Leishmaniasis

Question 1

Cause of mucocutaneous Leishmaniasis

Answer 1

L Braziliensis- typically jungle area of Peru

Question 2

Vector for Leishmania from new world?

Answer 2

Lutzomyia sandfly

Question 3

What is disseminated leish?

Answer 3

> 10 lesions in at least 2 body parts typically caused by L Barziliensis. Lesions are acneiform, ulcerative, papular and nodular

Question 4

What is diffuse cutaneous leish? Caused by?

Answer 4

L amazonensis or L mexicana
Diffuse lesions which are extensible nodular and they DO NOT ULCERATE. Negative skin test observed, high number of parasites in skin biopsy

Question 5

Tx of cutaneous vs mucocutaneous leish?

Answer 5

Sodium siboglutamate for 20 days
Extend to 30 if mucosa involvement. Amphotericin B

Question 6

What is the animal reservoir of visceral leish L.infantum/chagasi? vs L Donovani

Answer 6

Dogs (zoonotic)
For L Donovani it is humans (anthroponi)

Question 7

What are the clinical manifestation of VL?

Answer 7

Prolonged irregular fever
Splenomegaly
Hepatomegaly
Lymphadenopathy
Cachexia, pallor
Hyperpigementation- Kala-aazar

Question 8

Where are the different visceral leish species found?

Answer 8

Europe L Infantum
South America L Chagasi
India/Asia L Donovani

Question 9

What are some of the lab findings of VL?

Answer 9

Anaemia/leucopenia/thrombocytopenia
Malnutrition
Symptomatic Anaemia
Superinfections
Peichial rash/bleeding

Question 10

What is the incubation of VL?

Answer 10

2-6 months can be 10 days, but max 2 year
There can be asymptomatic carriers
Primary cutaneous lesions are rare

Question 11

What is post-kala azar dermal leish?

Answer 11

In Africa, get it 0-6 months after kala azar (up to 60% people get it)
In India it is much smaller % of people who get it and presents 1-2 days later
Pale spots and Painless nodules
It is omoe frequently seen with poor treatment adherence

Question 12

How do you tell PKDL from diffuse leish?

Answer 12

Looks very similar
Nodular

Question 13

When do you suspect VL?

Answer 13

Fever > 2 weeks and splenomegaly or weight loss
Pancytopenia and hypergammaglobulinemia

Question 14

Dx of VL?

Answer 14

Lymph node
Bone Marrow
Spleen biopsy is most sensitive

Can do direct agglutination test if this is borderline can confirm with splenic biopsy
RK39 RDT is best for India (L Donovani)

Question 15

Tx of VL? In HIV?

Answer 15

Liposomal Ampho B (can do Miltefosine or pentavalanet antimonials)
In HIV need to give Liposomal Ampho B and Miltefosine, pentamidine to prevent relapse as secondary prophylaxsis