Leishmaniasis (Kiswahili: “Leishmaniasi”)

Notes
  • The three types of Leishmaniasis, their causative agents and their global distribution are listed below:

Type of

Leishmania

Causative

Leishmania

Distribution

Visceral

L. donavani

L. infantum

L. chagasi

 

Kenya, Sudan, Ethiopía, China, India, Iran, Mediterranean basin, South America

Cutaneous

L. tropica

L. major

L. aethiopica

L. mexicana

Not so common in Kenya, Ethiopia, Mediterranean basin, Afghanistan, Middle East, W. and N. Africa, Central America and Amazon basin

Mucocutaneous

L. braziliensis

complex

South America

*Adopted with permission from Tonui (2006)

  • Visceral leishmaniasis is also known as kalaazar.
  • In East Africa, the sandflies, Phlebotomus orientalis (in dry areas) and Phlebotomus martini (in relatively wet areas) are the main vectors of VL.
  • Canines, and mostly dogs, are the main animal reservoirs.
  • Statistics: Global incidence: 0.9-1.3 million; number of deaths globally: 20 000 - 30 000; > 90% of global VL cases occur in India, Bangladesh, Sudan, South Sudan, Ethiopia and Brazil; prevalence of VL in West Pokot in Kenya in 1986 – 3.9%. Size of phlebotomine sandfly: 2-3mm.
  1. Transmission
  • Life-cycle;

_Promastigotes infected phlebotomine sandfly bites a man

_Promastigotes are phagocytozed by macrophages.

_Promastigotes are transformed into amastigotes

_Amastigotes multiply by binary fission

_The female phlebotomine sandfly bites an infected man and ingest amastigotes parasitized cells.

_Amastigotes are transformed into motile promastigotes in the insect midgut.

_Promastigotes multiply and migrate into proboscis

Symptoms

The Table below summarizes symptoms and signs of various types leishmaniasis:

Type of

Leishmania

Symptoms and signs

Visceral

§ Hepatomegaly (extensive that lead to highly swollen abdomen)

§ Splenomegaly (extensive)

§ Wasting (though with good appetite).

§ Anemia

§ Fever (that can be irregular)

§ Reduction in the number of RBC, WBC and platelets

Cutaneous and mucocutaneous

§ Clearly-demarcated painless skin lesion at the site of bite

§ The lesion are raised and have erythematous border

§ Rarely, nodular skin lesions that can be confused with those of lepromatous leprosy

§ Rarely, mucosal leishmaniasis that is characterized by nasal pain, stuffness and discharges that later evolves into debilitating lesions.

Diagnosis
  • Clinical evaluation
  • Microscopy of the tissues
  • Culture
  • Skin testing
  • PCR
  • Rapid test kits
Management
'-Deoxy-" '-Difluorocytidine
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