1. Haemoflagellates Leishmaniasis & Trypanosomiasis

2. Different stages of Haemoflagellates

3. The life cycle of Leishmania

5. 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. Sand fly

9. amastigotes

10. promastigotes

11. promastigotes

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

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

28. mucocutaneous

29. PKDL

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

31. Bone marrow aspiration
Bone marrow amastigotes

32. (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.

33. DAT test
ELISA test

34. Formol-gel

35. Treatment:
Pentavalent antimony (Pentostam)
Amphotericin B
Treatment of complications:
Anaemia
Bleeding
Infections etc.

36. Trypanosomiasis

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

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

49. AMERICAN TRYPANOSOMIASIS
LIFE CYCLE OF Trypanosoma cruzi

50. Reduviid (Triatomine) bug

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

52. T. cruzi causes cutaneous stage (chagoma)

53. Ocular (Romana’ sign)

54. C-shape

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

56. Trichomonas vaginalis

57. Transmission:
sexual intercourse
contact with contaminated objects.

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

59. trophozoites

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

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