Infectious Disease Book

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Leishmaniasis

Aka: Leishmaniasis, Leishmania, Kala Azar, Leishmania donovani, Visceral Leishmaniasis
  1. History
    1. First reported in 1903 by both Leishman and Donovan
  2. Epidemiology
    1. Incidence
      1. Worldwide: Up to 2 million new cases per year
      2. United States: Up to 100 cases/year (New World)
    2. Endemic Areas
      1. South-Central Texas
      2. Mexico and Central America
      3. South America (most common source for U.S. traveler)
        1. Most commonly contracted in Peru and Brazil
        2. No cases in Uruguay or Chile
      4. Middle East
      5. Africa
      6. Asia
  3. Pathophysiology
    1. Vector
      1. Transmitted by Sandflies
        1. Old World Genus: Phlebotomus
        2. New World Genus: Lutzomyia
      2. Sandfly is 2 mm long, hairy fly
        1. Not stopped by Mosquito netting
        2. Breeds in manure, rodent holes, leaf debris
    2. Leishmaniasis Parasite
      1. Promastigote (Infectious form)
        1. Motile form of Parasite with anterior flagellum
        2. Develops in sandfly over 10 days
        3. Transmitted to humans via sandfly bite
        4. Macrophages ingest promastigote
        5. Shifts to amastigote form to endure acidic lysosome
      2. Amastigote (Disease causing form)
        1. Non-motile, obligate intracellular Parasite
        2. Diameter up to 7 microns
        3. Results in disease and decreased cellular immunity
        4. Sandfly ingests amastigote form when feeding
  4. Types
    1. Some species cause visceral and Cutaneous Leishmaniasis
    2. Visceral Leishmaniasis (Kala Azar)
      1. Cause
        1. Leishmania donovani
      2. Description
        1. Incubation 3 months
    3. Cutaneous Leishmaniasis
      1. See Cutaneous Leishmaniasis
  5. Symptoms
    1. Irregular Recurrent Fever
    2. Weakness
    3. Sweating
    4. Cough
    5. Nausea or Vomiting
    6. Diarrhea
    7. Weight loss
  6. Signs
    1. Splenomegaly
    2. Hepatomegaly
    3. Lymphadenopathy
  7. Labs
    1. Complete Blood Count
      1. Leukopenia
      2. Anemia
      3. Pancytopenia
    2. Liver Function Tests
      1. Hypoalbuminemia
  8. Diagnosis: Visceral Leishmaniasis
    1. Culture, Biopsy, or buffy coat stain
      1. Skin lesion
      2. Bone Marrow
      3. Lymph node
  9. Complications
    1. Cirrhosis develops in 10% of Visceral Leishmaniasis
    2. Visceral Leishmaniasis is fatal without treatment
  10. Management: Visceral Leishmaniasis
    1. See Cutaneous Leishmaniasis
    2. Sodium Antimony Gluconate
      1. Initial Course
        1. Adult: 10 mg/kg IV/IM qd x20-30 days
        2. Child: 20 mg/kg IV/IM qd x20-30 days
      2. Relapse
        1. Treat for 40-60 days
    3. Resistant Cases
      1. Amphotericin B 0.5 - 1 mg/kg qod for 5-25 weeks
      2. Pentamidine 3-4 mg/kg qod for 5-25 weeks
  11. Resources
    1. Visceral Leishmaniasis
      1. http://www.geocities.com/donovanivl/
  12. Prevention
    1. See Prevention of Vector-borne Infection
    2. Insect Repellant
  13. References
    1. Pearson (1996) Clin Infect Dis 22:1-13 [PubMed]
    2. Tobin (2001) Am Fam Physician 63(2):326-32 [PubMed]

Genus: Leishmania (C0023270)

