Page 44 - Medical Parasitology_ A Textbook ( PDFDrive )

36 5 Hemoflagellates

Distribution

Leishmania tropica and L. major are found in Middle East, India, Afghanistan, eastern
Mediterranean countries and North Africa. L. aethiopica occurs in Ethiopia and
Kenya.

Habitat

In human, the amastigotes are found in the skin.

Morphology

Morphology of amastigote and promastigote of L. tropica complex is indistinguish-
able from that of L. donovani. The amastigotes are present in the skin, within large
mononuclear cells and neutrophils.

Life Cycle

The life cycle of L. tropica complex is similar to that of L. donovani. Incubation
period varies from 2 to 8 months. Modes of transmission is via bite of sandflies from
human to human or animal to human by direct inoculation of amastigotes.

Pathogenesis and Clinical Features

Early lesions are papular, followed by ulceration necrosis. Papule and ulcer are the
main pathological lesions. Amastigotes are found in histiocytes. There is an inflam-
matory granulomatous reaction with infiltration of lymphocytes and plasma cells.
They heal over months to years, leaving scars. The anthroponotic urban type causes
painless dry ulcerating lesions (oriental sore or Delhi boil) caused by L. tropica. The
zoonotic rural type causes moist ulcers which are inflamed, often multiple, caused by
L. major. Lesions due to L. major heal more rapidly than L. tropica. The non-
ulcerative and often diffuse lesions caused by L. aethiopica is known as diffuse cuta-
neous leishmaniasis.

Diagnosis

1. Microscopic examination
Smear made from the indurated edge of nodule or sore and stained by Giemsa
or Leishman stains to detect amastigotes.
2. Culture
Culture of the aspirated material in NNN medium.