Leishmaniasis: A Comprehensive Overview

2. LEISHMANIASIS HomaHajjaran Associate professor Dep. Parasitology School of Public Health (TUMS)

3. مقدمه و کلیات

4. William Leishman ا

5. Charles Donovan

6. LeishmaniaClassification Superkingdom Eukaryota Kingdom Protozoa Phylum Sarcomastigophora Subphylum Mastigophora Class Zoomastigophorea Order Kinetoplastida Suborder Trypanosomatina Family Trypanosomatidae Genus Leishmania&Trypanosoma

7. Distribution 22 countries in the New World 66 countries in the Old World Not found in South-east Asia 350 million people at risk 12 million people infected / year There are 59,000 deaths / year

9. What isLeishmania? Parasite Protozoan in the familyTrypanosomatidae In the genusLeishmania ~ 50 species

10. Surveillance data indicate… • Improved diagnosis and case notification • Inadequate vector or reservoir control • Opportunistic infections (HIV/AIDS) • Urbanization and deforestation • Emergence of Anti leishmania drug resistance • Economic hardship • Armed conflict and tourism ( non endemic in North USA & Northern Europe ( 600 USA Soldiers 2003 …UK 4(10)

11. Tissue and blood mastigophor • The individual amastigotes measure approximately 3 µm in diameter.  • The promastigotes are approximately 8-15 µm in length. • Metacyclic* • stationary

12. parasitophorous vacuoles of macrophages Leishmania: an obligate intracellular protozoan parasite (2-6 µm in diameter)

13. Promastigotes in Sand Fly gut and in Culture Media (about 15-30 µm by 2-3 µm),

14. LEISHMANIA Donovani

15. Electron photomicrograph of promastigotes

16. مورفولوژی انگل لیشمانیا متاسیکلیک پروماستیگوت پروماستیگوت آماستیگوت ThemeGallery is a Design Digital Content & Contents mall developed by Guild Design Inc.

17. Life Cycle

18. Vectors Phlebotomine Sand Flies Order Diptera Family Psychodidae Genera New World Lutzomyia Old World Phlebotomus

19. Vectors PhlebotomineSandflies 6 genera world wide distribution 500 species Females Haematophagus Males sap feeders

20. 20 to 40 days Sand Fly Life Cycle 30 to 70 eggs hatch 1 to 2 weeks pupal development 5-10 days adults crepuscular and nocturnal 4 instars diapauses in 4th instar

22. Other methods of transmission Congenital transmission from mother to child. Blood transfusion Sexual contact

23. Subgenera and species ofLeishmaniaAssociated with Human Disease New World Old World Leishmania L. amazonensis, L. chagasi, L. donovani, L. infantum, L. major, L. mexicana, L. pifanoiand L. tropica Viannia L. braziliensis, L. guyanensis, L. lainsoni., L. naiffi, L. panamensis, L. peruviana, andL. shawi.

24. LeishmaniaParasites Have two different morphological forms Have specific vectors Have specific reservoirs Cause several forms of disease

25. LeishmaniaParasites Have specific reservoirs

26. L. panamensis L. guyanensis L. braziliensis L. amazonensis L. mexicana L. major Sloths Rodents

27. L. nailfy L. amazonensis L. guyanensis Armadillo Opossum

28. Zoonotic Visceral Leishmaniasis L. donovani L. infantum L. chagasi Visceral Leishmaniasis L. donovani Anthroponotic

29. LeishmaniaParasites Cause several forms of disease Pathogenesis: Agent,vector,reservoir and clinical signs , epidemiologivcal and control.21/30 species

30. Clinical Forms of Leishmaniasis Cutaneous Mucocutaneous Diffuse Cutaneous Visceral Zoonotic Anthroponotic L. aethiopica

31. Clinical Forms of Leishmaniasis Cutaneous

32. Leishmaniasis Etiological AgentsNew world MucocutaneousCutaneous– Most species that affect man –L. braziliensis; L. panamensis Diffuse –L. amazonensis; L. mexicana; L. sp. (DOR); L. aethiopica Visceral –L. chagasi(NW); L. donovani(OW) L. infantum (OW);

33. L. tropicacomplex- Old World • L. tropica complex • L. major complex • L. aethiopica(CL, DCL(old world)) • بیماری به شکل ضایعات متعدد وشبیه به جذام لپروماتوز است.تعداد انگل در ضایعات فراوان و تست پوستی منفی است و نقص سیستم ایمنی در فرد است وعدم پاسخ مناسب به درمان.

34. اشکال بالینی لیشمانیا لیشمانیوز جلدی فرم خشک کمون 12-2 ماه 6 ماه بعد به شکل پلاک اندازه 2-1 سانتی متر بهبودی تا دو سال بعد عامل لیشمانیا تروپیکا فرم مرطوب کمتراز دوماه پاپول اریتروماتوز اندازه6-3 سانتی متر پاپول های اقماری بیشتر بهبودی پس از12-3 ماه عامل لیشمانیا ماژور.

35. L. mexicana complex • L. mexicana( CL) in New world • Chiclero,s ulcer زخم های چیکلرو • L. amazoniansis (DCL)in new world

38. بيمار مبتلا به ليشمانيوز جلدي

39. Clinical Forms of Leishmaniasis Mucocutaneous

40. Leishmaniasis Etiological Agents Cutaneous– Most species that affect man Mucocutaneous–L. braziliensis; L. panamensis Diffuse –L. amazonensis; L. mexicana; L. sp. (DOR); L. aethiopica Visceral –L. chagasi(NW); L. donovani(OW) L. infantum (OW);

41. Sub.Genus.Viannia(New world) • L. brasiliansis*(CL,MCL pharynx, (Espundia) • Reservoir.rodent,dog • L.guanensisCL (PianBois,lymphatic) • Reservoir.sloth • L.panamansis CL,MCL, nasopharenx • L.peruvianaCL (uta) reser.dog

45. Clinical Forms of Leishmaniasis Diffuse Cutaneous

46. Leishmaniasis Etiological Agents Cutaneous– Most species that affect man Mucocutaneous–L. braziliensis; L. panamensis Diffuse –L. amazonensis; L. mexicana; L. sp. (DOR); L. aethiopica Visceral –L. chagasi(NW); L. donovani(OW) L. infantum (OW);

47. Clinical Forms of Leishmaniasis Visceral Zoonotic

48. Leishmaniasis Etiological Agents Cutaneous– Most species that affect man Mucocutaneous–L. braziliensis; L. panamensis Diffuse –L. amazonensis; L. mexicana; L. sp. (DOR); L. aethiopica Visceral –L. chagasi(NW); L. donovani(OW) L. infantum (OW);

49. برخی اشکال بالینی غیر معمول لیشمانیا فرم جلدی منتشره( (DCL فرم پوستی بعد از کالاآزار( (PKDL لیشمانیوز عود کننده (Lupoid) احشایی- تروپیکال(Viscerotropic) lupoid DCL PKDL

50. Ninety percent of cases are fatal if untreated.