Leishmania* REVIEW PENDING

Leishmania* REVIEW PENDING

1. Intro

   • Arthropod vectors
   • Protozoa/Nematode parasite
   • Locality: Tropics/Sub tropics
   • genus: Leishmania

2. Manifestation

   • Cutaneos
   • Mucocutaeous
   • Visceral
   • Range
     • insignificant pustules
     • Fatal systemic diseases
       • T-cell immunity related
         • Related to HIV

3. Geographic distribution

   • 4 continents
     • South America
     • Africa
     • Central Asia
     • Mediteranian Europe

4. Transmission

   • Transmitted via sandflies
     • Sandfly Phlebotomus sp.
   • Reservoir
     • humans (anthroponotic)
     • animals (zoonotic)

5. Parasites

   • Trypanosomatidae family
     • diff host, diff form
       • vertabrates
         • amastigotes
       • invertabrates
         • promastigotes

6. Causative org

   • Cutaneous leishmaniasis
     • Localized
       • Old world
         • Leishmania Major
       • New World
         • L. mexicana
     • Diffuse
       • Old world
         • L.aethiopica
       • New World
         • L.mexicana
     • Recidivans
       • Old world
         • L.tropica
       • New World
         • L.braziliensis
   • Mucocutaneous leishmaniasis
     • New World
       • L. mexicana
       • L.brazielensis
   • Visceral Leishmaniasis
     • Old World
       • L.infantum
       • L.donovani
       • L.tropica
     • New World
       • L.chagasi

7. Disesase

   • Cut/mucocutaneous
     • Skin Ulcers
       • in a few weeks
       • face
         • L.braziliensis
           • Sores @ mouth & nose
       • ear,fingertips
     • Regional Lymph nodes
       • Diffuse cutaneous
         • L. viannia
           • Chronic Progeressive polyparasitic
           • widespread plaques
     • Can be multiple
     • Subcutaneous Nodules
   • Viceral
     • Devastating & fatal
       • Kala azar/ black fever
         • death from secondary infection (immunosuppression)
     • Systeimc Nfection
       • Liver
         • hepatomegaly
       • Spleen
         • Splenomegaly
       • Bone Marrow
         • Appears like Leukaemia
     • Pentad*
       • Fever
         • Night Sweats
       • Weight loss
         • anorexia
       • Hepatosplenomegaly
       • Pancytopepia
       • HYperagammaglobulinemia
     • Poverty death

8. Dx

   • Histopathology
     • Biopsy
     • impression smear
   • Culture
   • PCR
   • Antigen for viceral

9. Tx

   • Cutaneous
     • Pentavalen antibiotics
       • SE
         • Painful
         • Reversible hepatitis
         • Pancreatitis
         • cardiotoxic
     • Sodium stibogluconate
       • Intralesional
       • Iv
       • IM
     • meglumine antimoniate
       • 20mg/kg/day
       • im/iv for 20-28 days
     • alternative
       • IVpentamidine
       • IV Amphotecerin B
       • Oral Azoles
         • ketoconazole
         • Fluconazole
         • Itraconazole
       • Oral miltefosine
       • Topical paromomycin
       • Cryotheraphy, battery acid
   • Visceral
     • Amphotecerin B
     • Lipid associated amphoteracin
     • Alternative
       • Stibogluconate
       • Paromomycin
       • Miltefosine

10. Prevention & Control

    • Prevention
      • Long Sleeves,trousers, socks
      • avoid dusk and dawn
      • DEET repellent
      • Permethrin on clothes
      • Bed net
    • Control
      • Early diagnosis n Tx
      • control of Sandfly population
      • Health education
      • detect & contain epidemics
      • Dx and effective management of Leishmania/HIV co infection