Leishmaniasis

Leishmania donovani (complex) (VL) Leishmania tropica (CL) Leishmania major (CL) Leishmania aethiopica (CL) Leishmania mexicana (Complex) (CL) Leishmania brazilliensis (complex) (MCL) Leishmania peruriana
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The Parasite
Phylum
Order Family Genus

Sarcomastigophora
Kinetoplastida Trypanosomatidae Leishmania

Morphology
Digenetic Life Cycle

Promasitogte
Insect Motile Midgut

Amastigote
Mammalian stage Non-motile Intracellular

Morphology
Promastigote
Flagella

Amastigote

Kinetoplast
Golgi

Nucleus
Cytoskeleton
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Promastigote

 Amastigotes (*) of Leishmania donovani in the cells of a spleen. The individual amastigotes measure approximately 1 m in diameter.
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Amastigote

 Amastigotes of Leishmania in a macrophage from a lymph node of a dog.

 Leishmania (LeishmanDonovan or LD bodies). Lying in macrophage cells from liver. Giemsa. 12000. Enlarged by 9.6.

 A macrophage filled with Leishmania amastigotes.

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Life cycle
The organism is transmitted by the bite of several species of blood-feeding sand flies (Phlebotomus) which carries the promastigote in the anterior gut and pharynx. It gains access to mononuclear phagocytes where it transform into amastogotes and divides until the infected cell ruptures. The released organisms infect other cells. The sandfly acquires the organisms during the blood meal, the amastigotes transform into flagellate promastigotes and multiply in the gut until the anterior gut and pharynx are packed. Dogs and rodents are common reservoirs.
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Mammalian Hosts
Rodents Gerbils Hyraxes Bats Porcupines Opossums Sloths Primates Dogs Foxes Anteaters .....

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Vectors
Phlebotomine Sandflies 6 genera world wide distribution Phlebotomus & Lutzomia 500 species Females Haematophagus Males sap feeders

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Clinical Disease
Visceral
Fatal (90% untreated) Liver Spleen Bone marrow

Cutaneous
Generally Self- healing Skin Mucous membranes

SPECTRUM OF DISEASE

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Initial Infection
Similar in all species Inoculation of promastigotes Inflammation & chemotaxis Receptor mediated phagocytosis
Amasitgote
Transformation

Promastigote

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Parasite Spread
Macrophage lysis & parasite release Lymphatic spread Blood spread Target organs Skin/lymph nodes/spleen/liver/ bone marrow

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Visceral Leishmaniasis
1903 1920 1931 William Leishman Pentavalent antimony Experimental transmission

Leishmania donovani (Complex) L.d. archibaldi - L.d.chagasi - L.d.donovani - Ld.infantum

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VL - Clinical Manifestation
Variable - Incubation 3-100+ weeks Lowgrade fever Hepato-splenomegaly Bone marrow hyperplasia Anemia, Leucopenia & Cachexia Hypergammaglobulinnemia Epistaxis , Proteinuria, Hematuria
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 Profile view of a teenage boy suffering from visceral leishmaniasis. The boy exhibits splenomegaly, distended abdomen and severe muscle wasting.

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 A 12-year-old boy suffering from visceral leishmaniasis. The boy exhibits splenomegaly and severe muscle wasting.

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 Jaundiced hands of a visceral leishmaniasis patient.

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 Enlarged spleen and liver in an autopsy of an infant dying of visceral leishmaniasis.

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Post Kala Azar Dermal Leishmanoid

Normally develops <2 years after recovery Recrudescence Restricted to skin Rare but varies geographically

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Cutaneous leishmaniasis of the face.

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A cutaneous leishmaniasis lesion on the arm.

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INFECTION
Sub-clinical or inapparent infection

Recovery Immune to reinfection PKDL

Death Concurrent infection

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Diagnosis
Clinical signs & symptoms Hypergammaglobulinemia
ELISA/Formol gel

Bone marrow biopsy Spleen or liver biopsy Culture & Histology

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Speciation
Similar morphology Isoenzyme profiles - Zymodemes Monoclonal antibodies DNA hybridisation - PCR

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Treatment
Good nursing Diet Antibiotics Pentavalent antimony Pentamidine
New drugs - New delivery
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Control
Vector control Reservoir control Treatment of active cases Vaccination

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