CUTANEOUS LEISHMANIASIS

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CUTANEOUS LEISHMANIASIS

• Anam Saghir
• 12-10007

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Cutaneous Leishmaniasis

• Infectious disease
• Skin
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• Popular names
•         Oriental Sore, "Bay sore," or Delhi
  Boil.

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Epidemiology and Importance in Pakistan

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• 1.5 million
• Afghanistan, Iran, Iraq, Algeria, Saudi Arabia,
  Peru, and Pakistan.
• endemic in 88 countries,72 developing
  countries,350 million (WHO)
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• Hindukush and Karakoram sub mountain range
  (Chitral, Dir and Gilgit)
• Himalayan sub mountain range (Mansehra,
  Abbottabad, Rawalpindi)
• Kirthar and Suleman sub mountain range (Lasbela,
  Khuzdar,D.G.Khan, Rajanpur, Jacobabad, Larkana)
• Toba Kakar sub mountain range (Quetta, Qila
  Abdullah, Pishin, Qila Saifullah)
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•      KPK and FATA

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Causative Organism

• protozoa of genus Leishmania
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• Leishman and Donovan  (1903)
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• 20 species---------- human infecions
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Cutaneous leishmaniasis causing organism

• Leishmania tropica major
• Leishmania tropica minor
• Leishmania aethiopica
• Leishmania mexicana

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VECTOR

• Sand fly (Phlebotomus and Lutzomyia)
• 30  species
• tiny
• no noise
• unnoticeable bite

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• lesions (a small reddish blue sore )
• Size and appearance

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PATEINTS RESPONSES

• ANERGIC RESPONSE
• formation of small papule
• nodular plaque
• no ulcer formation
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• 2.  HYPERSENSTIVE RESPONSE
• papule appears
• raised borders and ulcer in the centre
• 3-4 months
• secondary infection
• healing 90
• hyperpigmented and irregular scar

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Promastigote and amastigote
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LIFE CYCLE

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DIAGNOSTIC TEST

• Clinical diagnosis
• history of origin specifying the endemic area of
  residence at the time of development of symptoms
• morphology of the lesions
• character of the lesions
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• parasitalogical, immunological and molecular tests

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PARASITLOGICAL TEST

• direct microscopic examination
• culture
• hamster inoculation

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Skin biopsy specimen

• Skin biopsy
• Excision biopsy
• Incisional biopsy
• Shave / tangential biopsy
• Punch biopsy
• Curettings
• Fine Needle Aspiration
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• touch prepations, smears, histopathology,
  cultures in different media (NMN, BHI, EMTM etc.,
  )

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• SLIT SKIN SMEAR
• margin of the lesion contains amastigotes
• area is punctred
• syringe is injected
• aspirated is taken
• examined microscopically or cultured
• CUTANEOUS SCRAPPING
• proper cleaning and drying
• centre and margins of ulcered lesions
• multiple slides
• VE or -VE

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MOLECULAR AND IMMUNOLOGICAL TESTS

• IMMUNOLOGICAL TEST
• Montenegro skin test
• ELISA
• Indirect Fluorescence Antibody Test (IFAT)
• Direct Agglutination Test (DAT)

• MOLECULAR TEST
• PCR
• DNA hybridization
• kinetoplast DNA

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TREATMENT

• No treatment self-healing lesions
• Medical
• Pentavalent antimony (Pentostam),
• Amphotericin B
• Topical paromomycin
• Surgical
• Cryosurgery
• Excision
• Curettage

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PREVENTION

• usage of  insect repellents such as DEET
• cover the exposed skin
• staying on higher floors of buildings in the
  evening or at night
• usage of fans
• insecticidal sprays
• Insecticide-treated bed nets, sheets and window
  curtains
• pumping of insecticides in rodent burrows to kill
  rodents
• treatment can also be considered a preventive
  measure
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• Vaccines.......