Dr Sami Ullah khalilDr Sami Ullah khalil

Name: XYZName: XYZ Age: 25 YearsAge: 25 Years Gender: MaleGender: Male Rank: SepRank: Sep Deployment: Miran shah Deployment: Miran shah

Present History

Non healing ulcerated plaque on elbow (Rt)……………………2 months

IHDIHD DiabetesDiabetes HypertensionHypertension AsthmaAsthma Tuberculosis Tuberculosis

Pallor: Pallor: NilNil Cyanosis: Cyanosis: Nil Nil Jaundice: Jaundice: NilNil Edema: Edema: NilNil Clubbing: Clubbing: Nil Nil Lymph Nodes: Lymph Nodes: Not palpableNot palpable

Temp: Temp: 98.4 F98.4 F Pulse: Pulse: 89 /Regular89 /Regular BP: BP: 110/80 mmHg110/80 mmHg Resp: Resp: 16 /Minute16 /Minute

GIT: GIT: NADNAD

CVS: CVS: NADNAD

CNS: CNS: NADNAD

Respiratory System: Respiratory System: NADNAD

Smear for LT Bodies ……….. +ve Smear for LT Bodies ……….. +ve

Patient counseled.

Consent for treatment taken.

Patient started on intralesional meglumine antimoniate twice weekly x 12 weeks.

CAPT JAMES DONOVAN WILLIAM LEISHMAN

LeishmaniasisLeishmaniasis

Cutaneous Mucocutaneous Visceral

Group of diseases caused by infection with Group of diseases caused by infection with one of the protozoan parasites of the genus one of the protozoan parasites of the genus LeishmaniaLeishmania

Designated one of the five most important Designated one of the five most important preventable diseases worldwide by the preventable diseases worldwide by the World Health OrganizationWorld Health Organization

Affects people in 88 countries of the worldAffects people in 88 countries of the world

Has a global prevalence of 12 million with Has a global prevalence of 12 million with additional 350 million at riskadditional 350 million at risk

Annual incidence of 1.5—2 millionAnnual incidence of 1.5—2 million

Cut Leishmaniasis is endemic mainly in Cut Leishmaniasis is endemic mainly in Baluchistan, Baluchistan, Interior Sind Interior Sind and and Rural areas of PunjabRural areas of Punjab..

Cut Leishmaniasis due to Cut Leishmaniasis due to L tropica L tropica has the widest has the widest distribution; occurring in urban areas of distribution; occurring in urban areas of Punjab Punjab and and Baluchistan, Northern areas, and Azad KashmirBaluchistan, Northern areas, and Azad Kashmir

Increasingly reported from towns of KPK, FATA Increasingly reported from towns of KPK, FATA and Baluchistanand Baluchistan

RODENTSRODENTS Tropical & subtropical Tropical & subtropical

china, India, Asia, china, India, Asia, Africa, Mediterranean, Africa, Mediterranean, & Central America & Central America

DOMESTIC DOGDOMESTIC DOG Mediterranean, Mediterranean,

southern Russia, southern Russia, Afghanistan, India & Afghanistan, India & PakistanPakistan

VECTOR (Sand Fly)VECTOR (Sand Fly)

1-HISTORY OF ENDEMIC AREA1-HISTORY OF ENDEMIC AREA

2-MORPHOLOGY OF THE LESION2-MORPHOLOGY OF THE LESION

3- CLINICAL CHARACTERISTICS 3- CLINICAL CHARACTERISTICS

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SLIT SKIN SMEARSLIT SKIN SMEAR BIOPSYBIOPSY NNN CULTURENNN CULTURE PCRPCR Kinetoplast minicircle DNAKinetoplast minicircle DNA

ELISA for circulating antibodiesELISA for circulating antibodies

Leishmanin Skin Test MontenegroLeishmanin Skin Test Montenegro

Pentavalent AntimonialsPentavalent Antimonials

Na stibogluconate & Meglumine Na stibogluconate & Meglumine

antimoniate antimoniate

1.1. Intra lesionalIntra lesional

2.2. Systemic Systemic

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FreezingFreezing

Local heatLocal heat

Oral ItraconazolOral Itraconazol

Topical amphotericinTopical amphotericin

Topical aminoglycoside antibioticsTopical aminoglycoside antibiotics

Paromomycin is sometimes effectiveParomomycin is sometimes effective

AllopurinolAllopurinol

Oral MiltefosineOral Miltefosine

Plastic surgeryPlastic surgery

TimingsTimings dawn and duskdawn and dusk

Full sleevesFull sleeves

Use repellant lotion and repeat after 4 hoursUse repellant lotion and repeat after 4 hours

Use nets if sleeping outdoorsUse nets if sleeping outdoors

Cutaneous Leishmaniasis has become a Cutaneous Leishmaniasis has become a huge public health problem.huge public health problem.

Cutaneous Leishmaniasis is a Cutaneous Leishmaniasis is a preventable diseasepreventable disease

Med professionals working at various Med professionals working at various levels must be able to recognize and levels must be able to recognize and manage the diseasemanage the disease

Cost-containment in med care demands Cost-containment in med care demands accurate diagnosis made without undue accurate diagnosis made without undue delaydelay