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Classification of Leishmania parasites
Kingdom :
Protista
Phylum :
Sarcomastigophora
Class
:
Zoomastigophora
Order
:
Kinet...
Leishmaniaiasis

Leishmaniasis is the collective name for a
number of diseases caused by protozoan
flagellates of genous l...
Causative agent

Parasitic protozoa of the genus leishmania
,transmitted to human by sandflies.
Over 20 species and subspe...
Morphology of leishmania
parasites
*in vertebrate hosts

* in sandfly vectors

Amastigote

Promastigote

(Leishman body)

...
Vector of Leishmania
Phlebotomus(sandfly )

Larvae of sandfly
Vectors of Cutaneous Leishmaniasis
in the world

Human are infected via bite of sandflies ( subfamily
phlebotominae)-tiny ...
Promastigote
(leptomonad) form
Vertebrate hosts
Amastigote form

.Leishmania organism
Life cycle of species of
Leishmania
Different clinical form of
Leishmaniaiasis
A) Visceral leishmaniasis
B) Cutaneous leishmaniasis
C) Muco-cutaneous leishman...
Distribution of Leishmaniaiasis
in the world
are developing countries 72

-Endemic in 88 countries
are among the least dev...
Disturbing increase in the
number of C.L. cases in
several area
In Brazil
: 1998; 21,800 cases, 2003; 60,000 cases
In Afgh...
Geographical
distribution
Different clinical form of
Cutaneous Leishmaniaiasis
(AnthroponoticC.L.(L.tropica
.(Dry sore or Urban C.L(

1) Old world C...
Clinical Features
of cutaneous leishmaniasis
• The factors determining the form of disease include;
leishmania species, ge...
Urban C. leishmaniasis
(Dry sore)
Lesions of Z.C.L.
( Wet sore)
Reservior hosts
of
Z.C.L

Rhombomys opimus and other wild rodents as reservior host of
.Z.C.L
Different form of
C. leishmaniasis
Epidemiology of common form of
Leishmaniasis in Iran
A) Anthroponotic Cutaneous Leishmaniasis:
-It is common in man and en...
Epidemiology of common form of
Leishmaniasis in Iran
B) Zoonotic Cutaneous Leishmaniasis:
- Rural Oriental sore is a zoono...
Geographical varieties of
visceral leishmaniasis
( Dum Dum fever , Kala-azar )

1) Indian kala-azar

Cuasative agent
(L.do...
Clinical Features of
visceral leishmaniasis
Persons who have visceral leishmaniasis usually have
fever, weight loss, and a...
Clinical Features of
visceral leishmaniasis
Epidemiology of
Visceral Leishmaniasis in Iran
Mediterranean Kala-azar:
- Causative agent is L. infantum
- Reservior host:...
Distribution of Leishmaniaiasis
in the Iran

- Incidence rate of C.L. is: 0.28 (thousands)
- The most cases related to Isf...
‫كا نونهاي فرمهاي مختلف‬
‫ليشمانيور در ايران‬

‫ك‬

‫ا‬

‫‪V.L. foci‬‬

‫‪A.C.L foci‬‬
‫‪Z.C.L. foci‬‬
Laboratory Diagnosis

Examination of Giemsa-stained slides
of the relevant tissue is still the
technique most commonly use...
Diagnostic findings
Microscopy
• Isolation of the organism in culture (diphasic NNN medium)
• Inoculation in experimental ...
Microscopy finding

A

B
Treatment
•

Physicians may consult CDC to obtain
information on how to treat leishmaniasis.
The drug sodium stibogluconat...
Number cases of
Cutaneous Leishmaniasis
in Abarkooh city from 1376 to 1383
390

400
350
300

290
255

250
192

200

180

1...
Number cases of
Cutaneous Leishmaniasis
in Ardakan city from 1376 to 1383
992

1000
900
800
700
600
500

417

400
300

213...
Number cases of
Cutaneous Leishmaniasis
in Bafgh city from 1376 to 1383
300

268

261

250
200
150
100
50
7
0

1376

2

13...
Number cases of
Cutaneous Leishmaniasis
in Taft city from 1376 to 1383
80

72

70
60
50

39

40

33

30

19

20

11

11

1...
Number cases of
Cutaneous Leishmaniasis
in Khatam city from 1376 to 1383

238

250

200

167

150

100
44
50
0
0

1376

0
...
Number cases of
Cutaneous Leishmaniasis
in Meyboad city from 1376 to 1383
160

143

140
120
100
80
60

44
31

40
20
0

10
...
Number cases of
Cutaneous Leishmaniasis
in Yazd city from 1376 to 1383
467

500

443

450
400
350
300
250

266

241

244

...
Numbf er cases o
Cutaneous Leishmaniasis
in Yazd province from 1376 to 1383
2500

