Post on 24-Apr-2015
description
Classification of Leishmania parasites
Kingdom : ProtistaPhylum : SarcomastigophoraClass : Zoomastigophora Order : KinetoplastidaFamily : Trypanosomatidae Genous : LeishmaniaSubg. : Leishmania Viania (Suprapylarian) (Peripylarian)
Leishmaniaiasis
Leishmaniasis is the collective name for a number of diseases caused by protozoan
flagellates of genous leishmania , which have diverse clinical manifestations
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.
Morphology of leishmania parasites
*in vertebrate hosts * in sandfly vectors
Amastigote Promastigote (Leishman body) (Leptomonad)
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 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.
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 leishmaniasis
Distribution of Leishmaniaiasis in the world
-Endemic in 88 countries -Population at risk: 350 millions-Annual incidence: estimated at-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 - -The DALY burden is 2,357,000-Annual death due to V.L. is 59,000 cases
*DALYS-Disability Adjusted Life Years (due to premature death and disability)
72 are developing countries 13 are among the least developed
countries 1-1.5 millions cases of
C.L 500,000 cases of V.L.
1,410,000 male
946,000 female
35,000 male
24,000 female
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,………
Geographical distribution
Different clinical form of Cutaneous Leishmaniaiasis
1) Old world C.L.
2) New world C.L.
AnthroponoticC.L.(L.tropica))Dry sore or Urban C.L(.
Zoonotic C.L.( L.major))Wet sore or Rural C.L(.
Diffuse or Disseminated C.L.) L. aethiopica(
Cutaneous L.(L. mexicana Complex) ) Chiclero ulcer(
Muco-cutaneous L.( L. braziliensis) ) spoundia or Pian bois or Uta (
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).
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 IranA) Anthroponotic Cutaneous Leishmaniasis:-It is common in man and endemic cities.-Cuasative agent: L.tropica; smaller than L.major-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
P. sergenti
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 ground-dwelling rodent.Secondary reservior are Meriones lybicus
erythrourus,Tatera indica, Nesokia indica and Meriones hurrianea.
- The principal vector in Iran is Phlebotomus papatasi, other vectors are P.caucasicus, P.ansarii,P.m ongolensis
Geographical varieties of Cuasative agent visceral leishmaniasis (L.donovani complex) ( Dum Dum fever , Kala-azar )
1) Indian kala-azar L.donovani donovani
2) Mediterranean kala-azar L.(d.) infantum
3) African kala-azar L.(d.) archibaldy
4) American kala-azar L.(d.) chagasi
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.
Clinical Features of visceral leishmaniasis
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.
Distribution of Leishmaniaiasisin 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)
A.C.L foci
Z.C.L. foci
V.L. foci
كا
مختلف فرمهاي نونهاي كاايران در ليشمانيور
Laboratory Diagnosis
Examination of Giemsa-stained slides of the relevant tissue is still the technique most commonly used to detect the parasite
Diagnostic findingsMicroscopy
• 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.
Microscopy finding
AB
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).
Number cases of Cutaneous Leishmaniasis in Abarkooh city from 1376 to 1383
255
192
390
180
83114 95
290
0
50
100
150
200
250
300
350
400
1376 1377 1378 1379 1380 1381 1382 1383
Number cases of Cutaneous Leishmaniasis in Ardakan city from 1376 to 1383
191
417
992
213 204164
166
100
0
100
200
300
400
500
600
700
800
900
1000
1376 1377 1378 1379 1380 1381 1382 1383
Number cases of Cutaneous Leishmaniasis in Bafgh city from 1376 to 1383
7 2 1 7 3 1
268261
0
50
100
150
200
250
300
1376 1377 1378 1379 1380 1381 1382 1383
Number cases of Cutaneous Leishmaniasis in Taft city from 1376 to 1383
72
11
39
5
19
4
11
33
0
10
20
30
40
50
60
70
80
1376 1377 1378 1379 1380 1381 1382 1383
Number cases of Cutaneous Leishmaniasis in Khatam city from 1376 to 1383
0 0 0 0
44 40
167
238
0
50
100
150
200
250
1376 1377 1378 1379 1380 1381 1382 1383
Number cases of Cutaneous Leishmaniasis in Meyboad city from 1376 to 1383
1021
143
22
31 30
44
16
0
20
40
60
80
100
120
140
160
1376 1377 1378 1379 1380 1381 1382 1383
Number cases of Cutaneous Leishmaniasis in Yazd city from 1376 to 1383
218
443467
266 244
209
241
180
0
50
100
150
200
250
300
350
400
450
500
1376 1377 1378 1379 1380 1381 1382 1383
Numbf er cases oCutaneous Leishmaniasis in Yazd province from 1376 to 1383
1076
1295
2174
760 642570
1027 1133
0
500
1000
1500
2000
2500
1376 1377 1378 1379 1380 1381 1382 1383
f
02
468
101214
161820
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frequency distribution of C.L cases according to month during 2001-2003
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Frequency distribution of C.L cases according to sex
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2001 2002 2003
male
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Frequency distribution of C.L cases according to place type
during 2001-2003
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Frequency distributon of C.L cases according to lesion type during 2001-
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frequency distribution of C.L cases according lesion site
during 2001-2003
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Life cycle of Leishmania sp.