Leishmania species are obligate intracellular parasites that are transmitted by an infected sandfly. The disease is endemic to Asia ASIA Spinal Cord Injuries, the Middle East, Africa, the Mediterranean, and South and Central America. Clinical presentation Presentation The position or orientation of the fetus at near term or during obstetric labor, determined by its relation to the spine of the mother and the birth canal. The normal position is a vertical, cephalic presentation with the fetal vertex flexed on the neck. Normal and Abnormal Labor varies, dependent on the pathogenicity of the species and the host’s immune response. The mildest form is cutaneous leishmaniasis (CL), characterized by painless skin Skin The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue. Skin: Structure and Functions ulcers. The mucocutaneous type involves more tissue destruction, causing deformities. Visceral leishmaniasis (VL), the most severe form, presents with hepatosplenomegaly Hepatosplenomegaly Cytomegalovirus, anemia Anemia Anemia is a condition in which individuals have low Hb levels, which can arise from various causes. Anemia is accompanied by a reduced number of RBCs and may manifest with fatigue, shortness of breath, pallor, and weakness. Subtypes are classified by the size of RBCs, chronicity, and etiology. Anemia: Overview and Types, thrombocytopenia Thrombocytopenia Thrombocytopenia occurs when the platelet count is < 150,000 per microliter. The normal range for platelets is usually 150,000-450,000/µL of whole blood. Thrombocytopenia can be a result of decreased production, increased destruction, or splenic sequestration of platelets. Patients are often asymptomatic until platelet counts are < 50,000/µL. Thrombocytopenia, and fever Fever Fever is defined as a measured body temperature of at least 38°C (100.4°F). Fever is caused by circulating endogenous and/or exogenous pyrogens that increase levels of prostaglandin E2 in the hypothalamus. Fever is commonly associated with chills, rigors, sweating, and flushing of the skin. Fever. Management is based on the clinical severity and patient's immune status. Some cutaneous lesions spontaneously resolve or require local therapy. Systemic treatment ( amphotericin B Amphotericin B Macrolide antifungal antibiotic produced by streptomyces nodosus obtained from soil of the orinoco river region of venezuela. Polyenes), however, is needed for VL.
Last updated: 4 Feb, 2021
In the sandfly:
In humans:
The life
cycle
Cycle
The type of signal that ends the inspiratory phase delivered by the ventilator
Invasive Mechanical Ventilation of the parasites from the genus Leishmania, the cause of the disease leishmaniasis:
On the left side (start at the bottom): Sandfly acquires amastigotes from an infected mammal. Amastigotes transform into extracellular promastigotes that multiply in the
midgut
Midgut
Development of the Abdominal Organs. Eventually, the promastigotes migrate to the sandfly proboscis, ready to be transferred to a host when the sandfly bites.
On the right side (start at the top): Promastigotes are transferred to mammals, and are phagocytosed by
macrophages
Macrophages
The relatively long-lived phagocytic cell of mammalian tissues that are derived from blood monocytes. Main types are peritoneal macrophages; alveolar macrophages; histiocytes; kupffer cells of the liver; and osteoclasts. They may further differentiate within chronic inflammatory lesions to epithelioid cells or may fuse to form foreign body giant cells or langhans giant cells.
Innate Immunity: Phagocytes and Antigen Presentation. In the cell, promastigotes transform into amastigotes and multiply. Affected cell ruptures and amastigotes spread to infect other cells.
Skin ulcer Skin ulcer An ulcer of the skin and underlying tissues. Secondary Skin Lesions due to leishmaniasis noted on the hand Hand The hand constitutes the distal part of the upper limb and provides the fine, precise movements needed in activities of daily living. It consists of 5 metacarpal bones and 14 phalanges, as well as numerous muscles innervated by the median and ulnar nerves. Hand: Anatomy of an adult from Central America
Image: “ Skin ulcer Skin ulcer An ulcer of the skin and underlying tissues. Secondary Skin Lesions due to leishmaniasis” by CDC/ Dr. D.S. Martin. License: Public DomainDiffuse or disseminated CL: seen in a patient with human immunodeficiency Immunodeficiency Chédiak-Higashi Syndrome syndrome ( HIV HIV Anti-HIV Drugs)
Image: “Diffuse or disseminated cutaneous leishmaniasis” by Rotterdam Centre for Tropical Medicine, Rotterdam, The Netherlands. License: CC BY 4.0Cutaneous leishmaniasis: leishmaniasis ulcer on left forearm Forearm The forearm is the region of the upper limb between the elbow and the wrist. The term “forearm” is used in anatomy to distinguish this area from the arm, a term that is commonly used to describe the entire upper limb. The forearm consists of 2 long bones (the radius and the ulna), the interosseous membrane, and multiple arteries, nerves, and muscles. Forearm: Anatomy
Image: “Leishmaniasis ulcer on left forearm Forearm The forearm is the region of the upper limb between the elbow and the wrist. The term “forearm” is used in anatomy to distinguish this area from the arm, a term that is commonly used to describe the entire upper limb. The forearm consists of 2 long bones (the radius and the ulna), the interosseous membrane, and multiple arteries, nerves, and muscles. Forearm: Anatomy” by Layne Harris. License: Public DomainMucocutaneous leishmaniasis: painful mucosal lesions on the palate Palate The palate is the structure that forms the roof of the mouth and floor of the nasal cavity. This structure is divided into soft and hard palates. Palate: Anatomy
Image: “Healing of lesion” by Department of Oral & Maxillofacial Surgery, E.S.I.C Dental College & Hospital, Rohini, Delhi 110089, India. License: CC BY 3.0Visceral leishmaniasis: bone Bone Bone is a compact type of hardened connective tissue composed of bone cells, membranes, an extracellular mineralized matrix, and central bone marrow. The 2 primary types of bone are compact and spongy. Bones: Structure and Types marrow slide showing Leishman-Donovan bodies (arrow)
Image: “Leishman-Donovan bodies” by Department of Medicine, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110002, India. License: CC BY 2.0Cutaneous leishmaniasis
2A: dermal
skin
Skin
The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue.
