Leishmaniasis
Leishmania donovani (complex) (VL)
Leishmania tropica (CL)
Leishmania major (CL)
Leishmania aethiopica (CL)
Leishmania mexicana (Complex) (CL)
Leishmania brazilliensis (complex) (MCL)
Leishmania peruriana
1
The Parasite
• Phylum Sarcomastigophora
• Order Kinetoplastida
• Family Trypanosomatidae
• Genus Leishmania
2
Morphology
Digenetic Life Cycle
• Promasitogte • Amastigote
• Insect • Mammalian stage
• Motile • Non-motile
• Midgut • Intracellular
3
Morphology
• Promastigote • Amastigote
Flagella
Kinetoplast
Golgi
Nucleus
Cytoskeleton
4
Promastigote
5
• Amastigotes (*)
of Leishmania
donovani in the
cells of a
spleen. The
individual
amastigotes
measure
approximately 1
µm in diameter.
6
Amastigote
7
• Amastigotes of
Leishmania in a
macrophage from
a lymph node of a
dog.
8
• Leishmania
(Leishman-
Donovan or LD
bodies). Lying in
macrophage cells
from liver. Giemsa.
×12000. Enlarged by
9.6.
9
• A macrophage
filled with
Leishmania
amastigotes.
10
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.
11
12
Mammalian Hosts
• Rodents • Sloths
• Gerbils • Primates
• Hyraxes • Dogs
• Bats • Foxes
• Porcupines • Anteaters
• Opossums • .....
13
Vectors
Phlebotomine Sandflies
6 genera world wide distribution
Phlebotomus & Lutzomia
500 species
Females Haematophagus
Males sap feeders
14
15
Clinical Disease
• Visceral • Cutaneous
• Fatal (90% • Generally Self- healing
untreated) • Skin
• Liver • Mucous membranes
• Spleen
• Bone marrow
SPECTRUM OF DISEASE
16
Initial Infection
• Similar in all species
• Inoculation of promastigotes
• Inflammation & chemotaxis
• Receptor mediated phagocytosis
Promastigote Amasitgote
Transformation
17
Parasite Spread
Macrophage lysis & parasite release
Lymphatic spread
Blood spread
Target organs
Skin/lymph nodes/spleen/liver/
bone marrow
18
Visceral Leishmaniasis
• 1903 William Leishman
• 1920 Pentavalent antimony
• 1931 Experimental transmission
Leishmania donovani (Complex)
L.d. archibaldi - L.d.chagasi - L.d.donovani - Ld.infantum
19
VL - Clinical Manifestation
Variable - Incubation 3-100+ weeks
Lowgrade fever
Hepato-splenomegaly
Bone marrow hyperplasia
Anemia, Leucopenia & Cachexia
Hypergammaglobulinnemia
Epistaxis , Proteinuria, Hematuria
20
• 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.
22
• Jaundiced hands of
a visceral
leishmaniasis
patient.
23
• Enlarged spleen and
liver in an autopsy of
an infant dying of
visceral leishmaniasis.
24
Post Kala Azar Dermal
Leishmanoid
Normally develops <2 years after
recovery
Recrudescence
Restricted to skin
Rare but varies geographically
25
Cutaneous leishmaniasis of the face.
26
A cutaneous leishmaniasis lesion on the
arm.
27
INFECTION
Sub-clinical or inapparent infection
Recovery Death
Immune to reinfection Concurrent infection
PKDL
28
Diagnosis
Clinical signs & symptoms
Hypergammaglobulinemia
ELISA/Formol gel
Bone marrow biopsy
Spleen or liver biopsy
Culture & Histology
29
Speciation
• Similar morphology
• Isoenzyme profiles - Zymodemes
• Monoclonal antibodies
• DNA hybridisation - PCR
30
Treatment
Good nursing
Diet
Antibiotics
Pentavalent antimony
Pentamidine
New drugs - New delivery
31
Control
• Vector control
• Reservoir control
• Treatment of active cases
• Vaccination
32
