Which does not belong to the Old World (epidemiological division)

Which of the following belongs to New World (Epidemiological division)

Insect Vector

Old world: ____ ; New world: _____

Reservoir host

Urban only

Reservoir host

Urban and Rural

Ovoid/rounded bodies

Live intracellularly in monocytes, PMNs, endothelial cells

Large nucleus

It arises from kinetoplast and extends to anterior tip

Single free flagellum

Found in hindgut, midgut, proboscis of insect vectors

4th step

When parasitized cell ruptures, amastigotes released will infect new cells or taken up by sandflies during feeding, where they transform into promastigotes in the gut, multiply by binary fission and migrate to foregut

Mode of Transmission

Immune response of the host against the infection

Factors that may affect the outcome of the infection

Most common form of Leishmaniasis

(Caused by L. tropica, L. major, L. mexicana)

An erythematous papule/nodule at inoculation site with raised edges, central crater, and forms a violacenous ulcer as it enlarges in size

Incubation period of cutaneous leishmaniasis

• Aka anergic/lepromatous leishmaniasis

• Localized, non-ulcerating papule

• Developing numerous diffuse satellite lesions that affect the face and extremities

• Initially diagnosed as lepromatous leprosy

• Develops in 2 to 5% of persons infected with L. braziliensis

• Contiguous spread of cutaneous leishmaniasis (L. tropica)

• Involve mucous membranes of nasal & oral cavities that progress to the pharynx and larynx

• Lesions usually manifest with few parasites

• Systemic Th1 response is strong

• Increased levels of peripheral mononuclear cells in blood

• AKA kala azar

• Disseminated parasitosis by L. donovani complex (L. donovani, L. chagasi & L. infantum)

• Manifestations stems from parasite spread into bone marrow, spleen, liver

Regarding VL

• x2 daily fever spikes (double quotidian)

• with accompanying chills may be present

• may be mistaken for malaria

• Sequela of visceral leishmaniasis

• Endemic area

• Cutaneous eruption

• Results in: hypopigmented macules, malar erythema, nodule, ulceration

• Usually manifest a few months to several years after treatment

The microscopic demonstration of _________ confirms the diagnosis of leishmaniasis via lesions scrapings, aspirates, or biopsy (Giemsa and hematoxylin-eosin stains)

____________ are unreliable due to the difficulty of isolating the parasites

• Used to detect exposure to the parasite

• Usually POSITIVE in cases of CL & MCL

• NEGATIVE in cases of DCL & kala azar

It demonstrated high sensitivity and specificity for VL in certain immunocompetent patient populations (i.e. ELISA & Rk38 antigen dipstick test)

It is used to identify the species of Leishmania

Intradermal application of a solution containing antigenic preparation of promastigote forms of Leishmania.

Results are evaluated w/in 48 hours w/ ballpen (+ if papule is equal or greater than 5mm)

Treatment used in areas where susceptibility is good due to their low cost

Examples of antimonials used for leishmaniasis

This treatment requires daily intramuscular or intravenous administration for 4 weeks, hospital confinement, and should only be done after consultation w/ an infectious disease expert

Treatment used in case of treatment failure with antimonials, or in areas where resistance is high

Only oral drug currently given to VL patients

Another second line drug for cutaneous and

visceral leishmaniasis but limited use due to side effects and prone to drug resistance

Treatment for

Cutaneous Leishmaniasis

Possible combination therapy/ies for leishmaniasis

Cutaneous leishmaniasis mostly occurs in

Mucocutaneous Leishmaniasis occurs in Bolivia, Brazil and Peru

Important opportunistic infection in AIDS patients and occurs in Bangladesh, Brazil, India, Nepal, and Sudan

Prevention and Control

(Bonus: Click both kapag tapos na basahin)

1. Insect repellants containing DEET and permethrin

2. Insecticide-treated clothing

3. Fine-mesh bed nets

4. Fine mesh screens

5. Spraying of houses and buildings

6. Regulation of zoonotic transmissions