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الصحة وزارة

eishmaniasis is a protozoal disease caused by Leishmania parasite, which is transmitted by the sand

fly.

Leishmaniasis is of three types ; cutaneous leishmaniasis, muco-cutaneous and the visceral (Kala-azar )

1

5

4

3

2

6

7

8Sand fly takes a blood meal

)Injects promastigote stage into the tissue (

Promastigotes arePhagocytized bymacrophages

Promastigotes transfer into amastigotes insidemacrophages

Amastigotes multiply in cells)Including macrophages (of

Various tissuesSand fly takes a blood meal

)ingest macrophagesInfected with amastigotes (

Ingestion of Parasitized cell

Amastigotes transform Into promastigote

stage in midgut

Divide in midgut and migrate to proboscis

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d

i

d

Infective stage

Diagnostic stage

Sand fly bite

Others (nfected blood transfusion and,Pregnancy in (VL) ,physical contact in CL)

Sand Flies are vector of the disease. More than 500 species and subspecies in the world.Of which ,only 35 types are known to transmit the disease,Phlebotomus in OCL,and Lutzomia in NCL.There are more than 21 Leishmanial species .

Leishman test: Intradermal injection of leishmanial antigen causes a delayed

tuberculin type of reaction .

Clinical features.

Smear from the base of the ulcer stained with Wright‘s stain detects round or ovoid parasite in the

cytoplasm of macrophages .

The dogs in the Mediterranean countries

The man in the Middle East

The wild rodents in Asia and Africa

Cutaneous Leishmaniasis Cutaneous Leishmaniasis Visceral Leishmaniasis Visceral Leishmaniasis

>12 Million people infected in 88 countries

>350 Million people are risk

Mucocutaneous LeishmaniasisMucocutaneous Leishmaniasis

Our focus of presentationOur focus of

presentation

Annually,0.5M (VL)80,000 Deaths,1.5M(CL)

•Death, 90% in •Bangladesh, Brazil, India,

Nepal,and in Sudan

*Fever *Hepatosplenomegaly *Weight loss

•Skin ulceration ,•90%Afghanistan•,Syria,Iran,Iraq,Brazil,Peru,•and Saudi Arabia

•Might be fatal. 90%•in Bolivia,• Brazil and Peru

*Skin and mucus membranes affection

It is known in the Kingdom back to 1950.Ministry of Health has established the leishmaniasis unit in the 1980 Under The precautionary medicine to follow-up the disease in the Saudi cities

There are VL and CL.VL caused by L.Donovani LON 42,and the Rattus rattus is the reservoir.2 types of CL(ZCL and ACL)In the Riyadh and Eastern province ,ZCL transmitted by P.Papatasi and caused by L.Major LON4

CL in Southern region is ACL transmitted by P.Sergenti and caused by L.Tropica LON 72

There are 20 types of Sand Flies in the KSA.7 are Phlebotomous and 13 are of Sergentomyia type.

Riyadh

Northern

Al-joufTabouk

Medina

Makkah

Baha

Aseer

Jazan

EasternNajran

Affected area

utaneous leishmaniasis has many local names

The peak of cutaneous leishmaniasis is in August, October, December, January and February. The least number of cases are

reported in May and June .

Riyadh

Qaseem

Northern

Al-jouf

Hail

Tabouk

Medina

Makkah

Baha

Aseer

Jazan

EasternNajran

Alhsa only 41.2 %

7.6 %

8.4 %

18.2 %

9.6 %

Riyadh

Qaseem

Northern

Al-jouf

Hail

Tabouk

Medina

Makkah

Baha

Aseer

Jazan

EasternNajran

Alhsa 20.9%

18.5 %

9.1 %

26.6%

4.1 %

4.1 %

Leishmaniasis usually affects children more than other age groups .

Mucosal Hyperkeratotic

Nodules Lymphangitis after Pentostam treatment

ErysipeloidPlaqueRecidivans

Lupoid/Disseminated