cutaneous leishmaniasis
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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.......