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Leishmania
- 1. Leishmania
- 2. Leishmaniasias Is a disease caused the protozoan parasites of the genus Leishmania
- 3. Three syndromes associated with Leishmania infection in humans
- 4. Kala Azar - Visceral Leishmaniasis • Caused by the L. donovani complex • General infection of macrophages in the entire RES • Weeks to months incubation period • The lead symptom is abdominal swelling due to hepato- and splenomegaly • High fever. Fever often oscillates with a peak every second day • Progressive drastic weight loss (Cachexia) • Darkening of the skin • Mortality of untreated disease 75- 95%
- 5. Visceral Leishmaniasis or Kala Azar • Systemic infection of reticulo-entdothelial cells (mostly macrophages) throughout multiple internal organs and the blood
- 6. Visceral LeishmaniasisVisceral Leishmaniasis • Most severe form of the disease, may be fatal if left untreated • Usually associated with fever, weight loss, and an enlarged spleen and liver • Anemia (low RBC), leukopenia (low WBC), and thrombocytopenia (low platelets) are common • Lymphadenopathy may be present • Visceral disease from the Middle East is usually milder with less specific findings than visceral leishmaniasis from other areas of the world
- 8. • Profile view of a teenage boy suffering from visceral leishmaniasis. The boy exhibits splenomegaly, distended abdomen and severe muscle wasting.
- 9. Cutaneous Leishmaniasis • Infection remains restricted to the initial site of infection (the bite site)
- 12. Espundia or mucocutaenous leishmaniasis • Caused by L. braziliensis • ~20% of infected patients develop ulcers of the oral and nasal mucosa
- 13. Mucocutaneous LeishmaniasisMucocutaneous Leishmaniasis • Occurs with Leishmania species from Central and South America • Very rarely associated with L. tropica which is found in the Middle East - This type occurs if a cutaneous lesion on the face spreads to involve the nose or mouth - This rare mucosal involvement may occur if a skin lesion near the mouth or nose is not treated • May occur months to years after original skin lesion • Hard to confirm diagnosis as few parasites are in the lesion • Lesions can be very disfiguring
- 14. Espundia or mucocutaenous leishmaniasis • Caused by L. braziliensis • ~20% of infected patients develop ulcers of the oral and nasal mucosa • Progression of the ulceration is slow but steady, ultimately destroying all soft parts of the nose, the lips, and the soft palate • Death can occur through secondary bacterial infection
- 16. Adapted from Paulo Pimenta Life cycle of Leishmania Promastigote Amastigote Sandfly vector Human host Differentiation Differentiation Growth Macrophage Differentiation Dwyer, D.M. Dwyer, D.M. Debrabant,A.
- 17. • Leishmania (Leishman- Donovan or LD bodies). Lying in macrophage cells from liver. Giemsa. ×12000. Enlarged by 9.6.
- 18. • A macrophage filled with Leishmania amastigotes.
- 19. PreventionPrevention • Suppress the reservoir: dogs, rats, gerbils, other small mammals and rodents • Suppress the vector: Sandfly • Critical to preventing disease in stationary troop populations • Prevent sandfly bites: Personal Protective Measures • Most important at night • Sleeves down • Insect repellent w/ DEET • Permethrin treated uniforms • Permethrin treated bed nets
Editor's Notes
- Based on our experience with Desert Storm, well nourished American soldiers generally have a less symptomatic, relatively oligoparasitic infection that was not life threatening but posed some diagnostic challenges
- Two children with visceral leishmaniasis. The size of the spleen is marked on the abdomen. Normally the spleen does not protrude below the bottom rib. Photograph provided by COL Charles Oster
- Photograph provided by COL Naomi Aronson
- Photograph provided by COL Naomi Aronson
- Much of the destruction is from a hyperimmune reaction to the Leishmania infection. There are not many parasites in the affected tissue so confirming the diagnosis can be difficult. This form of leishmaniasis would be unusual in soldiers infected in South West Asia.
- Photograph provided courtesy of COL Donald Skillman
- Sandflies bite dusk to dawn so personal protection is most important during these times. Even light clothing covering skin is sufficient to prevent the bite of the sandfly. DEET is the most effective insect repellent. Sandflies are small enough to fly through bed netting unless it is treated with permethrin.