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PARASITOLOGY > MIDTERM: LEISHMANIA > Flashcards

MIDTERM: LEISHMANIA Flashcards

1
Q

Leishmania spp. 4 MAIN COMPLEXES

A

o Leishmania braziliensis complex
o Leishmania donovani complex
o Leishmania mexicana complex
o Leishmania tropica complex

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2
Q

Leishmania braziliensis complex

A

o Leishmania braziliensis
o Leishmania panamensis
o Leishmania peruviana
o Leishmania guyanensis

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3
Q

Leishmania donovani Complex

A

o Leishmania donovani
o Leishmania infantum
o Leishmania chagasi

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4
Q

Leishmania mexicana Complex

A

o Leishmania mexicana
o Leishmania amazonensis
o Leishmania venezuelensis
o Leishmania pifanoi
o Leishmania garnhami

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5
Q

Leishmania tropica Complex

A

o Leishmania aethiopica
o Leishmania major
o Leishmania tropica

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6
Q

Old world Leishmania:

A
  • L. tropica (Asia and Eastern)
  • L. aethiopica (Africa)
  • L. major
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7
Q

New world Leishmania:

A

 L. Mexicana
 L. amazonensis
 L. guyanensis
 L. braziliensis
 L. chagasi

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8
Q

Causative agent of LEISHMANIASIS

A

Leishmania spp.

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9
Q

a general term used to describe diseases caused by the hemoflagellate genus Leishmania (a diploid protozoa)

A

Leishmaniasis

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10
Q

4 categories of Leishmaniasis:

A

▪ Cutaneous leishmaniasis (CL)
▪ Diffuse cutaneous leishmaniasis (DCL)
▪ Mucocutaneous leishmaniasis (MCL)
▪ Visceral leishmaniasis (VL)

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11
Q

vectors of Leishmania spp.

A

Sandflies of genus (female)

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12
Q

vectors of old world Leishmania spp.

A

Phlebotomus

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13
Q

vectors of new world Leishmania spp.

A

Lutzomyia

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14
Q

Primary reservoir:

A

o Dogs (urban)
o Rodents (urban and rural)

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15
Q

Mode of transmission:

A

o Congenitally
o Bite of sandfly
o Through blood transfusion
o Contamination of bite wounds
o Direct contact with contaminated
specimens

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16
Q

The immune response of the host against
the infection depends on:

A

▪ Leishmania-specific Th1-type CD4+ T-cells
▪ Macrophages
▪ Cytokines

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17
Q

However, other factors such as _________, ___________ and _______________may affect the outcome of infection

A

genetics, nutritional status, environmental factors

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18
Q

Symptoms manifested by leishmaniasis is often
compared to?

A

LEPROSY

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19
Q

Early descriptions of leishmaniasis have been
found as early as the first century A.D., where
they documented the disease in POTTERY FIGURES

A

American Indians

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20
Q

studied the “Delhi boil” in India

A. Cunningham (1885)
B. Henrique Aragao (1922)
C. Gaspar Viana (1911)
D. Leishman (1903)

A

Cunningham (1885)

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21
Q

properly identified the intracellular parasites

A. Cunningham (1885)
B. Henrique Aragao (1922)
C. Gaspar Viana (1911)
D. Leishman (1903)

A

Leishman (1903)

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22
Q

o later identified Leishmania braziliensis

A. Cunningham (1885)
B. Henrique Aragao (1922)
C. Gaspar Viana (1911)
D. Leishman (1903)

A

Gaspar Viana (1911)

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23
Q

identified the insect vector which transmitted the parasite

A. Cunningham (1885)
B. Henrique Aragao (1922)
C. Gaspar Viana (1911)
D. Leishman (1903)

A

Henrique Aragao (1922)

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24
Q

Leishmania spp. is actually divided into_________, differentiated from one another by the location of their development inside the insect vector,
as well as the areas in which they are endemic.

