CUTANEOUS LEISHMANIASIS
Anam Saghir
12-10007
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 major
Leishmania tropica minor
Leishmania aethiopica
Leishmania 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 biopsy
2.Excision biopsy
3.Incisional biopsy
4.Shave / tangential biopsy
5.Punch biopsy
6.Curettings
7.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 cultured
CUTANEOUS 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
o
o
Pentavalent antimony (Pentostam),
Amphotericin B
Topical paromomycin
• Surgical:
o
o
o
Cryosurgery
Excision
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.......