PARASITOLOGY

MIDTERMS/LECTURE SECOND SEMESTER

LEISHMANIA SPP.

LEISHMANIA SPP.
● L. braziliensis complex TREATMENT
● L. donovani complex
● L. mexicana complex
● L. tropica complex ● Sodium stibogluconate (Pentostam)
● Adult: 20 mg/kg (as pentavalent antimony) for 30 days
● Child: same as adult dose

LEISHMANIA SPP.
Alternatives:
● Liposomal amphotericin B (Ambisome)
● Diploid protozoan that causes
● Fluconazole (Diflucan), ketoconazole
● Leishmaniasis
● (Nizoral) and Itraconazole (Sporonox)
● Host: Humans and sandflies
● Produces amastigotes in its mammalian
● host and promastigotes in the gut of the
● insect vector (biological vector) Leishmania donovani complex

2 forms
Amastigotes LIFE CYCLE
● Ovoid or round (2-3 um) ● Sandflies responsible for L. donovani transmission:
● Large nucleus ○ Lutzomyia sandfly
● Axoneme arises from the kinetoplast that ○ Phlebotomus sandfly
● extends to the anterior tip
● Primarily affects the visceral tissue of the infected
Promastigotes human.
● Elongated and slender
● Single free flagellum CLINICAL MANIFESTATIONS
● 15-20 um in length, 1.5 – 3.5 um in width
● LIFE CYCLE
Visceral Leishmaniasis (kala-azar)

● Incubation period: 2-8 months

● The spread of parasites into the bone marrow, spleen,
CLINICAL MANIFESTATIONS and liver.
● Acute phase: twice-daily fever spikes with
● Fever accompanying chills
● Weight loss (cachexia; wasting) ● Subacute and chronic phase: fever, weakness, loss
● Hepatosplenomegaly of appetite, weight loss, hemorrhage, and abdominal
● Pancytopenia enlargement associated with hepatosplenomegaly.
● A high total protein level and a low ● Leishmania-specific Th1 response = low or absent.
● albumin level, with ● Post-kala azar dermal leishmaniasis (PKDL) -
● hypergammaglobulinemia sequela of visceral leishmaniasis

DIAGNOSIS DIAGNOSTIC TESTS

● Diagnosis is the microscopic examination ● Montenegro skin test

of the Giemsa-stained ● Giemsa-stained slides of blood, bone marrow, lymph
● Other more: node aspirates, and biopsies of the infected areas =
○ Culturing the infected material, which often demonstrates diagnostic amastigote forms.
demonstrates the promastigote stage ● Cultured tissues of blood and bone marrow =
● Diagnostic criteria: demonstrates promastigote forms.
○ Schizodeme analysis ● Sternal Marrow Aspirates
○ Zymodeme analysis (Gold standard) ● Serologic tests:
○ IFA (Indirect fluorescent antibody)
○ ELISA (Enzyme-linked immunosorbent
assay)

RORRY 1
 ○ DAT (Direct agglutination test)
Leishmania mexicana complex
EPIDEMIOLOGY
LIFE CYCLE
● The life cycle of the members of the L. mexicana
complex is identical to that of L. braziliensis and L.
donovani complex.
Subspecies Geographic Vector Reservoir
● The primary vectors are sandfly species of the genus
Distribution Host
Lutzomyia.
● also known as "New World”
L. Central Lutzomyia Dogs,
● Infective stage: promastigotes
donovani America, sandfly cats,
● Diagnostic stage: amastigotes
chagasi especially foxes
Mexico,
Promastigotes
West Indies,
● Single free flagellum
South
● 15 to 20 µm in length
America
● 1.5 to 3.5 µm in width

