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leishmaniasis
A disease of the reticuloendothelial system caused by protozoa of the genus Leishmania.
Epidemiology:
1) transmitted by female sandflies
2) animal reservoir
Laboratory: (also see visceral leishmaniasis)
1) light microscopy for visualization of amastigotes in smears, imprints or biopsies
- amastigotes
- 2-4 um in size
- delicate cytoplasm, a nucleus & a kinetoplast
- may appear smaller due to shrinkage with fixation
- Leishmania have a kinetoplast, but no cell wall
- distingush from Histoplasma capsulatum & Toxoplasma gondii
- different species of Leishmania cannot be distinquished by direct examination
2) growth of promastigotes in culture
a) Novy-MacNeal-Nicolle's medium
b) Schneider's Drosophila media supplemented with fetal calf serum
c) cultures show promastigotes in 2-5 days, but should be held for 4 weeks
3) immunohistochemistry with monoclonal antibodies is species-specific
4) Leishmania serology
5) Leishmania DNA
6) Leishmania rRNA
7) also see specific Leishmania species
Management:
1) sodium stibogluconate
a) available from CDC (404 639-3670)
b) 20 mg Sb[V]/kg IM/IV for 20 days (cutaneous) & 28 days visceral leishmaniasis
2) amphotericin B
3) pentamidine
4) miltefosine (Impavido)
(also see cutaneous, mucocutaneous & visceral leishmaniasis)
Related
Leishmania
Specific
cutaneous leishmaniasis (oriental sore)
mucocutaneous leishmaniasis (espundia)
visceral leishmaniasis (kala-azar)
General
fly/gnat-borne infection
protozoan infection
References
- Clinical Diagnosis & Management by Laboratory Methods,
19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia,
PA. 1996, pg 1266-68
- DeGowin & DeGowin's Diagnostic Examination, 6th edition,
RL DeGowin (ed), McGraw Hill, NY 1994, pg 902-3
- Harrison's Principles of Internal Medicine, 14th ed.
Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1189-93