Skin: Structure and Functions scrapings in Wright’s stain showing Leishman-Donovan bodies (amastigotes) in the macrophage
2B: dermal
skin
Skin
The skin, also referred to as the integumentary system, is the largest organ of the body. The skin is primarily composed of the epidermis (outer layer) and dermis (deep layer). The epidermis is primarily composed of keratinocytes that undergo rapid turnover, while the dermis contains dense layers of connective tissue.
Skin: Structure and Functions scrapings in Leishman’s stain
Giardia Giardia A genus of flagellate intestinal eukaryotes parasitic in various vertebrates, including humans. Characteristics include the presence of four pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. Nitroimidazoles | Leishmania | Trypanosoma | Trichomonas Trichomonas A genus of parasitic flagellate eukaryotes distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. Nitroimidazoles | |
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ELISA ELISA An immunoassay utilizing an antibody labeled with an enzyme marker such as horseradish peroxidase. While either the enzyme or the antibody is bound to an immunosorbent substrate, they both retain their biologic activity; the change in enzyme activity as a result of the enzyme-antibody-antigen reaction is proportional to the concentration of the antigen and can be measured spectrophotometrically or with the naked eye. Many variations of the method have been developed. St. Louis Encephalitis Virus: enzyme-linked immunosorbent assay
DFA: direct immunofluorescence assay
NAAT: nucleic acid amplification Nucleic acid amplification Laboratory techniques that involve the in-vitro synthesis of many copies of DNA or RNA from one original template. Septic Arthritis assay
PCR PCR Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR): polymerase chain reaction Polymerase chain reaction Polymerase chain reaction (PCR) is a technique that amplifies DNA fragments exponentially for analysis. The process is highly specific, allowing for the targeting of specific genomic sequences, even with minuscule sample amounts. The PCR cycles multiple times through 3 phases: denaturation of the template DNA, annealing of a specific primer to the individual DNA strands, and synthesis/elongation of new DNA molecules. Polymerase Chain Reaction (PCR)
Blood smear Blood smear Myeloperoxidase Deficiency demonstrating Trypanosoma trypomastigotes Trypomastigotes Trypanosoma brucei/African trypanosomiasis
Image: “ Ms MS Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease that leads to demyelination of the nerves in the CNS. Young women are more predominantly affected by this most common demyelinating condition. Multiple Sclerosis. Michaels forms” by CDC/Dr. Myron G. Schultz. License: Public DomainGiemsa’s stain of Giardia Giardia A genus of flagellate intestinal eukaryotes parasitic in various vertebrates, including humans. Characteristics include the presence of four pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. Nitroimidazoles lamblia trophozoites Trophozoites Cells or feeding stage in the life cycle of sporozoan protozoa. In the malarial parasite, the trophozoite develops from the merozoite and then splits into the schizont. Trophozoites that are left over from cell division can go on to form gametocytes. Amebicides
Image: “ Trophozoites Trophozoites Cells or feeding stage in the life cycle of sporozoan protozoa. In the malarial parasite, the trophozoite develops from the merozoite and then splits into the schizont. Trophozoites that are left over from cell division can go on to form gametocytes. Amebicides of Giardia Giardia A genus of flagellate intestinal eukaryotes parasitic in various vertebrates, including humans. Characteristics include the presence of four pairs of flagella arising from a complicated system of axonemes and cysts that are ellipsoidal to ovoidal in shape. Nitroimidazoles lamblia” by Eva NohĂ˝nková, Department of Tropical Medicine, 1st Faculty of Medicine, Charles University in Prague and Hospital Bulovka, Czech Republic. License: CC BY 4.0Giemsa’s stain of Leishmania promastigotes
Image: “ Giemsa stain Giemsa stain Borrelia” by Arriyadh Community College, King Saud University, P.O. Box 28095, Riyadh 11437, Saudi Arabia. License: CC BY 3.0Microscopic images of Trichomonas Trichomonas A genus of parasitic flagellate eukaryotes distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. Nitroimidazoles vaginalis trophozoites Trophozoites Cells or feeding stage in the life cycle of sporozoan protozoa. In the malarial parasite, the trophozoite develops from the merozoite and then splits into the schizont. Trophozoites that are left over from cell division can go on to form gametocytes. Amebicides
Image: “ Trichomonas Trichomonas A genus of parasitic flagellate eukaryotes distinguished by the presence of four anterior flagella, an undulating membrane, and a trailing flagellum. Nitroimidazoles protozoa Protozoa Nitroimidazoles” by isis325. License: CC BY 2.0.