2174

2000

1500

1295
1027

1076
1000

...
‫‪frequency distribution of C.L cases‬‬
‫3002-1002 ‪according to month during‬‬

‫‪f‬‬

‫فگ ورديگن‬
‫گر گ‬
‫اگگگرديبهشت‬
‫...
Frequency distribution of C.L
cases according to sex
70
60
50
40
30
20
10
0

male
female

2001

2002

2003
Frequency distribution of C.L
cases according to place type
during 2001-2003

33%
67%

‫رگو تاگگيگي‬
‫س‬
‫شگهگري‬
Frequency distributon of C.L cases
according to lesion type during 20012003
60
‫خگگشك‬

40

‫مگگرطوب‬

20
0

‫نگگگگگاگ ص‬
...
‫‪frequency distribution of C.L‬‬
‫‪cases according lesion site‬‬
‫3002-1002 ‪during‬‬
‫صورتگ‬

‫05‬

‫ورت وپگاگگگگ‬
‫ص‬

...
Life cycle of Leishmania
sp.
Leishmania parasites
Leishmania parasites
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Leishmania parasites

  1. 1. Classification of Leishmania parasites Kingdom : Protista Phylum : Sarcomastigophora Class : Zoomastigophora Order : Kinetoplastida Family : Trypanosomatidae Genous : Leishmania Subg. : Leishmania Viania (Suprapylarian) (Peripylarian)
  2. 2. Leishmaniaiasis Leishmaniasis is the collective name for a number of diseases caused by protozoan flagellates of genous leishmania , which have diverse clinical manifestations
  3. 3. Causative agent Parasitic protozoa of the genus leishmania ,transmitted to human by sandflies. Over 20 species and subspecies infect humans, each causing a different spectrum of symptoms.
  4. 4. Morphology of leishmania parasites *in vertebrate hosts * in sandfly vectors Amastigote Promastigote (Leishman body) (Leptomonad)
  5. 5. Vector of Leishmania Phlebotomus(sandfly ) Larvae of sandfly
  6. 6. Vectors of Cutaneous Leishmaniasis in the world Human are infected via bite of sandflies ( subfamily phlebotominae)-tiny sand-coloured blood-feeding flies that:- breed in dark,damp places, forest area, caves,or the burrows of small rodents -are relatively weak flyers, with a range of only 50 metres from their breeding sites -are most active in the evening and at night - Their numbers are related to natural factors such as rainfull, and may increase with global warming. A ) IN Old World: are phlebotomus sp.;P. sergenti & P.papatasi(mainly vectors in Iran) and other vectors are P. prrfiliewi, P. caucasicus, P. perniciosus B)In New World: are Lutzomyia sp.
  7. 7. Promastigote (leptomonad) form
  8. 8. Vertebrate hosts
  9. 9. Amastigote form .Leishmania organism
  10. 10. Life cycle of species of Leishmania
  11. 11. Different clinical form of Leishmaniaiasis A) Visceral leishmaniasis B) Cutaneous leishmaniasis C) Muco-cutaneous leishmaniasis
  12. 12. Distribution of Leishmaniaiasis in the world are developing countries 72 -Endemic in 88 countries are among the least developed 13 countries -Population at risk: 350 millions millions cases of 1-1.5 -Annual incidence: estimated at C.L .cases of V.L 500,000 -Overall prevalence: 12 millions people - More than 90% of C.L. cases occur in; Iran, Algeria Afghanistan,, Brazil, Peru, Saudi Arabia and Syria More than 90% of V.L. Cases occur in 5 countries ; Bangladesh, India , Nepal, Sudan, and Brazil male 1,410,000 -The DALY burden is 2,357,000 946,000 -Annual death due to V.L. is female female 24,000 59,000 cases male 35,000 *DALYS-Disability Adjusted Life Years (due to premature death and disability)
  13. 13. Disturbing increase in the number of C.L. cases in several area In Brazil : 1998; 21,800 cases, 2003; 60,000 cases In Afghanistan : 1994; 14,200 cases, 2002; 67,500 cases In Syria : 1998; 3900 cases, 2002; 6,275 cases Related factors: - Economic development Behavioural and enviromental changes including : development of new settlements, deforestatio, massive migration from rural to urban area, fast and unplaned urbanization,………
  14. 14. Geographical distribution
