastigote Amastigote Flagella Kinetoplast Golgi Nucleus
Cytoskeleton

5. Promastigote

6. Amastigotes (. ) of Leishmania donovani in the cells of a spleen
Amastigotes (*) of Leishmania donovani in the cells of a spleen.  The individual amastigotes measure approximately 1 µm in diameter. 

7. Amastigote

8. Amastigotes of Leishmania in a macrophage from a lymph node of a dog. 

9. Leishmania (Leishman-Donovan or LD bodies)
Leishmania (Leishman-Donovan or LD bodies). Lying in macrophage cells from liver. Giemsa. × Enlarged by 9.6.

10. A macrophage filled with Leishmania amastigotes.

11. Life cycle
The organism is transmitted by the bite of several species of blood-feeding sand flies (Phlebotomus) which carries the promastigote in the anterior gut and pharynx. It gains access to mononuclear phagocytes where it transform into amastogotes and divides until the infected cell ruptures. The released organisms infect other cells. The sandfly acquires the organisms during the blood meal, the amastigotes transform into flagellate promastigotes and multiply in the gut until the anterior gut and pharynx are packed. Dogs and rodents are common reservoirs.

13. Mammalian Hosts Rodents Gerbils Hyraxes Bats Porcupines Opossums
Sloths
Primates
Dogs
Foxes
Anteaters

14. Vectors Phlebotomine Sandflies 6 genera world wide distribution
Phlebotomus & Lutzomia
500 species
Females Haematophagus
Males sap feeders

16. Clinical Disease Visceral Cutaneous Fatal (90% untreated) Liver Spleen
Bone marrow
Cutaneous
Generally Self- healing
Skin
Mucous membranes
SPECTRUM OF DISEASE

17. Promastigote Amasitgote
Initial Infection
Similar in all species
Inoculation of promastigotes
Inflammation & chemotaxis
Receptor mediated phagocytosis
Promastigote Amasitgote
Transformation

18. Macrophage lysis & parasite release Skin/lymph nodes/spleen/liver/
Parasite Spread
Macrophage lysis & parasite release
Lymphatic spread
Blood spread
Target organs
Skin/lymph nodes/spleen/liver/
bone marrow

19. Visceral Leishmaniasis
1903
1920
1931
William Leishman
Pentavalent antimony
Experimental transmission
Leishmania donovani (Complex)
L.d. archibaldi - L.d.chagasi - L.d.donovani - Ld.infantum

20. VL - Clinical Manifestation
Variable - Incubation weeks
Lowgrade fever
Hepato-splenomegaly
Bone marrow hyperplasia
Anemia, Leucopenia & Cachexia
Hypergammaglobulinnemia
Epistaxis , Proteinuria, Hematuria

21. Profile view of a teenage boy suffering from visceral leishmaniasis
Profile view of a teenage boy suffering from visceral leishmaniasis. The boy exhibits splenomegaly, distended abdomen and severe muscle wasting. 

22. A 12-year-old boy suffering from visceral leishmaniasis
A 12-year-old boy suffering from visceral leishmaniasis. The boy exhibits splenomegaly and severe muscle wasting.

23. Jaundiced hands of a visceral leishmaniasis patient. 

24. Enlarged spleen and liver in an autopsy of an infant dying of visceral leishmaniasis.

25. Post Kala Azar Dermal Leishmanoid
Normally develops <2 years after recovery
Recrudescence
Restricted to skin
Rare but varies geographically

26. Cutaneous leishmaniasis of the face.

27. A cutaneous leishmaniasis lesion on the arm.

28. Sub-clinical or inapparent infection
Recovery Death
Immune to reinfection Concurrent infection
PKDL

29. Clinical signs & symptoms Hypergammaglobulinemia
Diagnosis
Clinical signs & symptoms
Hypergammaglobulinemia
ELISA/Formol gel
Bone marrow biopsy
Spleen or liver biopsy
Culture & Histology

30. Speciation Similar morphology Isoenzyme profiles - Zymodemes
Monoclonal antibodies
DNA hybridisation - PCR

31. New drugs - New delivery
Treatment
Good nursing
Diet
Antibiotics
Pentavalent antimony
Pentamidine
New drugs - New delivery

32. Control Vector control Reservoir control Treatment of active cases
Vaccination