Includes many different species:
description
Transcript of Includes many different species:
Includes many different species: Leishmania TrypanosomaGeneral Characters:
1- Present in blood and tissue. 2- Move by Flagellum3- Require vector (blood sucking insect) for transmission.4- Alternate cycles & acquire 2 interchangeable stages in host & vector.5- Multiply by simple binary fission.
Trypanosoma spp.
Haemoflagellatesand
Polymorphic Trypanosomes: Monomorphic Trypanosomes:1 -Trypanosoma gambiense
2 -Trypanosoma rhodesiense Trypanosoma cruzi
Leishmania spp.
Leishmania tropica complex: Leishmania donovani complex:1 -Leishmania tropica
2 -Leishmania major3 -Leishmania aethiopica
1 -Leishmania donovani2 -Leishmania infantum
3 -Leishmania chagasiLeishmania mexicana complex: Leishmania braziliensis complex:Leishmania mexicana Leishmania braziliensis
Blood Flagellates1- Are Protozoa that swim in the blood of patients using
Amastigote
Promastigote Epimastigote
Trypomastigote
Eccentric nucleus
Central nucleus
Free Flagellum
Free Flagellum
Free Flagellum
No free flagellum
Central nucleus
Central nucleus
kinetoplast
kinetoplast
3- Include: Leishmania
Undulating membrane
Undulating membrane
kinetoplast
& Trypanosoma4- Acquire the following shapes:
flagellum (mastigote) then invade their tissues.
oval
elongated
2- Transmitted to man through arthropods bite خيط
Leishmania spp.Introduction
1- Leishmania established everywhere in Forest, desert, mountains, towns, countries 2 -Leishmaniasis is a variety of syndromes that are wide-spread giving rise to:
Cutaneous – Mucocutaneous – Visceral Leisons.3- Species variation & the cellular immune response determine the type of lesion
4 -Leishmania spp. are strictly obligatory intracellular parasite of macrophages/ monocyte series (Histiocytes – Epitheloid cells – Kupfer cells – R.E.Cs5- Multiply by binary fission within macrophages of : SKIN – RETICULO- ENDOTHELIAL SYSTEM & other VISCERA 6 -Acquire interchangeable stages:
Amastigotes: in Man- Dogs –Rodents. Promastigotes: in vector & culture
7- Transmission of the disease is seasonal – mainly zoonotic. Exceptions are L. donovani in india & L. tropica ….. Whereas man is the only source of maintaining infection (Anthroponotic)
8 -Vector of transmission is Sandfly “Phlebotomus” (old world) and “Lutzomyia ”) new world.(
DiseaseI- Cutaneous Leishmaniasis “Oriental Sore:”
A- Old World Cutaneous Leishmaniasis (O.W.C.L.):1 -Single Dry Non-Exudative Lesion L.tropica
2 -Multiple Wet Exudative Lesion L.major
3 -Disseminated Cut. Leishmaniasis L.aethiopica
4 -Chronic (Recidivan) Relapsing Cut. Leishmaniasis L.tropica
B- New World Cutaneous Leishmaniasis (N.W.C.L.):1 -Relapsing skin Lesion (Chiclero’s Ulcer) L.mexicana
2 -Mucocutaneous Leishmaniasis (Espundia) L.braziliensis
II- Mucocutaneous Leishmaniasis “ESPUNDIA:”
III- Visceral Leishmaniasis “Kala-azar:”L. braziliensis
L. donovani - L. infantum - L. chagasi
Disease SPECIES
Cutaneous leishmaniasisLeishmania tropica*Leishmania major*
Leishmania aethiopicaLeishmania mexicana
Mucocutaneous leishmaniasis Leishmania braziliensis
Visceral leishmaniasisLeishmania donovani*Leishmania infantum*
Leishmania chagasi
* Endemic in Saudi Arabia
Leishmania Parasites and Diseases
Leishmania Parasites and Diseases
Leishmania causes leishmaniasis
Liver
Disease is caused by Bite
of ♀ sandfly
Attacks human skinOld world cutaneous leishmaniasis
New world cutaneous leishmaniasisOld world visceral leishmaniasisNew world visceral leishmaniasis Different Leishmania species
Attacks human viscera
Mode of infection of LeishmaniasisThrough the bite of female sand fly (vector)
Infective stage
Promastigotes
Diagnostic stage
Biological transmission
AmastigotePromastigotesblock mouth & pharynx in skin or blood of patientPhlebotomus (OW) Lutzomyia (NW)
Multiply by binary fission
Alimentary canal of sand fly
_by sand flies.
_artificial transmission of leishmania via the sharing of contaminated syringes and needles, from one intravenous drug
user to another.
Rarely, Leishmaniasis is spread from a pregnant woman to her baby (Materno-
fetal transplacental transmission) .Blood transfusion or contaminated needles
also can spread Leishmaniasis.