  15. 15. Different clinical form of Cutaneous Leishmaniaiasis (AnthroponoticC.L.(L.tropica .(Dry sore or Urban C.L( 1) Old world C.L. (Zoonotic C.L.( L.major .(Wet sore or Rural C.L( .Diffuse or Disseminated C.L (L. aethiopica ( 2) New world C.L. (Cutaneous L.(L. mexicana Complex (Chiclero ulcer ( (Muco-cutaneous L.( L. braziliensis ( spoundia or Pian bois or Uta (
  16. 16. Clinical Features of cutaneous leishmaniasis • The factors determining the form of disease include; leishmania species, geographic location, and immune response of the host. • Cutaneous leishmaniasis is characterized by one or more cutaneous lesions on areas where sandflies have fed. • Persons who have cutaneous leishmaniasis have one or more sores on their skin. The sores can change in size and appearance over time. They often end up looking somewhat like a volcano, with a raised edge and central crater. • A scab covers some sores. The sores can be painless or painful. Some people have swollen glands near the sores (for example, in the armpit if the sores are on the arm or hand).
  17. 17. Urban C. leishmaniasis (Dry sore)
  18. 18. Lesions of Z.C.L. ( Wet sore)
  19. 19. Reservior hosts of Z.C.L Rhombomys opimus and other wild rodents as reservior host of .Z.C.L
  20. 20. Different form of C. leishmaniasis
  21. 21. Epidemiology of common form of Leishmaniasis in Iran A) Anthroponotic Cutaneous Leishmaniasis: -It is common in man and endemic cities. -Cuasative agent: L.tropica; smaller than L.major P. sergenti -Transmition ways: 1) man to man by sand fly vector 2)contact infection (inoculable & oinoculable) 3)Mechanical transmitionfrom an open ulcer( by stable fly:Stomoxys) -Reservior host: Mainly; man occasionally dog
  22. 22. Epidemiology of common form of Leishmaniasis in Iran B) Zoonotic Cutaneous Leishmaniasis: - Rural Oriental sore is a zoonosis with human infections occuring only sporadically. - Causative agent : is L. major - Reservior host: the principal reservior host in Iran is : the gerbil Rhobomys opimusm, a grounddwelling rodent.Secondary reservior are Meriones lybicus erythrourus,Tatera indica , Nesokia indica and Meriones hur rianea . - The principal vector in Iran is Phlebotomus papatasi, other vectors are P.caucasicus, P.ansarii,P.m ongolensis
  23. 23. Geographical varieties of visceral leishmaniasis ( Dum Dum fever , Kala-azar ) 1) Indian kala-azar Cuasative agent (L.donovani complex) L.donovani donovani 2) Mediterranean kala-azar L.(d.) infantum 3) African kala-azar L.(d.) archibaldy 4) American kala-azar L.(d.) cha gasi
  24. 24. Clinical Features of visceral leishmaniasis Persons who have visceral leishmaniasis usually have fever, weight loss, and an enlarged spleen and liver (usually the spleen is bigger than the liver). Some patients have swollen glands. Certain blood tests are abnormal. For example, patients usually have low blood counts, including a low red blood cell count (anemia), low white blood cell count, and low platelet count. Some patients develop post kala-azar dermal leishmaniasis. Visceral leishmaniasis is becoming an important opportunistic infection in areas where it coexists with HIV.
  25. 25. Clinical Features of visceral leishmaniasis
  26. 26. Epidemiology of Visceral Leishmaniasis in Iran Mediterranean Kala-azar: - Causative agent is L. infantum - Reservior host: involving canine such as Dog, Jackal and other wild carnivorouses. - The probably main vector in Iran is Phlebotomus major, other vectors are P.keshishiani, P.wenyoni,……. - Age distribution: the disease occure in children from 1 to 4 years of age.
  27. 27. Distribution of Leishmaniaiasis in the Iran - Incidence rate of C.L. is: 0.28 (thousands) - The most cases related to Isfahan and Bushehr provinces : 1.66 (thousands) -The least cases related to Mazandaran province : 0.22 (thousands) -Annually 20,000 cases of C.L.is repoted from different regions of Iran(1989, Azmoodae)
