Leishmaniasis

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Leishmaniasis
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Leishmaniasis

• Leishmania parasites cause cutaneous,
  mucocutaneous and visceral (kala-azar)
  leishmaniasis. There are about 10 million cases
  of cutaneous leishmaniasis and 400,000 cases of
  visceral leishmaniasis per year.

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Visceral leishmaniasis

• Is caused by
• L. donovani,
• L. infantum
• L. changasi
• the letter two species are indistinguishable. It
  is widespread (including the mediterranean) but
  90of cases occur in north east India,
  Bangladesh, Sudan, Ethiopia, Kenya or Brazil

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Cutaneous leishmaniasis

• Is caused by several species.
• L. tropica causes anthroponotic disease in urban
  areas.
• L. major causes zoonotic disease in rural areas.
• L. aethiopica causes cutaneous leishmaniasis in
  Ethiopia and parts on Kenya.

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• The L. mexican complex (L. m. mexicana, L. m.
  amazonensis, L. m. venezuelensis)
• and the L. braziliensis complex (L. b.
  braziliensis, L. b. panamensis, L.b. guyanensis,
  L. b. peruviana)
• cause cutaneous leishmaniasis in the Americas.
• L. Infantum causes small numbers of cases in
  Europe.

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• Sand fly bite in an endemic area.
• Visceral leishmaniasis irregular fever,
  progressive hepatosplenomegaly, pancytopenia,
  wasting.
• Cutaneous leishmaniasis chronic, painless, moist
  ulcers or dry nodules.
• Mucocutaneous leishmaniasis destructive
  nasopharyngeal lesions.
• Amastigotes in macrophages in aspirates, touch
  preparations, or biopsies.
• Positive culture, serologic tests, PCR, or skin
  test.

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General Considerations

• Leishmaniasis is a zoonosis transmitted by bites
  of sand flies of the genus Lutzomyia in the
  Americas and Phlebotomus elsewhere.

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• Visceral leishmaniasis  (kala azar) is caused
  mainly by Leishmania donovani in the Indian
  subcontinent and East Africa Leishmania infantum
  in the Mediterranean, Middle East, China, parts
  of Asia, and Horn of Africa and Leishmania
  chagasi in South and Central America.

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• Old World cutaneous leishmaniasis
• is caused mainly by Leishmania tropica,
  Leishmania major, and Leishmania aethiopica in
  the Mediterranean, Middle East, Africa, Central
  Asia, and Indian subcontinent.

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Clinical Findings

• A. Symptoms and Signs
• 1. Visceral Leishmaniasis (Kala azar)
• Most infections are subclinical, but a small
  number progress to full-blown disease. A local
  nonulcerating nodule at the site of the sand fly
  bite may precede systemic manifestations but
  usually is inapparent.

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2. Old world the new world cutaneous
leishmaniasis

• Cutaneous swelling appear 2 week to several
  months after sand fly bites and can be single or
  multiple.
• 3. Mucocutaneous Leishmaniasis (Espundia)
• In Latin America, mucosal lesions develop in a
  small percentage of persons infected with L
  braziliensis and some other species, usually
  months to years after resolution of a cutaneous
  lesion.

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• 4. Infections in Patients with AIDS
• Leishmaniasis is an opportunistic infection in
  persons with AIDS seen in southern Europe and
  other areas.

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B. Laboratory Findings

• Identifying parasites in tissue samples or
  culture material provides a definitive diagnosis.
  In visceral leishmaniasis, fine-needle aspiration
  of the spleen for culture and tissue evaluation
  is generally safe, and yields a diagnosis in over
  95 of cases.

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Treatment

• Treatment is not adequate because most drugs are
  quite toxic, require long courses, and are mostly
  administered parenterally.
• A. Visceral Leishmaniasis
• The treatment of choice for visceral
  leishmaniasis is liposomal amphotericin B, which
  is generally effective and well tolerated but
  very expensive.

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B. Cutaneous Leishmaniasis

• In the Old World, cutaneous leishmaniasis is
  generally self-healing over some months and does
  not metastasize to the mucosa, so it may be
  justified to withhold treatment in regions
  without mucocutaneous disease if lesions are
  small and cosmetically unimportant.

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C. Mucocutaneous Leishmaniasis

• Cutaneous infections from regions where parasites
  include those that cause mucocutaneous disease
  (eg, L braziliensis in parts of Latin America)
  should all be treated to help prevent disease
  progression.

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Prevention Control

• Personal protection measures for avoidance of
  sand fly bites include use of insect repellants,
  fine-mesh insect netting, long sleeves and pants,
  and avoidance of warm shaded areas where flies
  are common.

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• Thanks