Definition (MSH) A genus of flagellate protozoa comprising several species that are pathogenic for humans. Organisms of this genus have an amastigote and a promastigote stage in their life cycles. As a result of enzymatic studies this single genus has been divided into two subgenera: Leishmania leishmania and Leishmania viannia. Species within the Leishmania leishmania subgenus include: L. aethiopica, L. arabica, L. donovani, L. enrietti, L. gerbilli, L. hertigi, L. infantum, L. major, L. mexicana, and L. tropica. The following species are those that compose the Leishmania viannia subgenus: L. braziliensis, L. guyanensis, L. lainsoni, L. naiffi, and L. shawi.
Definition (CSP) genus of flagellate protozoa comprising several species that are pathogenic for humans; organisms have an amastigote and a promastigote stage in their life cycles; genus has been divided into two subgenera: Leishmania leishmania and Leishmania viannia.
Concepts Eukaryote (T204)
MSH D007891
SnomedCT 79357004
LNC LP20009-4
English Leishmania, Genus: Leishmania, Leishmanias, leishmania, leishmanias, Leishmania (organism), Leishmania, NOS
Swedish Leishmania
Czech Leishmania, leishmanie, ničivka
Finnish Leishmania
Russian LEISHMANII, ЛЕЙШМАНИИ
Japanese リーシュマニア(リーシュマニア属), リーシュマニア属, リューシュマニア(Viannia属), Leishmania属
Croatian LIŠMENIJE
Polish Leiszmania, Lejszmania, Leishmania
Norwegian Leishmania
Spanish Leishmania (organismo), Leishmania
French Leishmania
German Leishmania
Italian Leishmania
Dutch Leishmania
Portuguese Leishmania
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Leishmaniasis (C0023281)

Definition (MEDLINEPLUS)

Leishmaniasis is a parasitic disease spread by the bite of infected sand flies. There are several different forms of leishmaniasis. The most common are cutaneous and visceral. The cutaneous type causes skin sores. The visceral type affects internal organs such as the spleen, liver, and bone marrow. People with this form usually have fever, weight loss, and an enlarged spleen and liver.

Leishmaniasis is found in parts of about 88 countries. Most of these countries are in the tropics and subtropics. It is possible but very unlikely that you would get this disease in the United States. But you should be aware of it if you are traveling to the Middle East or parts of Central America, South America, Asia, Africa or southern Europe.

Treatment is with medicines that contain antimony, a type of metal, or with strong antibiotics. The best way to prevent the disease is to protect yourself from sand fly bites:

  • Stay indoors from dusk to dawn, when sand flies are the most active
  • Wear long pants and long-sleeved shirts when outside
  • Use insect repellent and bed nets as needed