Amastigotes
Parts of Phlebotomu India, ● ovoid or rounded bodies
L. America, s sandfly none; ● 2 to 3 µm in length
donovani India, China ● nucleus is large
donovani Thailand, dogs
Peoples
Republic of CLINICAL MANIFESTATIONS
China,
Burma, East
Pakistan
● The wide spectrum of symptoms manifested by
leishmaniasis is often compared to leprosy.
● CL is similar to tuberculoid leprosy; DCL is similar to
L. Mediterrane Phlebotomu Dogs, lepromatous leprosy
donovani an Europe, s sandfly foxes,
infantum Near East, jackals, Four categories:
Africa; also porcupines ● cutaneous leishmaniasis (CL),
in Hungary; ● diffuse cutaneous leishmaniasis (DCL),
Romania, ● mucocutaneous leishmaniasis (MCL), and
southern ● visceral leishmaniasis (VL).
region of
former
Soviet CLINICAL MANIFESTATIONS
Union,
northern
China,
southern 1. Cutaneous Leishmaniasis
Sibria ● most common form of the disease
● Incubation Period: two weeks to several months
● an erythematous papule or nodule, called an "oriental
● button is produced at the inoculation site .
● Chiclero ulcer, usually affecting the ear.
TREATMENT 2. Diffuse Cutaneous Leishmaniasis
● called anergic or lepromatous leishmaniasis,
● Liposomal amphotericin B (Ambisome) - drug of ● localized, non-ulcerating papule, eventually
choice developing
● Sodium stibogluconate (Pentosam) ● numerous diffuse satellite lesions that affect the face
● Gamma interferon & pentavalent antimony and extremities
● Allopurinol (AIDS) ● initially diagnosed as lepromatous leprosy

● Prophylaxis (HIV infected; for second dose)

➢ New drug combination: paramomycin and miltefosine
DIAGNOSTIC TESTS
PREVENTION AND CONTROL
● Repellents (sandflies)
● Protective clothing ● Giemsa-stained slides preparations of lesion biopsy
● Screening (windows) material = demonstrates amastigote forms

RORRY 2
 ● NNN (Novy-MacNeal-Nicole) culture medium =
demonstrates promastigote forms
● Serologic testing using monoclonal antibodies
● Schizodeme analysis, zymodeme analysis, and
nuclear DNA hybridization are available on a research
basis.
PROMASTIGOTES
● Size: 9-15 um long
● Appearance: long and slender
● Nucleus: one located in or near center
● Other features: Kinetoplast, located in anterior end,
single free flagellum, extending from anterior end

AMASTIGOTES
● Diagnostic stage
Subspecies Geographic Vector Reservoir ● Size: 5 by 3 um
Distribution host ● Shape: round to oval
● Nucleus: one, usually off center
L. mexicana Belize, Lutzomyia Forest ● Other features: Kinetoplast present, consisting of
Guatemala, sandfly rodents dotlike blepharoplasty from which emerges a small
Yucatan for all for all axoneme , parabasal body located adjacent to the
peninsula species species blepharoplasty
comprising comprising
this this
comply complex CLINICAL MANIFESTATIONS

1. Cutaneous Leishmaniasis
L. pifanoi Amazon ● most common
River Basin, ● Incubation Period: 2 weeks to several months
Brazil, ● Oriental button - produce in the inoculation site
Venezuela ● A papule forms a violaceous ulcer after several weeks
L. Amazon 2. Mucocutaneous Leishmaniasis
amazonensi River Basin,
s/ Brazil

DIAGNOSTIC
L. gamhami Venezuela
Andes ● Microscopic demonstration of Leishmania from lesion,
aspirates, or biopsy
L. Venezuela ● Giemsa and hematoxylin-eosin stain
venezuelens ● Leishman skin test *Montenegro skin test
is

EPIDEMIOLOGY

TREATMENT ● L. tropica is the causative agent of cutaneous

leishmaniasis
● Na stibogluconate-PENTOSTAM ● found in the Mediterranean region, Middle East,
● meglumine antimoniate GLUCANTIME Armenia, Caspian region, Afghanistan, India, and
● Amphotericin B-IV Kenya)
● Oral ketoconazole ● Vector: Female Phlebotomus sandfly for all species
comprising this complex
● Reservoir Hosts: Possibly dogs

PREVENTION AND CONTROL

● Pest control TREATMENT
● Insect repellant
● Mosquito net
● Avoid visiting endemic areas ● Sodium stibo-gluconate (Pentosam)
● Paromomycin ointment - may also be given to aid in
healing

Leishmania Tropica complex

LIFE CYCLE
● identical to Leishmania braziliensis
● transmitted through the bite of female sandflies
● Infective stage: Promastigotes
PREVENTION AND CONTROL
● use of protective clothing, repellents, and screening
are essential to prevent future L. tropica complex
infections.

RORRY 3
RORRY 4