A

2 subgenera

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25
Q

Currently there are about ___ species of Leishmania
which cause clinical manifestations in humans

A

15 SPECIES

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26
Q

Currently there are about 15 species of Leishmania which cause clinical manifestations in humans.
* Historically divided and classified based on their:

A
  • BIOLOGICAL
  • CLINICAL
  • GEOGRAPHIC
  • EPIDEMIOLOGICAL CHARACTERISTICS
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27
Q

infective stage to humans

A

PROMASTIGOTE

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28
Q

INFECTIVE STAGE TO VECTORS (SANDFLY)

A

AMASTIGOTE

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29
Q

DIAGNOSTIC STAGE

A

AMASTIGOTE

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30
Q

Leishmania spp. produce amastigotes intracellularly
in the ________host

A

mammalian

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31
Q

Leishmania spp. produce promastigotes in the
parts of the insect vector (what parts?)

A

o HINDGUT(Viannia subgenus),
o MIDGUT(Viannia and Leishmania subgenera),
and;
o PROBOSCIS (Viannia and Leishmania
subgenera)

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32
Q

Shape: OVOID or ROUNDED
▪ Size: 2 to 3 μm in length
▪ Habitat: Monocytes, Polymorphonuclear Leukocytes, or; Endothelial Cells
▪ Nucleus: Large
▪ Axoneme: arises from the kinetoplast and extends to the anterior tip.

A

AMASTIGOTE

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33
Q

▪ have a SINGLE FREE FLAGELLUM arising from
the kinetoplast at the anterior end.
▪ Size: 15 to 20 μm in length;1.5 to 3.5 μm in width

A

PROMASTIGOTE

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34
Q

It is a NEW WORLD LEISHMANIASIS that is mainly
distributed in the SOUTH AMERICA. Particularly in the RAINFOREST REGIONS, where CHICLE SAP for chewing gum is harvested (associated with the chiclero ulcer)

A

Leishmania braziliensis complex

35
Q

Leishmania braziliensis complex
Commonly associated diseases and conditions:

A

o Mucocutaneous leishmaniasis
o Chiclero ulcer
o Espundia
o Forest yaws
o Pian bois
o Uta

36
Q

Leishmania braziliensis complex
VECTOR?

A

Lutzomyia & Psychodopygus (Sandflies)

37
Q

Leishmania braziliensis complex TARGETS?

A

Reticuloendothelial cells

38
Q

INFECTION SITE OF Leishmania braziliensis complex

A

SKIN AND THE MUCOUS MEMBRANE

39
Q
  • Affects 2-5% of people infected with L. braziliensis, either concurrently or even several years after the resolution of skin lesions.
    o It may be also due to the contiguous spread of cutaneous leishmaniasis caused by L. tropica.
    o Infects the NASAL and ORAL CAVITIES
    o Also called as “Uta” in the Peruvian Andes
    o Starts as skin lesions
     nasal stuffiness, epistaxis, and destruction of the nasal septum (disfiguration called espundia)
  • Incubation period: few weeks – months
A

MUCOCUTANEOUS LEISHMANIASIS (MCL)

40
Q

destruction of the nasal septum

A

Espundia

41
Q

Progression into the pharynx and larynx may threaten the airway passage that may lead to:

A

 Dysphonia (unable to talk)
 Dysphagia (difficulty to eat)
 Aspiration pneumonia

42
Q

_______is strong in cases of MCL, with increased levels of peripheral mononuclear cells in the blood

A

Systemic Th1 response

43
Q

o Causative agent: L. guyanensis
o The principal cause of mucocutaneous leishmaniasis in Guianas, parts of Brazil, and Venezuela.

A

FOREST YAWS (PIAN BOIS)

44
Q

It can be classified as a NEW WORLD or OLD WORLD Leishmaniasis because of its location
* TARGETS: Reticuloendothelial cells
* INFECTION SITE: Visceral organs (internal organs of the body)

A

Leishmania donovani complex

45
Q

VECTORS of Leishmania donovani complex

A

Lutzomyia; Phlebotomus (Sandflies)

46
Q

o MOST SEVERE TYPE
o is a disseminated parasitosis primarily caused by L. donovani complex
o Incubation period: 2-8 months
o Patients are asymptomatic, but symptoms appear if immunocompromised
o Affects the bone marrow, spleen, and liver

A

VISCERAL LEISHMANIASIS (VL)

47
Q

VISCERAL LEISHMANIASIS (VL) also known as the ?