Centers for Disease Control and Prevention

Definition (MSHCZE) Parazitární onemocnění způsobené prvokem Leishmania, který je přenášen savým hmyzem (komárky). Vyskytuje se v (sub)tropických oblastech. Má formu kožní a viscerální (útrobní), tzv. kala azar – černá nemoc. Tato forma se projevuje výrazným zvětšením jater, sleziny, mízních uzlin, krevními poruchami a šedavým zbarvením kůže. Bez léčby vede k postupnému chátrání až k smrti. Léčená viscerální l. má prognózu lepší, podávají se pentamidin a sloučeniny antimonu, důležitá je symptomatická terapie. Kožní l. se projevuje jako ostře ohraničené, vředovité léze s následným vznikem vtažené jizvy (srov. alepský či orientální vřed, suchý vřed, vlhký vřed). Rozsáhlejší kožní léze jsou u mukokutánní l. způsobené L. braziliensis. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) A parasitic infection caused by protozoa of the genus Leishmania. It is transmitted to humans via the bite of sandflies. There are three main forms of the disease: cutaneous, mucocutaneous, and visceral leishmaniasis. Cutaneous leishmaniasis causes skin ulcers; mucocutaneous leishmaniasis causes destructive lesions of the mucous membranes of the nose, mouth, and throat; visceral leishmaniasis is the most severe form of the disease and is manifested with anemia, weight loss, hepatomegaly and splenomegaly.
Definition (MSH) A disease caused by any of a number of species of protozoa in the genus LEISHMANIA. There are four major clinical types of this infection: cutaneous (Old and New World) (LEISHMANIASIS, CUTANEOUS), diffuse cutaneous (LEISHMANIASIS, DIFFUSE CUTANEOUS), mucocutaneous (LEISHMANIASIS, MUCOCUTANEOUS), and visceral (LEISHMANIASIS, VISCERAL).
Definition (CSP) disease caused by any of a number of species of protozoa in the genus Leishmania; there are four major clinical types of this infection: cutaneous (Old and New World), diffuse cutaneous, mucocutaneous, and visceral; visceral is characterized by fever, chills, vomiting, anemia, hepatosplenomegaly, leukopenia, hypergammaglobulinemia, emaciation, and an earth-gray color of the skin; cutaneous is characterized by development of single or multiple localized lesions on exposed areas of skin that typically ulcerate.
Concepts Disease or Syndrome (T047)
MSH D007896
ICD9 085.9, 085
ICD10 B55, B55.9
SnomedCT 186811002, 187511000, 266206004, 154377009, 80612004
English Leishmaniases, Leishmaniasis NOS, Leishmaniasis, unspecified, [X]Leishmaniasis, unspecified, leishmaniasis, leishmaniasis (diagnosis), Leishmaniasis [Disease/Finding], leishmania infection, leishmaniases, leishmaniosis, leishmania infections, [X]Leishmaniasis, unspecified (disorder), Leishmaniasis NOS (disorder), Leishmania infections, Leishmaniosis, Leishmaniasis (disorder), Leishmania; infection, infection; Leishmania, Leishmaniasis
Italian Infezioni da Leishmania, Leishmaniosi non specificata, Leishmaniosi NAS, Leishmaniosi
Dutch leishmaniasis NAO, leishmaniasis, niet-gespecificeerd, Leishmania; infectie, infectie; Leishmania, Leishmaniasis niet gespecificeerd, Leishmania-infecties, leishmaniasis, Leishmaniasis
French Leishmaniose SAI, Leishmaniose, non précisée, Infections à Leishmanies, Leishmaniose
German Leishmaniase NNB, Leishmanias, unspezifisch, Leishmaniose, nicht naeher bezeichnet, Leishmania-Infektionen, Leishmaniasis, Leishmaniase, Leishmaniose, Leishmaniosis
Portuguese Leishmaníase NE, Leishmania infecciosa, Leishmaniose
Spanish Leishmaniosis NEOM, Leishmaniosis no especificada, leishmaniasis, SAI, leishmaniosis, SAI, [X]leishmaniasis, no especificada, [X]leishmaniasis, no especificada (trastorno), leishmaniasis, SAI (trastorno), [X]leishmaniosis, no especificada (trastorno), [X]leishmaniosis, no especificada, leishmaniasis (trastorno), leishmaniasis, leishmaniosis, SAI (trastorno), leishmaniosis, Infecciones por Leishmania, Leishmaniosis, Leishmaniasis
Japanese リーシュマニア症、詳細不明, リーシュマニア症, リーシュマニア症NOS, リーシュマニア感染, リーシュマニアカンセン, リーシュマニアショウ, リーシュマニアショウNOS, リーシュマニアショウショウサイフメイ
Swedish Leishmania-infektion
Czech leishmanióza, Leishmanióza, blíže neurčená, Leishmaniózy, Leishmanióza, Leishmanióza NOS, leishmaniasis, kala azar
Finnish Leishmaniaasi
Russian LEISHMANIOZ, ЛЕЙШМАНИОЗ
Korean 상세불명의 리슈만편모충증, 리슈만편모충증
Polish Leiszmaniozy, Leishmaniozy, Lejszmaniozy
Hungarian Leishmania fertőzések, Leishmaniasis, Leishmaniasis k.m.n., leishmaniasis, nem meghatározott
Norwegian Leishmaniasis, Not Translated[Leishmaniasis]
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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