Transmission of Leishmaniasis
10
Female sand flies
MaleFemale
Vector
The life cycle of Leishmania
The life cycle of Leishmania
The life cycle of Leishmania
The life cycle of Leishmania
human_life_cycle_leish.swf
The life cycle of Leishmania
life_cycle_sand_fly_leish.swf
Sand fly
Promastigotes of Leishmania Amastigote
Leishmania spp.
Pathogenesis & Clinical Picture of Cutaneous Leishmaniasis
PromastigotesAmastigotes
forms at the site of bite due to multiplication of Leishmania in skin macrophages
forms with sharp-cut edges with raised indurated margin
Healing occurs leaving
The patient develops solid immunity
Nodule
An ulcer
a disfiguring scar
&granulomatous reaction around them.
Skin macrophage
Inflammatory cells
In about 1 year
Leishmania species causing ulcer in the Old World
1- L. tropica
Urban
2- L. major
Rural
In the Middle East
In Ethiopia & Kenya3- L. aethiopica
Affects patients producing diffuse cutaneous lesions resembling lepromatous leprosy.
Oriental sore
المدن الريف
القرحةالشرقية
dry chronic wet acute
In patients with deficient cell-mediated immunityDue to some characteristics of parasite species
I-Cutaneous Leishmaniasis “Oriental Sore”(O.W.C.L)
1 -Single Dry Non-Exudative Lesion Caused by L. tropica URBAN type
2- Long incubation Period (months to years).1 -Present in towns & cities (common in Saudi Arabia).
4- Lesions are slowly progressive.3- Lesions develop in exposed parts such as (face –limbs)
5 -Ulcer heals “self-limiting infection” scar tissue form6 -C.M.I. curtails the infection leading to resistance to reinfection
Appear as follows: single-small-Dry-painless nodule-nonexudative-delayed ulceration-small scar- non pruritic- uncommon 2ry bacterial infection.
2 -Multiple Wet Exudative Lesion Caused by L. major RURAL type
2- Relatively short incubation period (2-6 weeks).1 -Found in villages at edge of deserts(common in KSA).
4- Lesions are rapidly progressive.3- Lesions are more severe than L.tropica – big Ulcers
5- Dense nodules ulcerate & Coalesce big ulcersAppear as follows: Multiple-Big-Wet-painless nodule-Exudative2ry bacterial delay healing –Big disfiguring scar- pruritic.
I-Cutaneous Leishmaniasis “Oriental Sore”(O.W.C.L)
3 -Chronic (Recidivan) Relapsing Cut. Leishmaniasis Caused by L. tropica
Few cases following primary skin lesion become hyper-Sensitive to parasite antigen --- vigorous immune responsePersistent chronic infection (over years)
The Lesions appear as follows:.1 -Papules develop around the healed skin & scar tissue
2 -Ulcerate & heal by SCAR tissue formation
4 -Diffuse Cut. Leishmaniasis (D.C.L.) L. aethiopica (also L. amazonensis)Inefficient cellular immune response limited cellular infiltration around infected macrophages failure of immune response to abort infection spread of amastigote
The Lesions appear as follows:.1- Multiple nodules with abundant parasite – Rarely ulcerate.2- Skin becomes thick due to hyperplasia & hypertrophy.3- The lesion appear as “Lepromatous Leprosy”.
3 -Appear as Tuberculoid skin lesion “Lupus Vulgaris.”N.B: Montengro’s Test (is strongly +ve), while smear & culture for parasite is –ve????
I-Cutaneous Leishmaniasis “Oriental Sore”(O.W.C.L)
somewhat like a volcano with a raised edge and central crater
Areas where Cutaneous Leishmaniasis exists
L.infantumL.aethiopica
L.tropicaL.major
In the Old World
Leishmania species causing ulcer in the New WorldL.peruviana
Dry ulcer (Uta)
L.braziliensis
spread along lymphatics to mucous membrane producing erosion of
nasal septum, palate & larynx
(Espundia)
Leishmania pifanoi
Diffuse lesion resembles lepromatous
leprosy (does not heal or ulcerate).
Leishmania species causing ulcer in the New World
Leishmania mexicana:
(Chiclero’s ulcer or Bay sore)
single ulcer affects the ear causing destruction of the cartilage.
L.braziliensis
I-Mucocutaneous Leishmaniasis “Espundia”Caused by L. braziliensis present in hot humid forest of central & south America
1- Vector of transmission is Lutzomyia.
3- M.L. may develop 2-10 years following primary C.L..2- majority of cases primarily present with Cutaneous Lesion
4 -Deficient C.M.I. Spread of infection either directly or haematogenously to involve soft tissues of the Oronasal & Pharyngeal mucosa (NOSE-PHARYNX-LARYNX –UPPER LIP)
5-Lesion may be hypertrophy or severely destructive: Hypertrophy mainly NOSE & MOUTH. Destructive Mouth –Pharynx- Nasal (mucosa/cartilage Septum) nasal obstruction – bleeding – erosion massive destruction, severe pain & great deformity.
N.B: only non-visceral Leishmaniasis lesion that may cause death from (Pneumonia- Septicemia as superimposed 2ry bacterial infection – malnutrition – Deficient C.M.I.)