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Medical Flagellates. 山东大学 医学院 病原生物学研究所 寄生虫学教研室 何深一 MD, Ph.D. Flagellates. Leishmania donovani Giardia lamblia Trichomonas vaginalis . Mobility Comparison. Ameoba. Trichomonas. Giardia. Lecture Topics on Leishmania. Introduction The parasite and vector The life-cycle

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slide1

Medical Flagellates

山东大学 医学院

病原生物学研究所 寄生虫学教研室

何深一 MD, Ph.D.

flagellates
Flagellates
  • Leishmania donovani
  • Giardia lamblia
  • Trichomonas vaginalis
slide3

Mobility Comparison

Ameoba

Trichomonas

Giardia

lecture topics on leishmania
Lecture Topics on Leishmania
  • Introduction
  • The parasite and vector
  • The life-cycle
  • Clinical features
  • Diagnosis
  • Epidemiology
  • Chemotherapy
introduction
Introduction

Leishmaniasis

Protozoal disease of mammals

Largely zoonotic

23+ pathogenic species

Visceral Leishmaniasis

Mucocutaneous leishmaniasis

Cutaneous leishmaniasis

species pathogenic in humans

Species Pathogenic in Humans

Leishmania donovani (Laveran 1903) (VL)

Leishmania tropica (CL)

Leishmania major (CL)

Leishmania aethiopica (CL)

Leishmania mexicana (CL)

Leishmania brazilliensis (MCL)

charles louis alphonse laveran
Charles Louis Alphonse Laveran

France

Institute Pasteur Paris, France

1845 - 1922

The Nobel Prize in Physiology or Medicine 1907

"in recognition of his work on the role played by protozoa in causing diseases"

slide8

Leishmaniasis is prevalent world wide: ranging from south east Asia, Indo-Pakistan, Mediterranean, north and central Africa, and south and central America.

the parasite
Phylum

Order

Family

Genus

Sarcomastigophora

Kinetoplastida

Trypanosomatidae

Leishmania

The Parasite
morphology
Promasitogte

Insect

Motile

Midgut

Amastigote

Mammalian stage

Non-motile

Intracellular

Morphology

Digenetic Life Cycle

morphology1
Morphology
  • The individual amastigotes measure approximately 3 µm in diameter. 
  • The promastigotes are approximately 25 µm in length.  
vectors
Vectors

Phlebotomine Sandflies

6 genera world wide distribution

500 species

Females Haematophagus

Males sap feeders

life cycle
Life Cycle

Promastigote Amasitgote

Transformation

life cycle1
Life Cycle
  • 1  infective stage: promastigotes
  • 2  mode of infection:  biten by sandfly
  • 3  site of habitation:  macrophages
  • 4  pathogenic stage:  amastigotes
  • 5  diagnostic stage:  amastigotes
  • 6 reservoir host: dogs
mammalian hosts
Rodents

Gerbils

Hyraxes

Bats

Porcupines

Opossums

Sloths

Primates

Dogs

Foxes

Anteaters

. . . . .

Mammalian Hosts
clinical disease
Visceral

Fatal (90% untreated)

Liver

Spleen

Bone marrow

Cutaneous

Generally Self- healing

Skin

Mucous membranes

Clinical Disease

SPECTRUM OF DISEASE

initial infection
Initial Infection
  • Similar in all species
  • Inoculation of promastigotes
  • Inflammation & chemotaxis
  • Receptor mediated phagocytosis

Promastigote Amasitgote

Transformation

parasite spread
Parasite Spread

Macrophage lysis & parasite release

Lymphatic spread

Blood spread

Target organs

Skin/lymph nodes/spleen/liver/

bone marrow

visceral leishmaniasis
1903

1920

1931

William Leishman

Pentavalent antimony

Experimental transmission

Visceral Leishmaniasis

Leishmania donovani (Complex)

L.d. archibaldi - L.d.chagasi - L.d.donovani - Ld.infantum

vl clinical manifestation
VL - Clinical Manifestation

Variable - Incubation 3-100+ weeks

Lowgrade fever

Hepato-splenomegaly

Bone marrow hyperplasia

Anemia, Leucopenia & Cachexia

Hypergammaglobulinnemia

Epistaxis , Proteinuria, Hematuria

slide35
Profile view of a teenage boy suffering from visceral leishmaniasis. The boy exhibits splenomegaly, distended abdomen and severe muscle wasting. 
slide36
A 12-year-old boy suffering from visceral leishmaniasis. The boy exhibits splenomegaly and severe muscle wasting.
post kala azar dermal leishmanoid
Post Kala Azar Dermal Leishmanoid

Normally develops <2 years after recovery

Recrudescence

Restricted to skin

Rare but varies geographically

infection
INFECTION

Sub-clinical or inapparent infection

RecoveryDeath

Immune to reinfection Concurrent infection

PKDL

diagnosis
Diagnosis

Clinical signs & symptoms

Hypergammaglobulinemia

ELISA/Formol gel

Bone marrow biopsy

Spleen or liver biopsy

Culture & Histology

speciation
Speciation
  • Similar morphology
  • DNA bouyant density
  • Isoenzyme profiles - Zymodemes
  • Monoclonal antibodies
  • DNA hybridisation - PCR
slide46

1. Leishmaniasis is prevalent world wide: ranging from south east Asia, Indo-Pakistan, Mediterranean, north and central Africa, and south and central America.

  • 2. 我国:长江以北16个省市自治区,甘肃、四川、陕西、山西、新疆和内蒙古更多见。
treatment
Treatment

Good nursing

Diet

Antibiotics

Pentavalent antimony

Pentamidine

New drugs - New delivery

control
Control
  • Vector control
  • Reservoir control
  • Treatment of active cases
  • Vaccination