ATLASBLOOD, BONE MARROW, SPLEEN
      AND LIVER PARASITES
      ZOOMASTIGOPHOREA Order: Kinetoplastida

      VISCERAL LEISHMANIASIS

      leis1-ic

      Leishmania sp.: life cycle.


      Geographic distribution of Visceral Leishmaniasis

      don2-ic

      Visceral leishmaniasis has a wide geographic distribution.
      North-Eastern China, India, Middle-East, Southern Europe (Mediterranean bassin),
      Northern Africa, Central-East Africa and, in foci, Central and South America
      (especially Brazil and Honduras).

      (Adapted and redrawn from: Lutte contre les leishmanioses.
      Rapport d'un Comité OMS d'experts.
      Série de Rapports techniques, n.793, 1990.)



      Courtesy of Bayer, from Bayer Manual of Pest Control

      don2a-ic

      The infection is transmitted by various species of Phlebotomus, the sand fly.

      Phlebotomus spp.: Courtesy of Bayer,  from Bayer Manual of Pest Control


      don3-ic

      Leishamnia spp. wich affect humans can be differentiated by
      geographical distribution, clinical spectrum, immunological features,
      isoenzymes and Kinetoplast DNA (kDNA) characterization.
      (Leishmania amastigotes, bone marrow aspirate, Giemsa stain).


      By Dr. Marc Lontie By Dr. Marc Lontie

      don4-ic

      		Linfantum_GC05 Linfantum_GC04

      Visceral leishmaniasis (Kala-azar) is caused by parasites
      of the genus Leishmania, subgenus Leishmania, complex donovani
      (donovani, infantum, chagasi species).
      Viscerotropic strains of L.infantum and L.tropica have been described.
      (bone marrow aspirate)

      Linfantum_GC05 and _GC04-ic: Courtesy of Dr. Marc Lontie:
      Director of the laboratory of the Medisch Centrum voor Huisartsen, Maria Theresiastraat 63a; B-3000 Leuven, Belgium.


      don5-ic

      Diagnosis of the infection depends on identification of amastigotes in tissues
      (bone marrow, spleen, liver, limph nodes) or in blood.
      Other organs may be affected, expecially in HIV-1 positive patients
      (intestinal and respiratory tract).
      Amastigotes can be found inside and outside the reticuloendothelial cells.
      They measure 2-5 µm, are oval with a large nucleus (in red), a kinetoplast
      (usually perpendicular, in red to violet) and a pale blue cytoplasm.
      (Bone marrow aspirate).


      don6-ic

      Leishamnia sp.: Cultures (on NNN or Tobie media) of blood or tissues samples
      may permit isolation of the parasite, allowing the subsequent characterisation.
      When introduced in culture the amastigotes transform into promastigotes in 7-21 days.
      (Wet mount preparation).


      By Professor Dianella Savoia

      By Professor Dianella Savoia

      LmayorGFP1-ic

      LmayorGFP2-ic

      L.major: confocal fluorescent microscopy of the GFP gene.


      don7-ic

      Leishamnia sp.: Leishmania promastigotes measure 15-20 by 1.3-3.5 µm
      and have a single flagellum, measuring 15-28 µm.
      Serologic examination (EIA, direct Agglutination, IF, WB) is useful
      in immunocompetent individuals, not ALWAYS in HIV-1 positive patients.


      don8-ic

      Visceral leishmaniasis: liver biopsy can demonstrate the Leishmania amastigotes
      inside the reticuloendothelial cells. The hepatic structure is preserved.


      don9-ic

      Visceral leishmaniasis: liver biopsy at higher magnification with intracellular amastigotes.


      don10-ic

      Visceral leishmaniasis: spleen biopsy is a very high sensitive method of diagnosis
      but it is not widely used because of the risk of hemorrhage.
      Splenic tissue is rich in amastigotes allowing a rapid and sensitive diagnosis.


      don11-ic

      Visceral leishmaniasis: spleen biopsy with intracellular amastigotes.


      BLOOD....LIVER....