SKIN PARASITES
ZOOMASTIGOPHOREA Order: Kinetoplastida

LEISHMANIA (VIANNIA) GR. / L. MEXICANA
(CUTANEOUS NEW WORLD LEISHMANIASIS (N.W.L.) )

LEISHMANIA TROPICA/ L.MAJOR/
L. DONOVANI (infantum) / L.AETHIOPICA
(CUTANEOUS OLD WORLD LEISHMANIASIS (O.W.L.))

leis1-ic

Leishmania sp.: life cycle.

leis2-ic

Cutaneous leishmaniases, geographic distribution:
O.W.L. is found especially in Asia (Middle East),
Northern Africa and Southern Europe.
N.W.L. has a wide distribution in Central and
South America (from Yucatan to Brazil).
The mucocutaneous form is prevalent in South America.

don2a-ic

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

leis3-ic

Leishamnia sp.: wich affect humans can be differentiated by geographical distribution,
clinical spectrum, immunological features, isoenzymes
and Kinetoplast DNA (kDNA) characterization.
The clinical manifestations and the immunological,
isoenzimatic or kDNA Leishmania characterisation frequently overlap.
(Bone marrow aspirate).

leis4-ic	leis19-ic	leis20-ic

Lmex1-ic	Lbras1-ic

Image: leis4-ic Cutaneous leishmaniasis: new-world cutaneous leishmaniasis 
comprises a large spectrum of manifestations (single or limited lesions, 
diffuse cutaneous and mucocutaneous disease).
The host immunological status may modify the clinical feature.
(Skin lesion in a HIV patient).
Agents of the american leishmaniasis belong the genus Leishmania,
subgenus Leishmania, complex mexicana (mexicana, amazonensis, pifanoi)
and subgenus (Viannia) complexes brasiliensis and guyanensis. 

Image: leis19-ic  Brazilian patient with Espundia caused by L.(Viannia) braziliensis 

Image: leis20-ic  A patient with Espundia who also had megacolon caused by T.cruzi

Image: Lmex1-ic  cutaeous ulcer L. mexicana                                                                 

Image: Lbras1-ic  mucocutaneous infection L. braziliensis                                             

   leis5-ic            leis21-ic 

Image: leis5-ic Cutaneous leishmaniasis: old-world cutaneous leishmaniasis
comprises different manifestations:
single or limited lesions, diffuse cutaneous leishmaniasis.
The clinical aspects of the disease may be modified by the immunological status
(visceral forms in HIV positive patients).
Agents of the old-world leishmaniasis belong the genus Leishmania,
subgenus Leishmania, complexes major, tropica, donovani (infantum species),
aethiopica (diffuse form). (Typical oriental sore). 

Image: leis21-ic Lesion caused by L.(L.)major in an Egyptian worker in Saudi Arabia.

leis6-ic

Leishamnia sp.: diagnosis depends on demonstration of amastigotes (2 to 5 µm).
They have an ovoid or round shape and are found in intra- and extracellular position.
(Giemsa stain)

leis7-ic

Leishamnia sp.: the amastigote have an ovoid or round shape with a large nucleus (in red),
a kinetoplast (red to violet) and a cytoplasm (pale blue) when stained with Giemsa.

leis8-ic

Leishamnia sp.: cultures (on NNN or Tobie media) of skin aspirates or biopsies
may permit isolation of the parasite, and the subsequent characterisation.
When introduced in culture the amastigotes transform
into promastigotes in 7-21 days.
(Wet mount preparation).

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

leis9-ic

Leishamnia sp.: leishmania promastigotes measure 15-20 by 1.3-3.5 µm
and have a single flagellum, measuring 15-28 µm.
(Giemsa stain).
Serology does not have a significant role in the diagnosis
of the cutaneous form of the disease.

leis10-ic

Cutaneous leishmaniasis: smears obtained with scraping or
aspirating from the edge of the lesions,
or skin biopsies are the best methods for the diagnosis.
(Skin biopsy, H&E stain).

leis11-ic

Cutaneous leishmaniasis: the histology can demonstrate a wide range of changes:
granuloma formation, necrosis, and a variable inflammatory infiltration.
(Skin biopsy, H&E stain).

leis12-ic

Cutaneous leishmaniasis: within the lesion amastigotes
can be demonstrated inside the macrophages.
(Skin biopsy, H&E stain).

Leis 01-1000x	Leis 02-1000x	Leis 03-1000x	Leis 04-1000x

Cutaneous leishmaniasis: Skin biopsy from Sardinian patient:
intramacrophagic amastigotes; infection was presumably
transmitted by Phlebotomus bite during wild boar hunt.
H&E, 1000x oil immersion, microscope Leica DMLB.