Haemoflagellates

Leishmaniasis & Trypanosomiasis

Different stages of Haemoflagellates

Promastigotes of Leishmania

Amastigote of Leishmania

The life cycle of Leishmania

Leishmania Parasites and Diseases

SPECIES
Leishmania tropica*
Leishmania major*
Leishmania aethiopica
Leishmania mexicana

Disease
Cutaneous leishmaniasis

Leishmania braziliensis

Mucocutaneous leishmaniasis

Leishmania donovani*
Leishmania infantum*
Leishmania chagasi

Visceral leishmaniasis

* Endemic in Saudi Arabia

World distribution
of Visceral Leishmaniasis

Sand fly

Amastigotes of Leishmania

Promastigotes of Leishmania

lesion

lesion

lesion

Clinical types of cutaneous leishmaniasis

Leishmania major: Zoonotic cutaneous
leishmaniasis: wet lesions with severe reaction

Leishmania tropica: Anthroponotic cutaneous

leishmaniasis: Dry lesions with minimal ulceration

Oriental sore (most common) classical selflimited ulcer

Uncommon types
Diffuse cutaneous leishmaniasis (DCL):
Caused by L. aethiopica, diffuse nodular nonulcerating lesions. Low immunity to Leishmania
antigens, numerous parasites.

Leishmaniasis recidiva (lupoid leishmaniasis):

Severe immunological reaction to leishmania
antigen leading to persistent dry skin lesions, few
parasites.

Diffuse cutaneous leishmaniasis

Leishmaniasis recidiva

cutaneous leishmaniasis
Diagnosis:
Smear: Giemsa stain microscopy for LD
bodies (amastigotes)
Biopsy: microscopy for LD bodies or
culture in NNN medium for promastigotes

NNN medium

Treatment
No treatment self-healing lesions
Medical:
o Pentavalent antimony (Pentostam), Amphotericin B
o +/- Antibiotics for secondary bacterial infection.

Surgical:
o Cryosurgery
o Excision
o Curettage

Pentostam ( sodium stibogluconate) for treatment of all types of

leishmaniasis

Visceral leishmaniasis

There are geographical variations.

The diseases is called kala-azar
Leishmania infantum mainly affect children
Leishmania donovani mainly affects adults

Presentation
Fever
Splenomegaly, hepatomegaly,
hepatosplenomegaly
Weight loss
Anaemia
Epistaxis
Cough
Diarrhoea

Untreated disease can be fatal

After recovery it might produce a condition

called post kala-azar dermal leishmaniasis
(PKDL)

Fever 2 times a day due to kala-azar

Hepatosplenomegaly
in visceral leishmaniasis

Mucocutaneous leishmaniasis

Visceral leishmaniasis
Diagnosis
(1) Parasitological diagnosis:
Bone marrow aspirate
Splenic aspirate
Lymph node
Tissue biopsy

METHOD
1. microscopy
2. culture in NNN medium

Bone marrow aspiration

Bone marrow amastigotes

(2) Immunological Diagnosis:

Specific serologic tests: Direct Agglutination
Test (DAT), ELISA, IFAT
Skin test (leishmanin test) for survey of
populations and follow-up after treatment.
Non specific detection of
hypergammaglobulinaem by formaldehyde
(formol-gel) test or by electrophoresis.

DAT test

ELISA test

Formol-gel

Treatment:
Pentavalent antimony- sodium
stibogluconate (Pentostam)
Amphotericin B

Treatment of complications:
Anaemia
Bleeding
Infections etc.

Post-kalazar dermal leishmaniasis

(PKDL)

Trypanosomiases

African Trypanosomiasis

Life cycle of Trypanosoma

brucei gambiense & T. b. rhodesiense

African sleeping sickness

Trypanosoma brucei rhodesiense: East Africa,
wild and domestic animal reservoirs
Trypanosoma brucei gambiense: West and
Central Africa, mainly human infection

Animal reservoir hosts for African sleeping sickness

Tsetse fly

Pathology and clinical picture

1. Skin stage: chancre.
2. Haematolymphatic stage: generalized
lymphadenopathy, anaemia, generalized
organ involvement.
3. Central nervous system stage (CNS):
Meningoencephalitis.
(Development of the disease more rapid in
Trypanosoma brucei rhodesiense)

chancre

Winterbottoms stage

rd
3

stage CNS

Lymph node aspirate

trypanosoma

CSF

AMERICAN TRYPANOSOMIASIS

LIFE CYCLE OF Trypanosoma cruzi

Reduviid (Triatomine) bug

Diagnosis
Blood film
Serology: IFAT
Xenodiagnosis: feeding bugs on a suspected
cases.

T. cruzi causes cutaneous stage (chagoma)

Ocular lesion (Romana sign)

C-shape

TREATMENT
African trypanosomiasis
For early infection
pentamidine
suramin
For late infection
eflornithine (Diflouromethylornithine- DFMO)
American trypanosomiasis (Chagas disease)
benznidazole
nifurtimox

Trichomonas vaginalis

trophozoites

Trichomonas vaginalis

Trichomonas vaginalis
Transmission:
sexual intercourse
contact with contaminated objects.

Trichomoniasis
Pathology
Female:
vaginitis, profuse thin yellowish discharge with
bad smell
Male:
invasion of urethra, prostate and seminal vesicles,
causing urethritis but mostly asymptomatic.

Signs and Symptoms of Trichomoniasis in Women

Sign/Symptom

Percent of Patients

Asymptomatic

50%

Vaginal/vulvar erythema
(redness)

75%

Frothy, yellow/green
discharge

25%

Vulvar itching

20-50%

Strawberry cervix

< 2%

Vaginal odor

60%

pH > 5

60-90%

Dyspareunia (pain during

sexual intercourse)

< 25%

Dysuria (pain during

urination)

< 25%

Signs and Symptoms of Trichomoniasis in Men

Sign/Symptom

% of Patients

Asymptomatic

> 50%

Urethral discharge

65-100%

Pruritus (itching)

98.5%

Dysuria (pain during

urination)

5.5%

Trichomoniasis
Diagnosis
Identification of parasite by microscopy of
discharge.
Examination of vaginal or urethral
discharge for T. vaginalis

Trichomonas vaginalis

Trichomonas vaginalis

Trichomoniasis
Treatment:
metronidazole (flagyl).
Note:
Treat sexual partner because infection is
mostly asymptomatic in males.