LEISHMANIASIS

Question 1

Organism

Answer 1

Leishmania is a diverse group of diseases caused by intracellular protozoan parasites.
- The flagellate promastigote is present in the insect vector (sandfly), whereas the aflagellate amastigote is resides and replicates only within mononuclear phagocytes of the vertebrate host (animals) and the human is considered as an incidental host for parasite.

Question 2

Clinical picture

Answer 2

1-Localized Cutaneous Leishmaniasis
2-Diffuse Cutaneous Leishmaniasis
3-Mucosal Leishmaniasis
4-Visceral Leishmaniasis

Question 3

Visceral Leishmaniasis (Kala-Azar) in general

Answer 3

💔It is the most important & common form of L. that mainly caused by L. donovani (Africa and Asia), L. chagasi (New World), and L. infantum (Mediterranean region).
😟After inoculation of these organisms into the skin by sandfly, the child may become completely asymptomatic, oligosymptomatic, or symptomatic.

Question 4

Oligosymptomatic / Kala azan

Answer 4

• illness involve intermittent fever, malaise, fatigue, intermittent diarrhea, and mild hepatomegaly.
• Most patients will resolve spontaneously, whereas others may develop symptomatic disease within few months.

Question 5

Symptomatic (active) disease of Kala azar

Answer 5

🤒manifested as high fever, malaise, fatigability,
- hepatomegaly, marked splenomegaly, and severe cachexia.
🥶 Advanced disease → anemia, jaundice, edema, ascites, bleeding, and secondary bacterial infections which eventually result in death.
Malnutrition & immunedeficiency (especially HIV) are considered risk factors for kala-azar.

Question 6

Immunity?

Answer 6

Prior disease or subclinical infection usually gives immunity against subsequent symptomatic disease.

Question 7

D.Dx

Answer 7

Visceral Leishmaniasis include: 
malaria, 
typhoid fever, 
miliary tuberculosis, 
schistosomiasis,
 brucellosis, 
amebic liver abscess, 
infectious mononucleosis,
 lymphoma, and leukemia.

Question 8

Investigations to, Kala azar

Answer 8

1-serology
👻enzyme liked immunosorbent assay (ELISA)
🎃direct agglutination test (DAT)
🤖indirect fluorescent antibody test (IFAT)
2-cultures of material from splenic, bone marrow, or lymph node aspirations are usually diagnostic.
🙀 In experienced hands, splenic aspiration has a higher diagnostic sensitivity.
3-lab
😵 CBC; pancytopenia, i.e. severe anemia, leucopenia, & thrombocytopenia.
💀 LFT; ↑ liver enzymes.

Question 9

TX

Answer 9

• Sodium stibogluconate→ 20 mg/kg IV
• Liposomal amphotericin B
• Other drugs which also effective in the Rx of VL include: Paromomycin, Recombinant human interferon-γ (as an adjunctive Rx), and oral Miltefosine.

Question 10

Presentation

Answer 10

Avoid exposure to sandflies by the use of insect repellent and permethrin-impregnated mosquito netting.