Leishmania Flashcards
What is leishmaniasis? How does it present?
A trypanosomatidae family - intracellular amastigotes in macrophage
Presentation depends on species and on host immune response
Can be cutaenous, mucosal, visceral
What is the vector of leishmania?
Sand fly
What is the presentation of visceral leishmaniasis?
Kala-azar: fever, weight loss, hepatosplenomegaly, neutropenia, hypergammaglobulinemia
Lab findings = low blood cell counts, anemia, eosinopenia!!
When you see splenomegaly, what parasites do you think?
Leishmania
Schistosomiasis
Malaria
(also think miliary TB, histo, brucellosis, subacute bacterial endocarditis, mono, Salmonella bacteremia)
How do you diagnose leishmania?
Biopsy bone/edge of lesion/spleen –> culture on special media (don’t send to normal lab- CDC) –> look for amastigotes in macrophages
PCR to speciate it
What immune response protects against leishmania?
Th1 subtype of CD4 T cells
How do you treat leish?
Old world v. new world
Old world: heat, topical
New world: pentostam – very toxic, given for 20 days IV, has to be done through the CDC
OR
Liposomal Amphotericin B - IV
What is the presentation of cutaneous leish?
Painless ulcer that takes forever to heal - years
Ulcer has rolled up edges and tends to expand
It’s filled with macrophages that have leish in it
After it heals, you are always left with a hypopigmented scar
How do you get mucosal leish?
After the cutaneous leish heals, there is a recurrence in mucosa i.e. nose
It can cause destruction of the nasal septum
What is the load of leish in the different presentation?
Visceral: high parasite burden, very low cell mediated immunity
Self healing disease = cutaneous lesions – medium CMI, medium parasite burden
Mucosal disease = low parasite burden & very high CMI, which ends up being destructive
