Leshmaniasis Flashcards
What is the lector for Leishmania?
The sand fly
What are the two forms of Leishmania: when its in the vector vs when it’s in our cells? What’s the difference?
Vector form: promastigote Host form: amastigote.
Amastigote has kinetoplst. Promastigote has single flagellum and is motile.
What are the 3 main types of dz you get with Leishmania? What do we try to prevent in each one.
Cutaneous→ prevent morbidity
Mucosal→ prevent morbidity
Visceral → prevent mortality
Visceral is obviously the worst one.
In the Middle East we started having trouble with Leishmania during OIF and OEF. Describe what we saw
Lots of cutaneous leishmania (CL) from L. major and L. tropica.
How will you tell CL from Pyoderma, a pyogenic (pussy) bacterial skin infection?
CL: non painful papule, slow progression, ulcerates, rolled margins, induration around ulcer, no response to antibiotics
Pyoderma: painful/pruritic pustule, fast progression, ulcerates, non rolled margin, non indurated, responds to antibiotics
Basically, you know you’ve got pyoderma real quick because it hurts and comes on fast (doesn’t have time to have rolled margins or to indurate), and you’ll get rid of it quickly too because it responds to antibiotics
CL can also be seen outside the Middle East. What specifics of Leishmania causes it and what sx do you see.
L baziliensis
Also called a “pizza pie” lesion in lecture
How do you dx CL
Use multiple tests up front: Culture and PCR allow species ID.
Don’t use serology.
Must see kinetoplast to dx.
Hard to dx on skin biopsy.
Tx for CL?
Ranges based on the severity
Milder dz:
- None
- local liquid N2 or heat
- paromomycin cream for tropicals
- azoles
More serious dz:
- miltefosine
- antimonials
- amphotericin B
What species usually causes mucosal leishmaniasis?
L. brazilliensis
What are the sx of mucosal leishmanisis
Starts with nasal stuffiness, inflammation→ ulceration of nasal mucosa.
Can involve lips, cheeks, palate, pharynx, larynx. Complications: disfigurement, aspiration, DEATH.
How do you dx ML?
PCR b/c of lack of parasites
Tx for ML?
Same as CL but give more
Monitor for 2 years
What causes visceral leishmaniasis and where do you get it?
L. donovonii common in India and Nepal, E. Africa.
L infantum in the Mediterranean and Brazil
What is the classic pentad of sx seen in VL known as the kala azar or black fever
- Fever (double quotidian fever–two peaks of fever per day)
- Weight Loss
- Hepatosplenomegaly
- Pancytopenia
- Hypergammaglobulinemia
How do you usually die from VL?
Bacterial and viral infections (pneumonia, measles, sepsis etc)