A

kala azar (black fever), or dum dum fever

48
Q

In patients with VL, Leishmania-specific Th1 response is usually _________

A

LOW/ABSENT

49
Q

VISCERAL LEISHMANIASIS (VL) co-infects with HIV
TRUE OR FALSE?

A

TRUE
▪ Visceral leishmaniasis is an important OPPORTUNISTIC INFECTION in AIDS patients.
▪ VL infection ACCELERATES HIV replication
and PROGRESSION to AIDS.

50
Q
  • early stage (may resemble malaria or typhoid fever w/ the development of fever and chills)
    ▪ Twice-daily fever spikes (double quotidian) accompanied by chills
    ▪ Weight loss and emaciation (abnormally thin and weak)

ACUTE OR CHRONIC STAGE?

A

ACUTE STAGE

51
Q
  • late stage
    o Include fever, weakness, loss of appetite, weight loss, hemorrhage, and abdominal enlargement associated with hepatosplenomegaly

ACUTE OR CHRONIC STAGE?

A

CHRONIC STAGE (SUBACUTE)

52
Q

▪ Kidney damage (glomerulonephritis)
▪ Granulomatous areas of skin

A

ADVANCE STAGES

53
Q

 Sequela of visceral leishmaniasis
 Seen in endemic areas
 Manifests as a CUTANEOUS ERUPTION resulting in hypopigmented macules, malar erythema, nodules, and ulcerations
 Manifest a few months to several years after treatment

A

POST – KALA AZAR DERMAL LEISHMANIASIS
(PKDL)

54
Q

consequence of a previous disease or injury

A

sequela

55
Q
  • NEW WORLD
  • PRIMARY VECTORS: Sandfly (Lutzomiya spp.)
    o Identical to that of L. braziliensis and L.
    donovani complex
  • AFFECTS: SKIN
A

Leishmania mexicana complex

56
Q

Common associated disease of Leishmania mexicana complex and condition names:

A

o New World cutaneous leishmaniasis
▪ Also known as Chiclero ulcer and Bay
sore
o Diffuse Cutaneous Leishmaniasis

57
Q

o MOST COMMON FORM of the disease
o Caused by L. tropica, L. major & L. Mexicana
o in case of New World leishmaniasis, it may progress to other forms of leishmaniasis.
o usually characterized by a single pus-containing ulcer, which is generally self-healing
o ORIENTAL BUTTON
o Incubation period: 2 weeks to several months

A

CUTANEOUS LEISHMANIASIS (CL)

58
Q

▪ It is an erythematous papule or nodule, produced at the inoculation site.
▪ papule forms a violaceous ulcer as it enlarges in size. The lesion may heal spontaneously after a few months, leading to a disfiguring scar
▪ may cause pruritis (intense itching).

A

ORIENTAL BUTTON

59
Q

the inability of an individual to mount an adequate immune response

A

ANERGIC

60
Q

o Also called anergic or lepromatous leishmaniasis
o rare in NEW WORLD (rare form)
o LESION: characterized by a localized, non-ulcerating papule, eventually developing numerous
diffuse satellite lesions that affect the face and extremities.

A

DIFFUSE CUTANEOUS LEISHMANIASIS (DCL)

61
Q

DIFFUSE CUTANEOUS LEISHMANIASIS (DCL) may be initially diagnosed as _____________________
- This latter form of cutaneous leishmaniasis
usually occurs when the patient is anergic.

A

LEPROMATOUS LEPROSY

62
Q

the initial lesion appears, ulcerates or disappears and, after a period of months to years, appears in local and distant areas from the bite site with lepromatous appearing lesions.

A

L. pifanoi infections

63
Q

have been known to progress to an incurable diffuse cutaneous form of the disease.

