Leishmania%20brasiliensis

1
Leishmania brasiliensis

• Lida Shaygan

2
Background

• Transmitted by female sand fly
• Leads to destruction of mucosa and cartilage
• scarring ,disfigurement, pulmonary aspiration and
  death
• Incubation of 2-8 weeks

3
Historical Accounts

• tablets in library of King Ashurbanipal from the
  7th century BC
• Illustrations in pre- Inca sculptures
• existence in Peru and Ecuador in 1st century AD
• Texts from 15-16th century Inca period and
  Spanish conquests
• referred to as espundia

Statue of King Ashurbanipal
4
Development of Scientific Knowledge

• In 1911, Gaspar Vianna found difference in
  parasites in South America from those in Africa -
  Leishmania brasiliensis
• 1922- new genus named Lutzomyia.
• complex elaborations by Ralph Lainson and
  colleagues.

5
Cultural Practices

• Native Amazonians have lived for over 20,000
  years.
• sharing the hunt and the food they gather
• live in houses made of tree bark / palm leaves
• Sharing key to survival

6
Prevalence

• 50 to 100 cases in US
• 90 of cases found in Brazil, Bolivia, and Peru
• Found in temperate and tropical climates around
  the world.
• (except Australia)
• Afghanistan, Algeria, Brazil, Peru, Iran, Iraq,
  Syria, and Saudi Arabia

7
Historical Movements

• World War II
• Gulf War (1901-1991)
• 697,000 troops
• 19 cases of leishmaniasis and 12 cases of
  visceral
• Soldiers serving in Iraq 2003
• gt600 cases in American soldiers in 2004 alone
• More are expected

8
Effect of Infrastructure

• Extracting timber
• Mining
• Building dams
• Widening areas under cultivation
• Creating new irrigation schemes
• . . . all increase exposure to sand fly vector

9
Anthropogenic Environmental Changes

• rural to urban areas
• fast urbanization worldwide
• Coexistence with HIV
• Spreading as result of rapidly spreading epidemic
  of AIDS
• accelerates onset of AIDS

Countries reporting Leishmania / HIV co-infection
10
Response of Healthcare Community

• diagnosed in travelers, immigrants, military
  personal
• Physicians in US must be alert to diagnosis in
  travelers
• Diagnostic Methods
• Skin Scrape
• Punch Biopsy
• Needle aspiration of tissue fluid
• Immunological tests

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Treatments

• Pentavalent antimony treatment of choice
• Inhibits adenosine triphosphate synthesis
• side effects
• Aching, fatigue, gastrointestinal upset,
  elevation of liver enzyme levels, anemia,
  electrocardiographic abnormalities
• Amphotericin B (Fungizone)
• Pentamidine isethionate (Pentam 300)

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Prevention

• Early case detection
• Vector control (insecticides)
• environmental sanitation
• Reservoir Control
• Toxic plant extracts
• Vaccine development
• fine weave bednets
• More dermatologists in rural areas
• More adequate supply of appropriate drugs

13
References

• http//www.emedicine.com/DERM/topic219.htm
• http//www.ciesin.org/docs/001-613/001-613.html
• http//www.bookrags.com/Leishmaniasis
• www.cdc.gov
• www.who.int/