Leishmaniasis

Question 1

Name the types of Leishmaniasis

Answer 1

Visceral and Cutaneous (American, Non-American)

Question 2

Incidence of Leishmaniasis

Answer 2

1.5 million cases annually

Question 3

What is the Vector for Leishmania

Answer 3

Phlebotomas (Africa) Lutzomya (America) - the FEMALE sandfly conveys the parasite in the PROmastigote form. It is phagocytosed into the amastigote form. AMASTIGOTES ARE PROmastigotes that have been PHAGOCYTOSED.
you will never see a leishmania trpyomastigote in human tissues, they are always amastigotes within humans.

Question 4

What species causes visceral leishmania

Answer 4

L Donovani & L. Infantum

Question 5

What are the clinical presentations of cutaneous and visceral leish?

Answer 5

Cutaneous: ulcerating lesions appearing and spreading after sandfly bite
Visceral: Fatigue, hepatosplenomagy, ashy skin weight loss (Leish within the cells of the reticuloendothelial system)
Dermal: relapse after recovering from visceral, a cutaneous reactivation

Question 6

Diagnosis of Leishmania

Answer 6

1. Clinical
2. Parasite on microscopy: impression smear (skin), run a. slide over a wet ulcer or take a skin biopsy (cutaenous), splenic aspirate slides (for visceral)
3. Histology
4. Culture

NO ROLE FOR SEROLOGY

You can do PCR on fixed tissue!

Question 7

What are the treatment options for NON AMERICAN CL?

Answer 7

If shrinking: reassurance will pass and treatment is awful.

Intralesional sodium stibogluconate is the mainstay of treatment where the lesions are A) worsening b) appropriately located. 3 week course

Alternatives include Miltefosine, IV sodium stibogluconate, IV Amphoterrible or oral antifungal. IV required if sores worsening, lying over a joint, or there is cartilage / lymphatic involvement.

Side effects; fatigue, transaminitis, amylase elevation and joint aches. Rarely: cardiotoxic.

Question 8

Treatment of AMERICAN CL

Answer 8

NO OPTION FOR REASSURANCE; MUST TREAT
Intravenous sodium stibogluconate or meglumine antimoniate 20mg/kg for 21 days
• Intravenous liposomal amphotericin
• Miltefosine

Question 9

Prevention of Leishmaniasis

Answer 9

• Avoid sandfly bites
• Insect repellent
• Long sleeves
• Insecticide treated bed nets • Sleeping undercover
• Vector control programmes

Question 10

Decision to treat:

Answer 10

• Viannia species or other?
• Number and location of lesions?
• Local or systemic treatment?
• Immunosuppressed?

Question 11

What species causes Mucosal Leishmaniasis?

Answer 11

Mucosal leish is a secondary mucosal infection capcable of destroying the nasal bridge.
Causative species is Vianni

Question 12

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Answer 12

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