1. Haemoflagellates Leishmaniasis & Trypanosomiasis

2. Different stages of Haemoflagellates

3. Promastigotes of Leishmania Amastigote of Leishmania

4. The life cycle of Leishmania

5. Leishmania Parasites and Diseases DiseaseSPECIES Cutaneous leishmaniasis Leishmania major*(main species in KSA) Leishmania tropica* Leishmania aethiopica Leishmania mexicana Mucocutaneous leishmaniasis Leishmania braziliensis Visceral leishmaniasis Leishmania donovani* Leishmania infantum* Leishmania chagasi * Endemic in Saudi Arabia

7. World distribution of Visceral Leishmaniasis

8. Sand fly

9. Amastigotes of Leishmania

10. Promastigotes of Leishmania

11. lesion

13. 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

15. 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.

16. Diffuse cutaneous leishmaniasis Leishmaniasis recidiva

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

18. NNN medium

19. Treatment No treatment – self-healing lesions Medical: oPentavalent antimony (Pentostam), Amphotericin B o+/- Antibiotics for secondary bacterial infection. Surgical: oCryosurgery oExcision oCurettage

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

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

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

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

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

25. Hepatosplenomegaly in visceral leishmaniasis

26. Mucocutaneous leishmaniasis

27. Visceral leishmaniasis Diagnosis (1)Parasitological diagnosis: METHOD Bone marrow aspirate 1. microscopy Splenic aspirate 2. culture in NNN medium Lymph node Tissue biopsy

28. Bone marrow aspiration Bone marrow amastigotes

29. (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.

30. DAT test ELISA test

31. Formol-gel

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

33. Post-kalazar dermal leishmaniasis (PKDL)

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

35. Trypanosomiases

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

39. Animal reservoir hosts for African sleeping sickness

40. Tsetse fly

41. Pathology and clinical picture 1.Skin stage: chancre. 2.Haematolymphatic stage: generalized lymphadenopathy, anaemia, generalized organ involvement. 3.Central nervous system stage (CNS): Meningoencephalitis. (Development of the disease more rapid in Trypanosoma brucei rhodesiense)

42. chancre

43. Winterbottom’s stage

44. 3 rd stage CNS

45. Lymph node aspirate

46. trypanosoma

47. 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 lesion (Romana’ sign)

54. Heart damage due to American trypanosomiasis

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