  28. 28. ‫كا نونهاي فرمهاي مختلف‬ ‫ليشمانيور در ايران‬ ‫ك‬ ‫ا‬ ‫‪V.L. foci‬‬ ‫‪A.C.L foci‬‬ ‫‪Z.C.L. foci‬‬
  29. 29. Laboratory Diagnosis Examination of Giemsa-stained slides of the relevant tissue is still the technique most commonly used to detect the parasite
  30. 30. Diagnostic findings Microscopy • Isolation of the organism in culture (diphasic NNN medium) • Inoculation in experimental animals (hamsters) constitutes another method of parasitilogic confirmation of the diagnosis, and in addition can provide material for further investigations (e.g., isoenzyme analysis). • Antibody detection can prove useful in visceral leishmaniasis but is of limited value in cutaneous disease, where most patients do not develop a significant antibody response. • Other diagnostic techniques exist that allow parasite detection and/or species identification using biochemical (isoenzymes), immunologic (immunoassays), and molecular (PCR) approaches. Such techniques, however, are not readily available in general diagnostic laboratories.
  31. 31. Microscopy finding A B
  32. 32. Treatment • Physicians may consult CDC to obtain information on how to treat leishmaniasis. The drug sodium stibogluconate is available under an Investigational New Drug protocol from the CDC Drug Service. Also, see recommendations in The Medical Letter (Drugs for Parasitic Infections).
  33. 33. Number cases of Cutaneous Leishmaniasis in Abarkooh city from 1376 to 1383 390 400 350 300 290 255 250 192 200 180 150 114 83 100 95 50 0 1376 1377 1378 1379 1380 1381 1382 1383
  34. 34. Number cases of Cutaneous Leishmaniasis in Ardakan city from 1376 to 1383 992 1000 900 800 700 600 500 417 400 300 213 191 204 200 164 166 100 100 0 1376 1377 1378 1379 1380 1381 1382 1383
  35. 35. Number cases of Cutaneous Leishmaniasis in Bafgh city from 1376 to 1383 300 268 261 250 200 150 100 50 7 0 1376 2 1377 1 1378 7 1379 3 1380 1 1381 1382 1383
  36. 36. Number cases of Cutaneous Leishmaniasis in Taft city from 1376 to 1383 80 72 70 60 50 39 40 33 30 19 20 11 11 10 0 5 1376 1377 1378 1379 4 1380 1381 1382 1383
  37. 37. Number cases of Cutaneous Leishmaniasis in Khatam city from 1376 to 1383 238 250 200 167 150 100 44 50 0 0 1376 0 1377 0 1378 40 0 1379 1380 1381 1382 1383
  38. 38. Number cases of Cutaneous Leishmaniasis in Meyboad city from 1376 to 1383 160 143 140 120 100 80 60 44 31 40 20 0 10 1376 22 21 1377 1378 1379 30 16 1380 1381 1382 1383
  39. 39. Number cases of Cutaneous Leishmaniasis in Yazd city from 1376 to 1383 467 500 443 450 400 350 300 250 266 241 244 218 209 180 200 150 100 50 0 1376 1377 1378 1379 1380 1381 1382 1383
  40. 40. Numbf er cases o Cutaneous Leishmaniasis in Yazd province from 1376 to 1383 2500 2174 2000 1500 1295 1027 1076 1000 760 642 1133 1382 1383 570 500 0 1376 1377 1378 1379 1380 1381
  41. 41. ‫‪frequency distribution of C.L cases‬‬ ‫3002-1002 ‪according to month during‬‬ ‫‪f‬‬ ‫فگ ورديگن‬ ‫گر گ‬ ‫اگگگرديبهشت‬ ‫خداگگدگ‬ ‫ر‬ ‫تگير‬ ‫گ‬ ‫م داگگد‬ ‫ر‬ ‫شه يگور‬ ‫رگ‬ ‫مگهر‬ ‫اگگبان‬ ‫آگگذر‬ ‫دگگي‬ ‫بگگهمن‬ ‫اگ فنگگد‬ ‫س‬ ‫دگگرص آلودگگگگگي‬ ‫د‬ ‫02‬ ‫81‬ ‫61‬ ‫41‬ ‫21‬ ‫01‬ ‫8‬ ‫6‬ ‫4‬ ‫2‬ ‫0‬
  42. 42. Frequency distribution of C.L cases according to sex 70 60 50 40 30 20 10 0 male female 2001 2002 2003
  43. 43. Frequency distribution of C.L cases according to place type during 2001-2003 33% 67% ‫رگو تاگگيگي‬ ‫س‬ ‫شگهگري‬
  44. 44. Frequency distributon of C.L cases according to lesion type during 20012003 60 ‫خگگشك‬ 40 ‫مگگرطوب‬ 20 0 ‫نگگگگگاگ ص‬ ‫گمگشخ‬ ‫درگگص‬ ‫د‬
  45. 45. ‫‪frequency distribution of C.L‬‬ ‫‪cases according lesion site‬‬ ‫3002-1002 ‪during‬‬ ‫صورتگ‬ ‫05‬ ‫ورت وپگاگگگگ‬ ‫ص‬ ‫04‬ ‫پا‬ ‫03‬ ‫دگگست‬ ‫دگگست وصگگرگت‬ ‫و‬ ‫02‬ ‫دگگست وپاوصگگرگت‬ ‫و‬ ‫01‬ ‫تو پگگاگ‬ ‫دس‬ ‫سايرگ‬ ‫درگگص‬ ‫د‬ ‫0‬
  46. 46. Life cycle of Leishmania sp.
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