LEISHMANIASIS

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LEISHMANIASIS
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• Leishmaniae are protozoans transmitted to humans
  by insect bites and cause a spectrum of clinical
  syndromes, ranging from indolent ,self resolving
  cutaneous ulcers to fatal disseminated disease
• Trnsmitted by phlebotomus sandflies,which acquire
  the infection by feeding on infected animals.

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• It is mainly a disease of less developed
  countries where humans live in close proximity to
  animal hosts.
• sandfly
• inoculation of
  organisms into the skin .

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• phagocytosis by
  macrophages
• transform into
  Amastigotes
• 
  

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• reproduce within the
  macrophages
• rupture of the
  cell,infect other macrophages
• cluster of
  infected macrophages at the site of inoculation

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• Localized Cutaneous Leishmaniasis
• Disseminated Cutaneous Leishmaniasis
• Mucocutaneous Leishmaniasis
• Visceral Leishmaniasis.

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• Localized Cutaneous Leishmaniasis
• Leishmania species in Central South
  America,Northern Africa,the Middle East,India,and
  china produce localized cutaneous disease,also
  known as oriental sore or tropical sore.

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Localized Cutaneous Leishmaniasis

• Begins as a collection of amastigotes-filled
  macrophages that ulcerates the overling
  epidermis.
• In tissue sections, the oval amastigotes measure
  2micrometer and contain two internal structures
  a nucleus and a kinetoplast.
• L.D bodies ---Under low power amastigotes in
  macrophages appear as dots.

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• With progreesive develpoment of cell- mediated
  immunity macrophages become activatedand kill the
  bacteria.
• Slowly a granulomatous appearance
• Over the course of months,the cutaneous ulcers
  heals spontaneously.

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• Clinical features
• Cutaneous Leishmaniasisbegins as itching,
  solitary papule ,which erodes to form a shallow
  ulcer with sharp raised border with crust
  formation.
• These lesions grow up to 3-6cm.

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Diffuse Cutaneous Leishmaniasis

• Develops in some patients who lack specific
  cell-mediated immune responses to leishmaniae.
• The disease begins as a single nodule, but
  adjacent satelite nodules slowly form,evantually
  involving much of the skin.
• Closely resemble lepromatous leprae.

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• Caused by L.Braziliences
• Early course and pathologic changes are similar
  to those of localized cutaneous L.
• A solitary ulcer develops resolves spontaneously.
• Years after primary lesion has healed,an ulcer
  develops at a mucocutaneous junctionlarynx,nasal
  septum,anus,vulvaetc

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• Destruction of nose--------tapir nose
• Obstruction of the airways.

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• VISCERAL LEISHMANIASIS(KALA AZAR)
• Produced by several species of Leishmania
  Donovani
• Also called Black fever
• Involves reticuloendothelial system