1 LEISHMANIASIS AND DIAGNOSTIC METHODS BY PROF. DR. SUZAN ALEISHMANIASIS AND DIAGNOSTIC METHODS BY PROF. DR. SUZAN A. ALAZIZZ DEPARTMENT OF MICROBIOLOGY AND VETERINARY PARASITOLOGY COLLEGE OF VETERINARY MEDICINE UNIVERSITY OF BASRAH

3 Species Pathogenic in HumansLeishmaniasis Species Pathogenic in Humans Leishmania donovani (complex) (VL) Leishmania tropica (CL) Leishmania major (CL) Leishmania aethiopica (CL) Leishmania mexicana (Complex) (CL) Leishmania brazilliensis (complex) (MCL)

4 Three important SpeciesLeishmania donovani (VL ) VISCERAL LEISHMANIASIS : involving endothelial tissue liver, spleen, and bone marrow. Leishmania tropica (CL) OLD WORLD CUTANEOUS LEISHMANIASIS : involving epithelial cells the skin at the site of a sand fly bite. Leishmania brazilliensis (MCL) NEW WORLD MUCO CUTANEOUS LEISHMANIASIS : involving mucous membranes of the mouth and nose after spread from a nearby cutaneous lesion. Three important Species

5 Leishmaniasis in the Middle East90% of all visceral leishmaniasis occurs in Bangladesh, Brazil, India, and Sudan. 2893 cases were reported in Iraq in 2001 90% of cutaneous leishmaniasis occurs in Afghanistan, Iran, Saudi Arabia, Syria, Brazil and Peru 8,7% cases were reported in Iraq in 1992 Sore is commonly called the Baghdad boil 90% of mucocutaneous leishmaniasis occurs in Bolivia, Brazil and Peru Data on leishmaniasis is based on voluntary reporting by countries so true incidence may be higher in countries that are not likely to report. Numbers of cases in Iraq come from recent Promed messages (authors Desjeux and Deresinki)

7 Promastigote stage inside the SandflySand fly : Vectors Intermediate host, transmitted disease flagella

8 Promastigotes in rosettes in a culture of an orient sore on N. N. NPromastigotes in rosettes in a culture of an orient sore on N.N.N. medium (Giemsa stain).

9 Leishmania sp. amastigote stageOvoid small intracellular parasites in a bone marrow aspirate. The typical rod shaped kinetoplast is seen besides the nucleus.(Giemsa stain).

10 Life cycle

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21 Visceral LeishmaniasisVisceral disease (Kala-azar)

23 Post Kala Azar Dermal LeishmanoidNormally develops <2 years after recovery Restricted to skin, rare but varies geographically Some people recover spontaneously Some people who were treated later develop Post-Kala- azar dermal leishmanoid

26 Diagnosis Diagnosing Leishmaniasis can be difficult Sometimes the Lab tests are negative even if a person has Leishmaniasis.

27 Diagnosis 1. Clinical Diagnosis: signs & symptomsPatient history (travel, vectors) 2. Laboratory Diagnosis :

28 Laboratory Diagnosis of leishmaniasis :Cutaneous leishmaniasis : Tissue sample (scraping, aspirate or punch biopsy) for smear and culture Visceral leishmaniasis : Bone marrow biopsy or splenic aspirate for smear and culture.(N.N.N) V.L.(anemia , leukopenia , glubuline/albumine is high (Hypergammaglobulinia) Serology ( ELISA ) ( IFAT ). PCR Skin test Inoculate serum of infected person in lab. animals.

29 Animal inoculation Inoculate serum of infected person in lab. animals.

30 EARLY DIAGNOSIS L.D BODIES (SPLEEN, BONE MARROW, LYMPH NODE)ALDEHYDE TEST ELISA Polymerize chain reaction (PCR) Gen Sequence for recognize the strain

31 The End