Leishmaniasis life cycle

1. A parasitized sandfly takes a blood meal from human host.

2. As the sandfly feeds, promastigote forms of the leishmanial
parasite enter the human host via the proboscis.
3. Within the human host, the promastigote forms of the parasite
are ingested by macrophages.
4. Within the host cell, they metamorphose into amastigote form
and reproduce by binary fusion. They increase in number until the
cell eventually burst, then infect other phagocytic cells and
continue the cycle.
5. The infected host is bitten by another sandfly. The sandfly will
ingest macrophages that contain amastigotes.
6. Amastigotes transform into promastigotes (procyclic),
develop (metacyclic) in the gut (in the hindgut for leishmanial
organisms in the Viannia subgenus; in the midgut for organism’s
in the Leishmania subgenus), and migrate to the proboscis.
Intermediate Host
Sandflies (Phlebotomus sp. & Lutzomya sp.)
Family: Psychodidae
Subfamily: Phletominae
Morphology Life cycle Characteristic
- Adults are small sized about 1.5 to Laid in cracks and crevices, varies - Most species are exophagic with low
3.0 mm. depending on species. dispersal

- Yellowish in colour with - Hoping type of flight inhibited by wind

conspicuous black eyes.
- Larvae feed on decaying organic matter
- Hairy body, wings and legs.
- Larvae and pupae very difficult to
collect.

- Phlebotomonas sand flies can be found

at the Old World (Africa, Asia and
Europe)
- Lutzomyia sp. Can be found at New
World (Western hemisphere specifically
America).
Cutaneous Leishmaniasis

Lifecycle Mode of Disease Pathogenesis Cure

transmission
L. tropica DH: Humans Infected Produce cutaneous
L. major female sand fly ulcers variously
IH: Phlebotomus bites during known as:
sand flies blood meal. – Cutaneous
leishmaniasis
– Oriental sore
– Jericho boil
– Aleppo boil
– Delhi boil

L. mexicana DH: Humans Infected - Cutaneous - Cutaneous leishmaniasis Same as for L.

female sand fly leishmaniasis due to L. mexicana tropica.
IH: Phlebotomus bites usually heals spontaneously
sp and several during blood in a few months:
species of meal.
Lutzomyia – Except when the lesions
involved. are in the ear

– Ear cartilage is poorly

vascularized so immune
responses are weak
 Chronic lesions with a
duration of 40 years are
known:

– Considerable mutilation
may result

– Mucocutaneous and
visceral manifestations are
rare
Cutaneous Leishmaniasis
Pathogenesis Diagnosis Treatment
Incubation period lasts from few days to • Facilitated by finding amastigotes. Cutaneous leishmaniasis
several month. • Scrapings from the side/ edge of an ulcer sometimes heals on its
• Small, red papule at the site of bite. smeared own and may not require
• May disappear in few weeks, but on a slide and stained with Wright’s or treatment.
usually it develops a thin crust that Giemsa’s
hides a spreading ulcer underneath. stain, show the parasites in endothelial
• Two/ more ulcers may coalesce to form cells and
a large sore. monocytes.
• Uncomplicated ulcers will heal within • Cannot be found in blood circulation.
two months to a year, leaving a • Culture should be made if amastigotes
depressed, unpigmented scar. go
undetected.
Mucocutaneous Leishmaniasis
Leishmania braziliensis
Morphology Lifecycle Mode of Disease Pathogenesis Diagnosis Treatment Prevention
transmission
Morphologically, DH: Humans. Infected –Mucocutaneous Causes small, red - Skin tests for - - Avoid bites of
cannot be Reservoir female sand leishmaniasis papule on skin. occult (hidden) Chemotherapy the sand fly.
differentiated hosts include fly bites infection. - Antibiotic
from L. tropica, dogs, cats, during – Espundia • Itchy, ulcerated treatment for - Avoid
L. mexicana and ant eaters, blood meal. vesicle in 1-4 weeks - Culturing the secondary outdoor
L. donovani. sloths, and – Uta (similar parasites in vitro bacterial activities
other stage to oriental (L-D bodies infection. especially
mammals. – Pian bois (in sore). cannot - Antimony- during dusk to
Venezuela & be based drugs dawn since
IH: Paraguay) • Primary lesion demonstrated in applied to that is the
Phlebotomus heals within 6-15 routine lesions or time where
sp and several months. microscope injected the sand flies
species of preparation) intravenously generally
Lutzomyia • The parasites never or active.
involved (** cause a visceral intramuscularly
promastigotes disease - Apply insect
reproduce in but often develops a repellent
hindgut). secondary lesion on
some region of the
. body.

• Flat, ulcerated
plaques that remain
open and
oozing in Venezuela
& Paraguay (pian
bois)

• Necrosis and
bacterial infection
are
common.

• Ulceration involves
lips, palate, and
pharyngx
• Invasion of trachea
and larynx
destroys the voice.

• Genitalia rarely
become infected.

• May last for many

years, and death
may result from
secondary infection
or respiratory
complication
Visceral Leishmaniasis
L. donovani
Morphology Lifecycle Mode of Disease
transmission
- Live within cells of the RE DH: Humans. Reservoir Infected female Visceral Leishmaniasis
(reticuloendothelial) includes most mammals sand fly bites or Kala Azar
system, including spleen, liver, mesenteric during blood meal.
lymph IH: Phlebotomus sand flies.
nodes, intestine and bone marrow
- Not all strains of L. donovani
- L. donovani amastigotes cannot be are adapted to all
differentiated species and strains of
from other Leishmania sp. on morphological Phlebotomus.
basis.

Visceral Leishmaniasis or Kala Azar

Pathogenesis Diagnosis Treatment Prevention

Incubation period in humans between 10 Finding Leishman Donovan (L-D) Injections of - Related to human
days to 2-4 months. bodies in tissues or secretions. various activities and sand flies’
antimony- biology.
– spleen punctures
based drugs
Death (untreated cases) in 2-3 years. – blood or nasal smears
- Similar like other
– bone marrow
Leishmaniasis
prevention steps
In some cases, more acute onset, with chills,
fever (up to 40oC/ 104oF)
and vomiting, death may occur within 6-12
months.
- Edema of the face, bleeding of mucous
membranes, breathing
difficulties, and diarrhea.
- Immediate death is due to secondary
pathogen that the body unable to combat
- Skin condition known as post kala-azar
dermal
leishmanoid develops in some cases.
Immunodiagnostic are sensitive - Promising
but cannot differentiate oral drug -
Miltefosine
between species of Leishmania
and between current and
cured cases.
– IFA, ELISA tests (main limitation
was a crossreacting
positive with T. cruzi).
– Resolved by use of monoclonal
antibody
– Need to eliminate possibility of
typhoid, paratyphoid,
malaria, syphilis, tuberculosis,
dyssentery, and relapsing
fever which cause similar
symptoms.