CUTANEOUS LEISHMANIASIS

Anam Saghir12-10007

Cutaneous Leishmaniasis

• Infectious disease• Skin

      Popular names:        “Oriental Sore”, "Bay sore," or “Delhi Boil”.

Epidemiology and Importance in Pakistan

 • 1.5 million• Afghanistan, Iran, Iraq,

Algeria, Saudi Arabia, Peru, and Pakistan.

• endemic in 88 countries,72 developing countries,350 million (WHO)

 

• Hindukush and Karakoram sub mountain range (Chitral, Dir and Gilgit)

• Himalayan sub mountain range (Mansehra, Abbottabad, Rawalpindi)

• Kirthar and Suleman sub mountain range (Lasbela, Khuzdar,D.G.Khan, Rajanpur, Jacobabad, Larkana)

• Toba Kakar sub mountain range (Quetta, Qila Abdullah, Pishin, Qila Saifullah)

       KPK and FATA

Causative Organism

protozoa of genus Leishmania Leishman and Donovan  (1903) 20 species---------- human infecions 

 

Cutaneous leishmaniasis causing organism

Leishmania tropica majorLeishmania tropica minorLeishmania aethiopicaLeishmania mexicana

VECTOR

Sand fly (Phlebotomus and Lutzomyia)• 30  species• tiny• no noise• unnoticeable bite

 

• lesions (a small reddish blue sore )• Size and appearance

PATEINTS RESPONSES

1. ANERGIC RESPONSE:• formation of small papule• nodular plaque• no ulcer formation

 2.  HYPERSENSTIVE RESPONSE:• papule appears• raised borders and ulcer in the centre• 3-4 months• secondary infection• healing 90%• hyperpigmented and irregular scar

Promastigote and amastigote

LIFE CYCLE

 

DIAGNOSTIC TEST

Clinical diagnosis:• history of origin specifying the endemic area of

residence at the time of development of symptoms

• morphology of the lesions • character of the lesions  parasitalogical, immunological and molecular tests

PARASITLOGICAL TEST

• direct microscopic examination• culture • hamster inoculation

Skin biopsy specimen

1.Skin biopsy2.Excision biopsy3.Incisional biopsy4.Shave / tangential biopsy5.Punch biopsy6.Curettings7.Fine Needle Aspiration

  touch prepations, smears, histopathology, cultures in different media (NMN, BHI, EMTM etc., )

SLIT SKIN SMEAR:• margin of the lesion contains amastigotes • area is punctred• syringe is injected• aspirated is taken• examined microscopically or culturedCUTANEOUS SCRAPPING:• proper cleaning and drying• centre and margins of ulcered lesions• multiple slides• +VE or -VE

MOLECULAR AND IMMUNOLOGICAL TESTS:

IMMUNOLOGICAL TEST:• Montenegro skin test• ELISA• Indirect Fluorescence

Antibody Test (IFAT)• Direct Agglutination

Test (DAT)

MOLECULAR TEST:• PCR• DNA hybridization• kinetoplast DNA

TREATMENT

• No treatment – self-healing lesions• Medical:

o Pentavalent antimony (Pentostam), o Amphotericin Bo Topical paromomycin

• Surgical: o Cryosurgeryo Excisiono Curettage

PREVENTION• usage of  insect repellents such as DEET• cover the exposed skin• staying on higher floors of buildings in the evening

or at night • usage of fans • insecticidal sprays • Insecticide-treated bed nets, sheets and window

curtains • pumping of insecticides in rodent burrows to kill

rodents• treatment can also be considered a preventive

measure  Vaccines.......