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Trop Med > Leishmaniasis > Flashcards

Leishmaniasis Flashcards

1
Q

Where are the most endemic areas for visceral leishmaniasis?

A

Sudan
Bangladesh, India, Nepal
Brazil

90% of cases in these countries!

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2
Q

What is the investigation of choice for V.Leish?

A

Bone marrow or spleen aspirate and microscopy

Amastigotes inside macrophages

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3
Q

Rx of choice for VL?

A

Liposomal ampho

Also: Anitmonials - don’t work so well
Ampho B

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4
Q

What are the 2 stages of the life cycle that may be seen in cutaneous leishmaniasis?

A

Amastigote
Promastigote (only from vector)

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5
Q

Describe how to identify an emastigote?

A

Small - 2-4 microns
Intracellular pathoge
Prominent nucleus, with a bar-shaped kinetoplast

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6
Q

Vector for leish in old world?

A

Phlebotomos fly

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7
Q

Vector for leish in new world?

A

Lutzomyia fly

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8
Q

What is this?

A

Amastigotes
Mucocutaneous leish

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9
Q

Infective stage of cutaneous leish?

A

Promastigote

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10
Q

What causes cutaneous leish in old world?

A

L.major
L.Tropica
L.Ethiopica

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11
Q

Most common cause of visceral leish in old world?

A

L. infantum/chagasi (Europe) and L. donnovani (middle east, Horn of Africa)

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12
Q

Cause of cutaneous leish in new world?

A

L. braziliensis (jungle)
L.peruviana (highlands), L.panama, L.mexicana, L.Guyanensis

L.braziliensis causes mucocutaneous disease

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13
Q

What is the classical presentation of leish?

A

Slowly enlarging nodule at bite site, most self heal, crust forms centrally leading to uler with raised margins, leave hypopigmented and depressed scar

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14
Q

What is the definition of disseminated leish?

A

> 10 lesions in more than 1 limb/extremity

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15
Q

What is diffuse cutaneous leish?

A

Begins as localised disease, and does not ulcerate.
Soft nodules or plaques on face / limbs / entire body.
Patients usually have a defect in cell mediated immune response

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16
Q

What species often cause Diffuse CL?

A

Amazonensis, mexicana, aethiopica

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17
Q

Which species causes mucosal involvement of leish?

A

Caused by Viannia subegenus - mainly by L.V. braziliensis (also guyanensis, panamensin, peruviana)

18
Q

Diagnosis of cutaenous leish?

A

Direct smear from skin scrape, giemsa stain

In specialist labs: can culture promastigotes
Leishmanin skin test - like TST for TB
ELISA
PCR

19
Q

How do you Rx cutaenous leish?

A

IV pentavalent antimonials (Sb5+, stibogluconate) for 20 days

20
Q

How do you treat mucosal leish?

A

stibogluconate Sb5+ (pentavalent antimonials) IM or IV for 30 days

21
Q

What to do if patient has laryngeal involvement of mucosal leish?

A

Amphoterecin B

22
Q

What would you do at 20 days following Rx for cutaenous leish?

A

Failure of treatment at 20 days is if the lesion is extending despite 20 days of therapy

Look for 50% improvement over 20 days

23
Q

Alternative Rxs for visceral leish?

A

Anitmonials if Liposomal amphoterecin not available

24
Q

New World visceral leishmaniasis species?

A

Leishmania infantum/Chagasi

25
Q

How will you differentiate diffuse and disseminated leish?

A

Diffuse
- Skin test -ve
- Lots of organisms on biopsy/scrape
- Skin lesions do not ulcerate
- No antibodies/immune response
- No mucosal disease

26
Q

Parasitic stages of leish - infective and diagnostic?

A

Promastigotes from saliva of fly - infective
Amastigotes - tissue. Diagnostic

Very rare to see promastigotes in leish. Only in culture.

27
Q

Diagnosis of leish?

A

Amastigotes - 2-4 microns, kinetoplast - bar shaped DNA

28
Q

What is difference between leish and histo?

A

Histo no nucleus, yeast inside macrophage

29
Q

Which strain of VL has a reservoir other than humans?

A

Infantum
Dogs

30
Q

What is the reservoir for L.Donnavani?

A

Humans

31
Q

Classical presentation of VL?

A

Fever - prolonged
Splenomegaly
Hepatomegaly
Lymphadenopathy
Bone marrow invasion - pallor
Hyperpigmentation - Kala Azar
often wasted and malnourished

32
Q

Bloods in VL?

A

Pancytopenia
Hypergammaglobulinaemia

33
Q

Post treatment manifestation of VL

A

PKDL - chronic form
Often on face
Dermatitis - pale spots and painless nodules - contain amastigotes!
Up to 50% of people in East Africa

34
Q

Diagnosis of VL?

A

Parasite detection
Antibody detection
Antigen detection (urine antigen test)

35
Q

parasite detection, best method?

A

Splenic aspiration
Bone marrow Bx
Lymph node Bx (very poor)

36
Q

The now best way of diagnosing VL apart from parasite detection?

A

Direct agglutination testing
Rapid tests
Always do before splenic aspiration

37
Q

Cause of false negatives and false positives in serology for VL?

A

HIV - false neg
Asymptomatic immunity - false positive

38
Q

Problem of rK39 antibody RDT?

A

Varies depending on the region - Asia excellent sensitivity, Ethiopia bad!

39
Q

Options for Rx VL

A

GS: Ampho (liposomal) + Miltefisine

Pentavalent antimonial
Paramomycin

40
Q

How to change Rx if have HIV and VL??

A

Longer course Rx

41
Q

Options for Rx for PKDL?

A

Same Rx but longer

Trop Med (49 decks)

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