Leishmania spp

3 species of Leishmania parasitize in human body. They are Leishnania

donovani, Leishmania tropica, Leishmania braziliensis.
1. Leishmania tropica
It causes cutaneous leishmaniasis ( Oriental sore ), this disease is
prevalent in frica, central and south merica, !estern and southern sia,
but not in "hina. #o$s or rodents are reservoir hosts. The vectors are sand
fly or stable fly ( stomo%ys calcitrans, may be mechanical transmission ).
The sore ruptures to form the ulcer. "ontact infection is possible also. The
course of disease lasts one year.
2. Leishmania braziliensis
Leishmania braziliensis causes mucocutaneous leishmaniasis
(espundia ). It is found in mid and southern merica, but not in "hina. #o$s,
cats and horse are reservoir hosts. The vector is sandfly. &esides cutaneous
lesion the parasites lead to mucosa lesion in the nose, mouth and pharyn%.
The ulcers ta'e place in the dama$ed portion. The course is about ()1*
months.
3.
Leishmania donovani
Leishmania donovani causes visceral leishmaniasis ( +ala azar ). +ala
azar is an India name, meanin$ , blac' fever -( dar'enin$ of the s'in ). It is
one of the five ma.or parasitic diseases in "hina. Its clinical manifestations
are irre$ular fever for lon$ period, massive hypertrophy of spleen and liver,
anemia, bleedin$, The ratio of albumin to $lobulin is inverted ( /01123, but
re$ular ratio is 1.*)321 ). The mortality is about 4*5 !ithout treatment. This
disease !as prevalent in 1( provinces, cities and autonomous re$ion. There
!ere (66 thousands patients in "hina in 1474, 366 thousands patients in
8handon$. 8handon$, 9ian$su, nhui, :unan, :ubei, 8han%i, 0ansu,
;in.ian$ !ere heavily infected districts. &ut it has been basically eliminated
from "hina since 14*< ( the incidence is less 15 in endemic areas ).
I. =orpholo$y
1. masti$ote sta$e ( Leishmania form or L. #. body )2 Oval in shape, 3)
3 micrometers in size, has one nucleus and one 'inetoplast, a basal
body and a rhizoplast. It live in the mononuclear macrophan$ocytosis
system. It is patho$enic sta$e.
3. >romasti$ote (Leptomand form )2 17)36 % 3

m in size, fusiform in
shape. It has one nucleus central in position, a fla$ellum comes from
the basal body, !hich is .ust as lon$ as its body len$th. >romasti$ote
is found in the di$estive tract of sand fly. It is infective sta$e.
II. Life cycle
1. In the mammalian host2 s female sand fly suc'in$ blood, the
infective sta$e, promasti$otes, invade the !ound and are en$ulfed by
mononuclear macropha$ocytes, in !hich they multiply by binary
fission, until the host cell is destroyed, !hereupon ne! macropha$e
cells are parasitized. The mammals are considered as the hosts.
3. In the di$estive tract of sand fly2 s female sand fly suc'in$ blood of
a patient, it $ets infection. In its intestine, macropha$cyte is di$ested
and amasti$otes become promasti$otes and then multiply by binary
fission. 8even days later, as the sand fly suc'in$ blood a$ain, the
final host is infected by the in.ection of sand fly?s proboscis.
III. Symptomatology and Pathology
@isceral leishmaniasis is due to the mononuclear macropha$ocytosis system
is parasized by the parasite. The onset of the disease is $radual, and the
incubation period may vary from 3 !ee's to 1< month ( usually3)7 month).
The mortality rate in untreated cases is about 4*5, and spontaneous
recovery from the diseases is rare, but survivors and cured cases usually
have lastin$ immunity.
"linical manifestation and patho$enic mechanism2 see also the dia$ram of
patho$enic mechanism of visceral leishmaniasis.
1. Irre$ular fever for lon$ period is due to the bro'en piece from parasitized
tissue.
3. =assive hypertrophy of spleen and liver are caused by the proliferation
of mononuclear macropha$ocytosis system.
3. &ecause bone marro! is involved and spleen is hyperfunction, anemia
ta'e place. The number of red blood cells( A&"s), !hite blood cells
(B&") and platelet all decrease.
7. &leedin$ results from the decrease in blood platelets.
