LEISHMANIASIS

Leishmaniasis
Leishmania donovani (complex) (VL)
Leishmania tropica (CL)
Leishmania major (CL)
Leishmania aethiopica (CL)
Leishmania mexicana (Complex) (CL)
Leishmania brazilliensis (complex) (MCL)
Leishmania peruriana

The Parasite
Phylum
Order
Family
Genus

Sarcomastigophora
Kinetoplastida
Trypanosomatidae
Leishmania

Morfologi
Digenetic Life Cycle

Promasitogte
Insect
Motile
Midgut

Amastigote
Mammalian stage
Non-motile
Intracellular

Morfologi
Promastigote
Flagella
Kinetoplast

Amastigote

Golgi
Nucleus
Cytoskeleton

Promastigote

Amastigote

 Amastigotes (*)
Leishmania
donovani pada
sel limpa.
Ukuran
amastigotes
kurang-lebih 1
m

 Amastigotes
Leishmania pada
macrophage
kelenjar limpa
anjing

 Macrophage
yang
mengandung
Leishmania
amastigotes.

Siklus hidup
Manusia terinfeksi Leishmania melalui gigitan
lalat tanah (sand flies / Phlebotomus) yang
membawa promastigote pada anterior gut dan
pharynx.
Promastigote masuk ke sel-sel mononuclear dan
berubah menjadi amastogotes dan berkembang
biak sampai sel pecah. Amastogotes menginfeksi
sel-sel disekitarnya.

Mammalian Hosts

Rodents
Gerbils
Hyraxes
Bats
Porcupines
Opossums

Sloths
Primates
Dogs
Foxes
Anteaters
.....

Sand fly

GAMBARAN KLINIS
Viscera
Fatal (90%
untreated)
Liver
Spleen
Bone marrow

Kulit
Generally Self- healing
Skin
Mucous membranes

SPECTRUM OF DISEASE

Initial Infection

Similar in all species

Inoculation of promastigotes
Inflammation & chemotaxis
Receptor mediated phagocytosis

Promastigote

Amasitgote
Transformation

Penyebaran Parasite
Macrophage lysis & parasite release
Lymphatic spread
Blood spread
Target organs
Skin/lymph nodes/spleen/liver/
bone marrow

Gambaran klinisViseral
Leishmania (VL)
Bervariasi; Inkubasi 3-100+ minggu
Demam ringan
Hepato-splenomegal
Hiperplasi Sumsum tulang (Bone marrow
hyperplasia)
Anemia, Leukopenia & Kahexia
Hypergammaglobulinnemia
Epistaxis , Proteinuria, Hematuria

 visceral leishmaniasis:
splenomegal,
distended abdomen
dan severe muscle
wasting.

 The boy exhibits

splenomegaly and
severe muscle
wasting.

 Jaundiced hands of
a visceral
leishmaniasis
patient.

 Enlarged spleen and

liver in an autopsy of
an infant dying of
visceral leishmaniasis.

Post Kala Azar Dermal

Leishmanoid
Umumnya timbul <2 tahun setelah recovery
Recrudescence
Batas pada kulit
Kasus jarang

Cutaneous leishmaniasis
pada wajah

Lesi cutaneous
leishmaniasis

INFEKSI
Sub-clinical or inapparent infection

Recovery
Immune to reinfection
PKDL

Death
Concurrent infection

Diagnosis
Clinical signs & symptoms
Hypergammaglobulinemia
ELISA/Formol gel

Bone marrow biopsy

Spleen or liver biopsy
Culture & Histology

Pemeriksaan khusus

Similar morphology
Isoenzyme profiles - Zymodemes
Monoclonal antibodies
DNA hybridisation - PCR

Terapi
Perawatan yang baik
Diet
Antibiotik
Pentavalent antimony
Pentamidine

PENGENDALIAN

Pengendalian Vector
Pengendalian Reservoir
Treatment pada kasus aktif
Vaksinasi