Haemoflagellates Leishmaniasis

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Haemoflagellates Leishmaniasis
Trypanosomiasis
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Different stages of Haemoflagellates
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Promastigotes of Leishmania
Amastigote of Leishmania
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• The life cycle of Leishmania

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Leishmania Parasites and Diseases
Disease 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 Endemic in Saudi Arabia
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World distribution of Visceral Leishmaniasis
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Sand fly
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Amastigotes of Leishmania
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Promastigotes of Leishmania
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lesion
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lesion
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lesion
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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

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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.

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Diffuse cutaneous leishmaniasis
Leishmaniasis recidiva
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cutaneous leishmaniasis

• Diagnosis
• Smear Giemsa stain microscopy for LD bodies
  (amastigotes)
• Biopsy microscopy for LD bodies or culture in
  NNN medium for promastigotes

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NNN medium
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Treatment

• No treatment self-healing lesions
• Medical
• Pentavalent antimony (Pentostam), Amphotericin B
• /- Antibiotics for secondary bacterial
  infection.
• Surgical
• Cryosurgery
• Excision
• Curettage

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Pentostam ( sodium stibogluconate) for treatment
of all types of leishmaniasis
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Visceral leishmaniasis

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

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Presentation

• Fever
• Splenomegaly, hepatomegaly, hepatosplenomegaly
• Weight loss
• Anaemia
• Epistaxis
• Cough
• Diarrhoea

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

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Fever 2 times a day due to kala-azar
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Hepatosplenomegaly in visceral leishmaniasis
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Mucocutaneous leishmaniasis
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Visceral leishmaniasis

• Diagnosis
• Parasitological diagnosis METHOD
• Bone marrow aspirate 1. microscopy
• Splenic aspirate 2.
  culture in NNN medium
• Lymph node
• Tissue biopsy

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Bone marrow aspiration
Bone marrow amastigotes
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(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.

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DAT test
ELISA test
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Formol-gel
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• Treatment
• Pentavalent antimony- sodium stibogluconate
  (Pentostam)
• Amphotericin B
• Treatment of complications
• Anaemia
• Bleeding
• Infections etc.

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Post-kalazar dermal leishmaniasis (PKDL)
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Trypanosomiases
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African Trypanosomiasis
Life cycle of Trypanosoma brucei gambiense T.
b. rhodesiense
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African sleeping sickness

• Trypanosoma brucei rhodesiense East Africa, wild
  and domestic animal reservoirs
• Trypanosoma brucei gambiense West and Central
  Africa, mainly human infection

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Animal reservoir hosts for African sleeping
sickness
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Tsetse fly
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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)

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chancre
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Winterbottoms stage
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3rd stage CNS
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Lymph node aspirate
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trypanosoma
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CSF
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AMERICAN TRYPANOSOMIASIS
LIFE CYCLE OF Trypanosoma cruzi
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Reduviid (Triatomine) bug
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Diagnosis

• Blood film
• Serology IFAT
• Xenodiagnosis feeding bugs on a suspected cases.

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T. cruzi causes cutaneous stage (chagoma)
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Ocular lesion (Romana sign)
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C-shape
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TREATMENT

• African trypanosomiasis
• For early infection
• pentamidine
• suramin
• For late infection
• eflornithine (Diflouromethylornithine- DFMO)
• American trypanosomiasis (Chagas disease)
• benznidazole
• nifurtimox

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trophozoites
Trichomonas vaginalis
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Trichomonas vaginalis
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Trichomonas vaginalis

• Transmission
• sexual intercourse
• contact with contaminated objects.

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Pathology
Trichomoniasis

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

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Signs and Symptoms of Trichomoniasis in Women

Sign/Symptom Percent of Patients
Asymptomatic 50
Vaginal/vulvar erythema (redness) 75
Frothy, yellow/green discharge 25
Vulvar itching 20-50
Strawberry cervix lt 2
Vaginal odor 60
pH gt 5 60-90
Dyspareunia (pain during sexual intercourse) lt 25
Dysuria (pain during urination) lt 25
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Signs and Symptoms of Trichomoniasis in Men

Sign/Symptom of Patients
Asymptomatic gt 50
Urethral discharge 65-100
Pruritus (itching) 98.5
Dysuria (pain during urination) 5.5
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Diagnosis
Trichomoniasis

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

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Trichomonas vaginalis
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Trichomonas vaginalis
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Trichomoniasis

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