*. The decrease of liver function and the proliferation of plasma cells brin$
about the ratio of albumin to $lobulin is inverted (201123, re$ularly,
2011.*)321 ).
In advanced sta$e, the patients may be emaciation !ith ascites, dar'ened
s'in, fever, bleedin$ of the $ums, the decrease in immunity. #ie of
infective complication ( noma, pnuemonia) and bleedin$.
(. >ast 'ala arza dermal leishmaniasis
It is usually seen in Indian, 8udan, occasionally in "hina, and
$enerally occur in 1)3 years after curin$ visceral leishmaniasis, there are
pi$mented areas in the s'in, occasionally depi$mented areas present in
"hinese patients? s'in, follo!in$ nodule formation in !hich L.#.bodies
can be detected. Be must pay attention to distin$uishin$ from leprosy.
Diagram of Pathogenic Mechanism of Visceral Leishmaniasis
L.#. bodies live in mononuclear mcropha$ocytosis system
>roliferation and destruction of m. m. p. system

(3) Hypertrophy of &one marro! &ro'en piece
liver, lymph node, spleen is destrained
Liver cells 8pleen
destruction hyperfunction Ceverin$ material
>lasma cells
proliferation

lbumin #estroy B&", "entral nervous system
decrease A&" and platelet
0lobulin
increase !" #nemia $"%ever for a long time
&"'leeding
(*) (he ratio of alb)min to glob)lin
is inverted#*+,$*2,
reg)larly, #*+,2*$"
Dmaciation !ith ascites, dar'ened s'in, fever, bleedin$ of the $ums,
immunity decrease. #ie of infective complications( noma, >neumonia)
I@. Diagnosis
In endemic area, clinical manifestations may lead to a presumptive
dia$nosis, but the confirmative dia$nosis depends on demonstration of
amasti$otes ( L.#. body ) in direct smear or promasti$otes in 3E medium
!hich cultures the parasites from the liver, spleen, bone marro! and lymph
node puncture. The bone marro! puncture is usually used because it is safe
for the patients. The lymph node puncture is used as evaluation to curative
effect. Immunolo$ical tests can be used ( !ater test, complement fi%ation
test, DLI8.).
I@. Treatment
ntimony sidium $luconate ( pentavalent ) is very effective to the parasites
and is administered intravenously or intramuscularly. >entamidine is useful
to the parasites !ith resistance to the pentavalent.
@. -pidemiology
This disease is a zoonosis. Transmittin$ cycle2
=an =an
nimal nimal
1. 0eo$raphic distribution2 There are 3 ma.or endemic areas in the !orld.
(1) The India, !here infection is found amon$ adults, especially youn$
adults. The infection is from man to man !ithout reservoir host.
(3) The =editerranean re$ion central sia !here infection occurs chiefly in
infants. #o$ is the reservoir host.
(3) "hina, In "hina there are three endemic areas.
. =an to man form ( >lain form )2 is chiefly prevalent in urban and
rural areas, amon$ youn$ adults. The vector is >hlebotomus
chinensis, such as 8handon$, 9ian$su etc.
&. #o$ to man form2 is chiefly prevalent in rural mountain, amon$
infants. #o$ is reservoir host. The do$ that suffers from 'ala azar is
called man$y do$. &ecause the s'in lesion of the do$ is obvious,
!here there are $reat deal of L.#F bodies, do$ serves as an infectve
source, it is more important than man does. The vector is
>hlebotomus chinensis.
". Eatural foci form (animal to animal form )2 is prevalent in desert
areas, usually transmittin$ bet!een !ild rodents ( such as =eriones
un$uiculatus ). It is natural foci disease, can be transmitted to man by
>hlebotomus lon$iductus or >. ma.or !ui. Dndemic area are
;in.ian$, 0ansu.
@I. Prevention
Treat all the patients !ith chemotherapy2 control sand flies by
sprayin$ insecticide and climate the breedin$ place of sand flies. The 'ey
of controllin$ 'ala azar is eradicatin$ sand fly.
8and flies are easily controlled, because of the follo!in$ reasons2
1. The breedin$ places of sand fly are limited.
3. The life cycle is lon$, more than 3 months.
3. The reproductive ability is !ea', there are t!o $enerations at
the most a year.
