Leishmaniasis

Kala azar (visceral leishmaniasis)
- visceral leishmaniasis is caused by L.donovani
- transmitted by bite of female phlebotomine sandfly
- presented with fever, typically rise twice in 24 hours
- hepatosplenomegaly and lymphadenopathy (organism multiplies in monocytes and macrophages in liver and spleen, bone marrow, lymphoid tissue and small intestine mucosa)
- diagnosis is by demonstrating parasite in stained smears of aspirate of bone marrow, lymph node, spleen or liver.
- pancytopenia, hypoalbuminemia and hypergammaglobulinemia are common.
- treatment: pentavalent antimony salt (sodium stibogluconate)



Cutaneous leishmaniasis
- caused by L.tropica, L.major  or L.mexicana
- following a sandflies bite, leishmania amastigotes multiply in dermal macrophages
- single or multiple painless nodules occurs following bite which enlarge and ulcerate with characteristic erythematous raised border
- Giemsa stain on a split skin smear demonstrate leishmania parasite in 80% cases
- small lesions require no treatment, large lesion can be treated by topical antiparasite agents



Mucocutaneous leishmaniasis
- caused by L.braziliensis
- cutaneous sore are followed months or years later by indurated or ulcerating lesions affecting mucosa or cartilage, typically on lips or nose (espundia)
- treatment: amphotericin B