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

Sarcomastigophora

Order

Kinetoplastida

Family

Trypanosomatidae

Genus

Leishmania

Morphology
Digenetic Life Cycle

Promasitogte

Insect
Motile
Midgut

Amastigote

Mammalian stage
Non-motile
Intracellular

Morphology

Promastigote

Amastigote

Flagella
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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12

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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15

Clinical Disease

Visceral
Fatal (90%
untreated)
Liver
Spleen
Bone marrow

Cutaneous
Generally Self- healing
Skin
Mucous membranes

SPECTRUM OF DISEASE

16

Initial Infection

Similar in all species

Inoculation of promastigotes
Inflammation & chemotaxis
Receptor mediated phagocytosis

Promastigote

Amasitgote
Transformation

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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.

21

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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