Leishmania

Front 1

What is the phylum, order, family, and genus of the parasite that causes Leishmaniasis

Back 1

Phylum Sarcomastigophora
Order Kinetoplastida
Family Trypanosomatidae
Genus Leishmania

Front 2

What are some morphological and pathological characteristics of the genus Leishmania

Back 2

- Flagellated parasites
- Intracellular
- Macrophage tropism
- Live in phagolysosomes

Front 3

What are the species of Leishmania that are infective to humans

Back 3

- L. tropica
- L. major
- L. mexicana
- L. donovani
- L. braziliensis
- L. infantum

Front 4

What is the vector for the parasites that causes Leishmaniasis

Back 4

Phlebotomine Sand flies:
Family: Psychodidae, subfamily Phlebotominae, 5 genera, worldwide distribution:

- Phlebotomus & Sergentomyia (old world)
- Lutzomia, Brumptomyia, and Warileya (New world)

Front 5

What are the developmental forms of the parasite that causes Leishmaniasis

Back 5

Metacyclic promastigote: infective stage with increased expression of surface protease: lipophosphoglycan (LPG)I

Promastigote

Amastigote: Smallest known nucleated cell. Non-motile, Remain in site of infection, Intracellular

Front 6

What are the main forms of Leishmaniasis, what is it characterized by, and which parasites cause it

Back 6

Cutaneous: involving the skin at the infection site (L. tropica, L. major, L. mexicana) **Most common
Visceral: involving liver, spleen, and bone marrow (L. donovani) **DEADLIEST
Mucocutaneous: involving mucous membranes of the mouth and nose after spread of nearby cutaneous lesion, very rare (L. braziliensis)
L. infantum: asymptomatic.

Front 7

What are the characteristics of Cutaneous Leishmaniasis

Back 7

Disease characterized by ≥ one sores/papules/nodules on skin (within few days - months)
- can change size & appearance over time. Usually painless, crusty appearance, with raised edge & central crater.
- Swollen lymph nodes may be present near sores.
- Delayed type hypersensitivity reaction **
- Sores can heal on own or take months - years.

Front 8

What are the symptoms a person would suspect for Cutaneous Leishmaniasis and is the method of diagnosis

Back 8

Disease presents with fevers, weight loss, gastrointestinal complaints, anemia, abnormal liver tests. Patients with any of the following should be referred early to avoid long-term complications:
o Big (> inch in size) and/or many (≥ three) lesions
o Sores on the face, hands & feet, and/or over joints
- Biopsy of infected area

Front 9

What are the characteristics of Mucocutaneous Leishmaniasis

Back 9

This disease type occurs if a cutaneous lesion on the face spreads or was not treated. May occur months - years after original lesion.
- A hyperimmune reaction of the host
- Hard to confirm diagnosis as few parasites are in lesion
- Can be very disfiguring
Secondary lesions: degeneration of cartilage & soft tissue.

Front 10

What is the vector of the parasite Leishmania braziliensis

Back 10

Lutzomyia sand fly species transmit this parasite

Front 11

What are the treatments for Cutaneous and Mucocutaneous Leishmaniasis

Back 11

Biopsy and culture to determine species is required prior to treatment of infection.

Drug treatments include:
Antimony (Pentostam®, Sodium stibogluconate) is the drug of choice: 20 days of intravenous therapy
Fluconazole may decrease healing time in L. major infection: Six weeks of therapy is needed

Front 12

What are the species of Leishmania that cause the Cutaneous form of Leishmaniasis

Back 12

Disease caused by the parasites
- L. tropica
- L. major
- L. Maxicana

Front 13

What are the species of Leishmania that cause the Mucocutaneous form of Leishmaniasis

Back 13

Disease caused by the parasites
- L. braziliensis
- L tropica (rarely)

Front 14

What are the species of Leishmania that cause the Visceral form of Leishmaniasis

Back 14

Disease caused by the parasite
- L. donovani

Front 15

What is the vector of the parasite Leishmania donovani

Back 15

Parasite transmitted by the sand fly of the genus Phlebotomus

Front 16

What are the characteristics of Visceral Leishmaniasis

Back 16

Disease that infects phagocytic cells: macrophages, monocytes.
- Found in spleen and lymph nodes.
- Neutrophils and eisonophils are killed by parasites.
- Hyperplasia- overproduction of macrophages and other phagocytic cells at the expense of red blood cells

Front 17

What are the symptoms of Visceral Leishmaniasis

Back 17

Disease with an incubation time of ten days - year
- Edema (face), bleeding of mucous membrane, diarrhea, breathing difficulty.
- Usually associated with fever, weight loss, enlarged spleen and liver causing stomach swelling (Hepatosplenomagaly), anemia & leukopenia (low WBC), and thrombocytopenia (low platelets).
- Lymphadenopathy may be present

Front 18

What are the methods of diagnosing Visceral Leishmaniasis

Back 18

Diagnosis of this disease may require genetic testing and/or microscopy:
Antibodies to parasite may be present in patient’s serum but this will not confirm or exclude diagnosis. ** ELISA
Diagnosis requires finding parasite on biopsy of bone marrow, liver, enlarged lymph node, or spleen. Amastigotes- Leishman Donovan bodies (dark stain)

Front 19

What are the treatments for Visceral Leishmaniasis

Back 19

Drugs to treat this disease are:
Liposomal amphotericin-B (AmBisome®) is the drug of choice and widely available
- 3 mg/kg per day on days 1-5, day 14 and day 21
- Mixed with liposomes to cross the plasma membrane
Pentostam® is an alternative therapy
- 28 days of therapy is required

Front 20

What is Post Kala Azar Dermla Leishmanoid

Back 20

Disease that normally develops <2 years after “recovery” ← failure to exterminate fully the original parasite
- Recrudescence
- Restricted to skin
o Reddish pigmented nodules
o Lack melanin
- Rare but varies geographically