7. The fli$ht ability is feeble, active ran$e is limited.
*. They have susceptibility to insecticides.

Hemoflagellates
ll $enera of the blood and tissue fla$ellates belon$ to the family
Trypanosomatidea. 8i% distinct morpholo$ic types, each representin$ a
$enus, have been identified in this family. Of these, four are pf medical
si$nificance. The amasti$ote (leishmanial form) is a small, round or oval
body !ithout a fa$ellum but containin$ a nucleus and 'inetoplast. The
promasti$ote (leptomonal form) is elon$ated and slender !ith !ith a free
fla$ellaum e%tendin$ from a%oneme. The 'inetoplast is near the anterior end
of the or$anism. The epimasti$ote (crithidial form) is some!hat li'e the
promasti$ote in body form but less slender and is characterized by the
shiftin$ of 'inetoplast to a position anterior to the nucleus and the
development of an undulatin$ membrane !hich at the e%treme anterior
becomes the free fla$ellum. The trypomasti$ote (trypanosomal form) is
characterized by a shift of the 'inetoplast to a posteror position !ith an
undulatin$ membrane e%tendin$ the full len$th of the body. free fla$ellum
may or may not be present.
T!o $enera, Leishmania and Trypanosoma are of medical importance. The
species of medical si$nificance are as follo!2
Leishmania Tropica
Leishmania braziliensis
Leishmania donovani
Trypanosoma cruzi
Trypanosoma $ambiense
Trypanosoma rhodesiense
Trypanosoma cruzi
Trypanosoma cruzi cause merica trypanosomiasis or ,"ha$as- diasease.
"onfined to the !estern hemisphere, found chiefly in =e%ico, "entral
mericah merica. @arious species of triatomid bu$s, or 'issin$ bu$s, are
the vectors or arthropod hosts. #o$s, cats, and other animals may serve as
reservoir hosts.
Trypanosoma $ambiense
Trypanosoma $ambiense produce 0ambian trypanosomiasis or =id) and
Best frican sleepin$ sic'ness. The endemic home of T. $ambiense is the
tropical heart of frica. #urin$ the early or febrile sta$e of sleepin$
sic'ness. T. $ambiense occurs in the blood and lymph nodes, !hile after
development of cerebral symptoms, it is primarily found in cerebrospinal
fluid. It does not invade or live !ithin tissue cells but inhabitsconnective
tissue spaces of the various or$ans and the reticular tissue of the lymph
nodes and spleen, the intracellular spaces in the brain, and is present in the
lar$e numbers in the lymph channels throu$hout the body.
Transmission of T. $ambiense from man to man typically occurs throu$h
the bites of 0lossina (Testes) flies after a cycle of development !ithin the
insects. &oth male and female flies bite man and may serve as vectors.
There is no proof that any of the $ame animals of frica act as reservoir of
in fection for man, even thou$h various species of antelopes may be
e%perimentally infectedG but domestic animals, particularly cattle, pi$ and
$oats, carry this infection for lon$ periods of time !ithout apparent
symptoms.
The symptoms of dia$nostic importance early sta$es of sleepin$ sic'ness
are irre$ular attac's of fever, enlar$ement of lymph nodes, especially those
of the posterior trian$le of the nec', erythematous s'in eruptions and
delayed sensation to pain. The dia$nosis of infection !ith T. $ambiense is
based on the characteristic symptoms, history of livin$ or havin$ lived in an
endemic area, and is established by demonstration of the parasite
successively in blood, lymph nodes .uice, sternal bone marro! or
cerebrospinal fluid. Darly dia$nosis is essential since early treatment most
successful.
There t!o forms of human treypanosomiasis in frica2 one caused by T.
$ambiense havin$ a much lon$er, milder, chronoc course and endin$ fatally
!ith central nervous system involvement after several years duration and the
other caused by T. $ambiense, havin$ a short course and endin$ fatally
!ithin a year.
Trypanosoma rhodesiense
T. rhodesiense produce Ahodesian trypanosomiasis or Dast frican sleepin$
sic'ness. This tranpanosome is the cause of a disease !hich typically runs a
rapidly fatal course, often endin$ in death before the development of the
nervous symptoms so typical of T. rhodesiense infections.