A

L. amazonensis infections

64
Q
  • OLD WORLD
  • VECTOR: Sandfly (Phlebotomus spp.)
  • PRIMARILY ATTACKS: human lymphoid tissue of
    the skin
A

Leishmania tropica complex

65
Q

Leishmania tropica complex
Common associated diseases and condition names:

A

Old World cutaneous leishmaniasis
Also known as:
 Oriental sores
 Delhi boils
 Baghdad boils
 dry or urban cutaneous leishmaniasis

66
Q

o MOST COMMON FORM of the disease
o Caused by L. tropica & L. Mexicana
o One or more pus-containing ulcers that self-heal
o Sometimes self-healing does not occur because of the thick plaques of skin along with multiple lesions/nodules
o Small red papule occurs at bite site often, with
intense itching.
o 2 cm or larger in diameter
o Incubation and appearance vary with subspecies.

A

CUTANEOUS LEISHMANIASIS (CL)

67
Q

DIAGNOSIS OF Leishmania spp.

A
  • MICROSCOPIC DEMONSTRATION
  • GIEMSA AND HEMATOXYLIN-EOSIN STAINS
  • CULTURES
  • NOVY, MACNEAL, AND NICOLLE MEDIUM (NNN)
  • SCHNEIDER’S MEDIUM
  • ANIMAL INOCULATION USING HAMSTERS
  • MONTENEGRO SKIN TEST
  • IMMUNOLOGIC ASSAYS such as ELISA and rk39
    antigen dipstick test
  • FLOW CYTOMETRY & MOLECULAR DIAGNOSTIC MODALITIES
  • Restriction Fragment Length Polymorphism (RFLP)
68
Q

often used in microscopic and histologic samples, and the demonstration of amastigotes confirms the diagnosis of leishmaniasis

A

GIEMSA AND HEMATOXYLIN-EOSIN STAINS

69
Q

are unreliable due to the difficulty of isolating
the parasites, especially in old lesions.

A

CULTURES

70
Q

There are reports of successful primary isolation of the NEW WORLD cutaneous Leishmania using this medium

A

NOVY, MACNEAL, AND NICOLLE MEDIUM (NNN)

71
Q

could detect low intensity of infection.

A

ANIMAL INOCULATION USING HAMSTERS

72
Q

o leishmanin skin test
o used to identify exposure to the parasite.

A

MONTENEGRO SKIN TEST

73
Q

MONTENEGRO SKIN TEST is _____ in cases of CL and MCL

A

POSITIVE

74
Q

MONTENEGRO SKIN TEST is _____ in cases of DCL and kala azar.

A

NEGATIVE

75
Q

have demonstrated HIGH SENSITIVITY and
specificity for VL in certain immunocompetent
patient populations.

A

IMMUNOLOGIC ASSAYS such as ELISA and rk39
antigen dipstick test

76
Q

o Primary pharmacologic treatment
o notably the pentavalent antimonials

A

ANTIMONY COMPOUNDS

77
Q

PENTAVALENT ANTIMONIALS:

A

o Sodium stibogluconate
o n-methyl-glucamine (meglumine)

78
Q

o DRUG OF CHOICE in cases where there is treatment failure with antimonials, or in area where resistance is high
o has a HIGH CURE RATE
o but has side effects
o cost and availability of the drug are significant
limiting factors.

A

INTRAVENOUS AMPHOTERICIN B

79
Q

▪ Lipid-based preparations of the Amphotericin B
▪ highly effective
▪ better tolerated
▪ overall cost-effective drug formulation for cutaneous and visceral leishmaniasis

A

AmBisome

80
Q

o An antineoplastic drug
o Was introduced in 2002 where sodium pentavalent antimony resistance is high in India
o only oral drug currently given to VL patients.

A

MILTEFOSINE

81
Q

o another SECOND-LINE drug for CUTANEOUS as
well as the VISCERAL FORM of the disease
o due to side-effects and the development of drug
resistance, pentamidine use has been limited.

A

PENTAMIDINE

82
Q

shows efficacy for the cutaneous form of
leishmaniasis

A

TOPICAL PAROMOMYCIN

83
Q

drug of choice for treating visceral leishmaniasis

A

Liposomal amphotericin B (Ambisome)

84
Q

effective treatment for infections with L. donovani complex

A

Sodium stibogluconate (Pentosam)

PARASITOLOGY (23 decks)

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