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

2. 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.
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3. Transmitted by Sandflies (The vector).
Rodents & dogs are reservoirs = A zoonotic cycle .
Subclinical infections occurs
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4. Pathogenesis
Organism replicates & resides only within mononuclear phagocytes of the host.
Entry into the macrophage.
Reticuloendothelial cell hyperplasia.
Granulomatous reaction .
Cellular immune mechanism.
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5. 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.
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6. (3) Mucosal leishmaniasis .
ML (Espundia)
L. brazilienses .
Uncommon but serious.
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13. 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.
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14. Severe cachexia with hepatosplenomegaly.
Jaundice, edema & ascitis.
Anemia & Pancytopenia.
Bleeding episodes e.g Epistaxis.
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15. Secondary bacterial infections . Without treatment, mortality is 90% .
Splenic infarcts .
Secondary bacterial infections .
Without treatment, mortality is 90% .
Post-kala-azar dermal leishmaniasis (PKDL)
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17. Diagnosis
Materials from splenic , bone marrow or lymph node aspirations .
Tissue sections : ! Giemsa stain for amastigotes Culture on NNN media .
Hypergammaglobulinemia.
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20. !! Indirect flluorescence assay !! Direct agglutination.
↑ liver enzymes.
Serology :
!! Enzyme immunoassay .
!! Indirect flluorescence assay
!! Direct agglutination.
!! ELIZA : 100% sensitive.
!! Called “Serodiagnostic tests”
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22. Differential Diagnosis
Malaria .
Miliary TB .
Typhoid fever.
Schistosomiasis.
Brucellosis .
Lymphoma .
Amebic liver abscess.
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23. 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 %
 Meglumine antimoniate ( Glucantime )
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24.  Side effects are : # Arthralgia, ↑ Liver enzymes, amylase & lipase
 Side effects are : # Arthralgia, ↑ Liver enzymes, amylase & lipase. # ECG & Hematologic changes. # Cardiac toxicity with sudden death.
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25. Parenteral Paromomycin.
Amphotericin B desoxycholate  mg/kg/d for 20 doses  Renal toxicity .
Lipid formulation of Amphotericin B  3mg/kg on days 1-5 &  Less nephrotoxic
Parenteral Paromomycin.
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26. 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.
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27. 7. Pentamidine : For LCL . 8. Ketoconazole : Adults with LCL.
9. Allopurinol : As adjunct therapy for CL.
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28. Prevention Protect against nocturnal Sandflies.
Insect repellent & mosquito netting.
Insecticide spraying .
Treatment of cases.
Vaccination .
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29. Thank You All