The morpholo$y of T. rhodesiense both in man and in the transmittin$ flies
is identical !ith that of T. $ambiense. T. rhodesiense inhabits the blood,
lymph nodes,cerebrospinal fluid, and tissues of man and is present in the
blood of cattle and various of antelope. It alsolives and and multiplies !ithin
the intestinal tract, salivary duct and $lands of flies belon$in$ to the $enus
0lossina.
=edical Dntomolo$y (rthropodolo$y)
There are more than one million species in the animal 'in$dom. The
number of >hylum AT:AO>O# constitute the lar$est assembla$e in in
the animal 'in$dom. =ore than <65 of all animal species belon$ to the
>hylum AT:AO>O#. There are aHuatic, terrestrial and aerial.
The athropods are so common that everyone has had some e%perience
!ith them. Cor e%ample, you must have been bitten by mosHuitoes many
times since you !ere born.
rthropods play an important role in human health and !elfare, both
beneficial and destructive2 honey bees produce honey and pollinate flo!ers
(fruits). They also serve as food source for other animals. They are very
important in the food chain in the animal 'in$dom. 8ome of them are plant
pests. Locusts destroy crops. 8ome of arthropods are parasites of man and
animals, intermediate hosts of human and animal parasites and vectors of
diseases. =edical entomolo$y deals only !ith those arthropods of medical
importance. rthropoda are hi$hly or$anized invertebrates. "haracteristics
of the >hylum rthropoda (adult)2
9ointed or articulated appenda$es (arran$ed in pairs)
chitinized e%os'eleton.
:emocele) !ith hemolymph in an open circulatory system.
8e%es are separate
&ilateral symmetry
Life cycle2 the life cycle of arthropods is divided into t!o main types2 1)
complete metamorphosis (holometabola))e$$)larva (several sta$es)) pupa I
adultG 3) incomplete metamorphosis (hemimetabola))e$$(larva)) nymph
(several sta$es)) adult.
"lassification2 there five classes of medical importance is the phylum
arthropoda2
"lass Insecta (:e%apoda)) flies and mosHuitoes.
"lass arachnida) spiders, scorpins, tic's, and mites.
"lass Ducrustacea)crabs crayfishes, shrimp.
"lass chilopoda)centipedes.
"lass pentastomida (ton$ue !orms) I parasites of vertebrates and
occasionally of man. dults lives in respiratory tract and larva in tissue.
:armful effects of arthropods
1. #irect harm
a. nnoyance)flies interfere !ith your !or' and rest.
b. @enom)stin$s of scorpions and spiders may even cause death.
c. >arasites)pentastomida are parasites of reptiles, birds, mammals, and
sometimes men. Cly larvae may cause myiasis. 8cabies and man$e are cause
by 8arcoptes scabiei.
Transmission of diseases
=echanica' transmission. Clies may transmit typhoid bacillus, protozoan
cysts and ascaris e$$s mechanically.
&iolo$ical transmission. >atho$ens spend a part of their lift cycle in the
arthropods.
(1) >ropa$ative)arthropods act li'e culture media for the patho$ens. Jersinia
pestis multiply in fleas.
(3) "yclopropa$ative) the patho$enic or$anisms under$o a developmental
cycle in the arthropod !ith multiplication and chan$e in form. >lasmodium
sp. in anopheline mosHuitoes.
(3) "yclodevelopmental) the patho$ens under$o a chan$e in form in the
arthropod !ithout multiplication. Cilaria in mosHuitoes.
The arthropods involved in both cyclopropa$ative and cyclodevelopmental
transmission are hosts of the patho$ens. Bithout these arthropoda, the
patho$ens !ill die.
Transovarian) some of the arthropods ta'e only one blood meal in their
!hole life cycle. The transmission of the disease is accomplished
transovarially. That is, the first $eneration $ets the infection and the second
$eneration spreads the disease. D%. 9apenese river fever, a ric'ettsial in
fection.
"ontrol2 the control of arthropods is complicated procedure. It must combine
several methods2
1. Aeconstruction of environment so that the environment is not fit for their
$ro!th.
3. =echanical)steamin$, net (screenin$).
3. "hemical) =ost insecticides !ill 'ill both harmful and beneficial insects.
There many side effects)poisonous to animals and men, food contamination,
environmental pollution, etc.
7. &iolo$ical I includes natural enemies, hereditary measures (se%ual
interference) etc.