Visceral Leishmaniasis
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A SYSTEMIC PROTOZOAL DISEASE Visceral Leishmaniasis Annie Kleve April 6, 2010
description
Visceral Leishmaniasis. A Systemic Protozoal Disease . Annie Kleve. April 6, 2010. Leishmaniasis is caused by various species of Trypanosome in one genus. Genus: Leishmania Characterized by William Boog Leishman Two lifecycle forms: a small, round amastigote AND - PowerPoint PPT Presentation
Transcript of Visceral Leishmaniasis
A SYSTEMIC PROTOZOAL DISEASE
Visceral Leishmaniasis
Annie KleveApril 6, 2010
Leishmaniasis is caused by various species of Trypanosome in one genus
Promastigote being engulfed by macrophage
Genus: Leishmania
Characterized byWilliam Boog Leishman
Two lifecycle forms: a small, round amastigoteAND a larger, flagellated promastigote Image taken from
biologyreference.com
Leishmaniasis is caused by various species of Trypanosome in one
genus: Leishmania
CDC Dr. Francis Chandler
WHO/TDR El-Hassan
Leishmania donovani amastigotes in a PBL in bone marrow
Macrophages in the spleen infected with many amastigotes
Visceral Leishmaniasis aka Kala-azar* is Endemic World-wide
Chappuis et al. Nature Rev Micro 5, 2007
*Hindi for “Black fever”
WRAMC
Visceral Leishmaniasis aka Kala-azar* results from infection by different species
of Leishmania with different reservoirs
Chappuis et al. Nature Rev Micro 5, 2007
*Hindi for “Black fever”
L. chagasi
L. donovani
L. donovani
L. chagasi
L. infantum
But 90% of cases occur in just 5 countries:
Brazil, India, Bangladesh, Nepal, & Sudan
Chappuis et al. Nature Rev Micro 5, 2007
More than 500,000 people are infected
10% of those infected die every year
Left untreated, 95% of people with active, presenting
symptoms will die
Peter Martell/ IRIN news
Médecins Sans Frontières (MSF)
More than 50,000 deaths per year
Images taken from WHO/TDR Kuzoe
Symptoms:
• Fever
• Anemia
• Weight Loss and Muscle Atrophy
• Enlarged Spleen and Liver
200,000 million people live in at-risk areas
VL Appears in Very Different Environments
Nature Revs Micro 5, (2007)
Vector/Host systems are united by the close proximity of animal reservoirs
VL Has aTwo Stage Life Cycle
Parasite detection requires serological tests or invasive tissue analysisDAT test
Diagnosis: Finding a Gold Standard
OR
WHO/TDR
Chappuis et al. Nature Rev Micro 5, 2007
Treatment: Few Options Until Recently
SSG = Sodium Stibogluconate(Pentavalent Antimonials)
Amphotericin B
intravenous
Paromomycin Developed by OneWorld Health
Aminoglycoside from Streptomyces
Given by intramuscular injection
Miltefosine: The first oral treatment
•Mass produced in India beginning in 2004
•Major Restriction:
Teratogenic
VL and the “War on Terror”
Images taken from USACHPPM
Elimination through Vaccine and Vector Control?
MSF Station in Umkara, Sudan
Ongoing Vaccine Trials in Bihar, India
WHO/TDR/Crump
WHO/TDR
WHO/TDR
A Disease of the “Poorest of the Poor”
Treatment averages $20-50 U.S
Risk factors for visceral leishmaniasis have increased in the last 20 years
References and Further ReadingChappuis F., Sundar S., Hailu A., Ghalib H., Rijal S., Peeling R.W., Alvar J., Boelaert M. Visceral leishmaniasis: what are the needs for diagnosis, treatment and control? Nat Rev Microbiol, 5:873-882 (2007).
Desjeux P. The increase in risk factors for leishmaniasis worldwide. Trans R Soc Trop Med Hyg, 95: 239-243 (2001).
Murray H.W., Berman J.D., Davies C.R., Saravia N.G. Advances in leishmaniasis. Lancet, 366(9496): 1561–1577 (2005).
Van Griensven J., Balasegaram M., Meheus F., Alvar J., Lynen L., Boelaert M. Combination therapy for visceral leishmaniasis. Lancet Infect Dis, 10: 184-194 (2010).
Rodriguez-Cortes A., Ojeda A., Francino O., Lopez-Fuertes L., Timon M., Alberola J. Leishmania Infection: Laboratory Diagnosing in the Absence of a "Gold Standard" Am J Trop Med Hyg , 82: 251-256 (2010).
Sundar S., and Olliaro P.L. Miltefosine in the treatment of leishmaniasis: clinical evidence for informed clinical risk management. Ther Clin Risk Manag, 3:733-740 (2007).
Sundar S., Rai M., Chakravarty J., et al. New treatment approach in Indian visceral leishmaniasis: single-dose liposomal amphotericin B followed by short-course oral miltefosine. Clin Infect Dis, 47: 1000- 1006 (2008).
References and Further Reading
The Institute for OneWorld HealthThe United States first Non-profit pharmaceutical
companyhttp://www.oneworldhealth.org/
U.S. Army Center for Health Promotion and Preventative Medicine
http://phc.amedd.army.mil/default2.asp
UNDP/World Bank/WHO/TDR Special Programme for Research and Training in Tropical Diseases
http://apps.who.int/tdr/
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