Leishmaniasis

Question 1

leishmaniasis

carried by what vector?

lives in sand flies as what form?

lives where in humans?

lives in humans as what form?

Answer 1

sand flies; as promastigotes

live in human WBCs as intracellular amastigotes

Question 2

amastigote vs promastigote forms

Answer 2

A - round, intracellular; in humans

P - flagellum, long, in the sand fly

Question 3

leishmaniasis : 3 syndrome types

worst?

Answer 3

cutaneous, mucosal and visceral

visceral L –> most deadly

Question 4

which two forms of L cause visceral disease?

Answer 4

L donovani and L infantum

Question 5

L tropica is associated with what forms of disease?

Answer 5

cutaneous or mucosal disease

Question 6

cutaneous Leishmaniasis

three types?

presentation?

is there pus?

Answer 6

L major or L tropica (IRAQ)

(L mexicana in Texas)

skin ulcerative lesions and edema; can be disfiguring if bad

(doesnt make pus; pus indicates secondary infection)

Question 7

how can you differentiate between pyoderma (infected bug bite) or cutaneous Leishmaniasis?

Answer 7

CL = not painful, slow progression, ulcerative, rolled margins, no response to antibiotic

Pyoderma - pus, painful/itchy, fast progression, NO rolled margin, responds to antibiotic

Question 8

is serology helpful in diagnosing cutaneous Leishmaniasis?

Answer 8

NO

Question 9

leishmania on tissue scraping

you have to see the…

Answer 9

kinetoplast

Question 10

Leishmaniasis treatment

Answer 10

simple –> topical

complex –> systemic therapy

heat, miltefosine, antimonials, amphotericinB

Question 11

antimonial drug used around world to treat leishmaniasis

Answer 11

sodium stibogluconate

Question 12

mucosal leishmaniasis

type?

presentation?

complications?

Answer 12

L. viannia (L.v. braziliensis)

months to years after skin lesion

nasal stuffiness, inflammation and then ulceration of nasal mucosa/septum

can progress to lip/cheek/palate/pharynx/larynx

complications: disfiguring, aspiration, death

Question 13

mucosal leishmaniasis treatment

Answer 13

same as cutaneous but just higher dose

Question 14

visceral leishmaniasis

2 types?

mech?leads to?

Answer 14

L. donovani (india/africa) = worse

L. infantum (mediterraenean/sicily) = less severe

incubation period is weeks to months

causes wasting and immunosuppression

(TNFalpha and IL2 are secreted by infected macrophages)

death due to bacterial/viral infections = pneumonia, measles, sepsis, TB, dysentery

Question 15

what cytokine plays an important role in leishmaniasis?

Answer 15

IL-10

Question 16

kala azar

Answer 16

pentad that can occur with visceral leishmaniasis

fever + weight loss + hepatosplenomegaly + pancytopenia + hypergammaglobulinemia

wasted body with extended abdomen

Question 17

what type of fever occurs with visceral leishmaniasis?

Answer 17

double quotidian fever

2 fever peaks per day

Question 18

diagnosis for visceral leishmaniasis

can you use serology?

Answer 18

yes can use serology (unlike cutaneous)

bone marrow

ELISA rK39 test (recombinant kinesin like antigen)

antileishmanial antibody

Question 19

treatment for visceral leishmaniasis

Answer 19

MAIN –> liposomal amphotericin B

or

pentavalent antimonials (sodium stibogluconate)

or

miltefosine