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Leishmania
(Tissue Flagellates)
LESSON LEARNING OUTCOMES
Leishmanias are heteroxenous.
Vector/ IH Infected FEMALE sand fly (Phlebotomus sp & Lutzomyia sp).
*Promastigotes (in the midgut of the sand fly) will be injected in human while
blood meal takes place.
* found only in Leishmanias
Amastigotes (Leishman-Donovan (L-D) bodies) found in humans
macrophages (intracellular).
Vertebrates hosts are primarily mammals
Humans, dogs, and several species of rodents
Cause a complex of diseases called Leishmaniasis.
sandfly
Complex of diseases (Leishmaniasis)
epidemiology approach
Amastigot
es
DIAGNOS
*sandfly ingests macrophages
TIC
infected by amastigotes STAGE
The sandflies inject the infective stage (promastigotes) from their
proboscis during blood meals.
Promastigotes that reach the puncture wound are phagocytized by
macrophages and other types of mononuclear phagocytic cells.
Progmastigotes transform in these cells into the tissue stage of the
parasite (amastigotes).
Amastigote then multiply by simple division and proceed **to infect
other mononuclear phagocytic cells.
Parasite, host, and other factors affect whether the infection
becomes symptomatic and whether cutaneous or visceral
leishmaniasis results.
Sandflies become infected by ingesting infected cells during blood
meals.
In sandflies, amastigotes transform into promastigotes (procyclic),
develop (metacyclic) in the gut (in the hindgut for leishmanial
organisms in the Viannia subgenus; in the midgut for organisms in
the Leishmania subgenus), and migrate to the proboscis.
Simplified view
Promastigot
es Promastigot
(Metacyclic) es
(Metacyclic)
Promastig
otes
(Procyclic)
Procyclics and Metacyclics
Promastigote
4.Metacyclic Promastigotes
(procyclic) differentiate
& replicate into
complement resistant
metacyclic promastigote
in the midgut
2. Procyclic
3. Replication
into
Metacyclic
1. Amastigotes
Ingest macrophages (contains
amastigotes)
Parasite interacts with the sand fly
midgut
Promastigotes attach
(procyclic) and detach to
the midgut (metacyclic)
epithelium.
(d
) Attachment helps them to
remain in the insect gut
when the blood meal is
passed.
(c
)
However, later they need to
detach to move to the
pharynx and proboscis for
infection
(b
)
Sand flies (Phlebotomus sp. &
Lutzomya sp.)
In the Old World (Africa, Asia & Europe), Phlebotomus
sand flies are primarily responsible for the transmission
of leishmaniasis.
Phlebotomus Lutzomya
sp. sp.
14
15
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Vector Control
Visceral
Lutzomyia longipalpis Central and South America
Phlebotomus argentipes Middle East
Phlebotomus chinensis China
Cutaneous
Phlebotomus sergenti India
Phlebotomus papatasi Mediterranean
Lutzomyia verrucarum s.l. Central and South America
Mucocutaneous
Lutzomyia intermedia Central and South America
http://cipa.snv.jussieu.fr/index.html
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Cutaneous Leishmaniasis
L. tropica
L. major
L. mexicana
20
Leishmania tropica & L.major
Produce cutaneous ulcers variously known as:
Cutaneous leishmaniasis
Oriental sore
Jericho boil
Aleppo boil
Delhi Boil
Oriental
sore
Diffuse Cutaneous
Leishmaniasis
Cutaneous
Leishmaniasis
30
Patients with diffuse
cutaneous
leishmaniasis develop
hundreds of papules,
nodules, and plaques
throughout the skin
in a clinical picture
that can be
reminiscent of
lepromatous leprosy.
This form of
leishmaniasis often is
resistant to therapy
and may assume a
chronic course.
L. tropica is found L. major is found in
in more densely sparsely inhabited
populated areas. regions.
Dry lesion, Its papule ulcerates
persist for month quickly, is of short
before ulcerating duration (open &
wet sore).
Has numerous
Contains few
amastigotes
amastigotes.
Diagnosis
Facilitated by finding amastigotes.
Scrapings from the side/ edge of an ulcer smeared on a slide and
stained with Wrights or Giemsas stain show the parasites in
endothelial cells and monocytes.
Cannot be found in blood circulation.
Culture should be made if amastigotes go undetected.
Treatment
Cutaneous leishmaniasis sometimes heals on its own and may not
require treatment.
Immune system shuts it down??
TREATMENT
34
Mucocutaneous
Leishmaniasis
L. braziliensis
Leishmania braziliensis
Produce disease in humans variously known as:
Mucocutaneous leishmaniasis
Espundia
Uta
Pian bois (in Venezuela & Paraguay)
Life Cycle
Promastigot
es
reproduce
in hindgut
Espundia or Mucocutaenous
Leishmaniasis
~20% of infected patients develop ulcers of the oral and nasal mucosa
Pathogenesis
Causes small, red papule on skin.
Chemotheraphy.
Relapse is common, but, once cured, a person usually has lifelong immunity.
If the infection is not cured but merely becomes occult, there may be a relapse with onset of
espundia many years later.
Prevention
Avoid bites of the sand fly.
Avoid outdoor activities, especially from dusk to dawn, when sand flies
generally are the most active.
When outdoors (or in unprotected quarters):
Minimize the amount of exposed skin. To the extent that is
tolerable in the climate, wear long-sleeved shirts, long pants,
and socks; and tuck your shirt into your pants.
Apply insect repellent to exposed (uncovered) skin and under the
ends of sleeves and pant legs.
The most effective repellents are those that contain the chemical
DEET (N,N-diethylmetatoluamide).
Visceral Leishmaniasis
L. donovani
In 1900 Sir William Leishman discovered L. donovani in splean smears
of a soldier who died of a fever at Dum-Dum, India.
The scientific name honors these men, as does the common name of the
amastigotes form (L-D bodies).
Geographic Distribution of L. donovani
57
Leishmania donovani extracellular
amastigote
(form present in vertebrate host)
58
L. donovani tissue smear of the
spleen of an infected rodent.
TREATMENT
A bottle of
capsules of
Miltefosine, the
first oral drug
for treating 65
Prevention
68
Visceral Leishmaniasis/ HIV Co-
Infection
69
Other Trypanosomatid
Parasites
Genus Leptomonas
Genus Herpetomonas
Genus Crithidia
Genus Blastocrithidia
Genus Phytomonas
Infective stagemetacyclic
: promastigotes
Diagnostic stage:
amastigotes in cell/
tissues
Stages in Leishmania sp:
metacyclic promastigotes, procyclic
promastigotes & amastigotes (in cells of
infected tissue)
Recap on Leishmaniasis
IH (Sand fly)
in midgut procyclic promastigotes
in proboscis metacyclic
promastigotes
EXAM JUNE 2014
Leishmania spp. are primarily zoonotic in nature, that are transmitted from host to host by the bite of
small blood sucking insects in the family Psychodidae.
a) Name the insect involved.
(2 marks)
Sandfly (1m), Phlebotomus and Lutzomyia (each Genus name, 0.5m)
Metacyclic promastigotes that reach the wound are phagocytized by macrophages (1m) and other
types of mononuclear phagocytic cells (1m). Promastigotes transform into amastigotes (1m) inside
macrophages. Amastigotes multiply in macrophages of various tissues (1m).