Fig.

A male patient , aged 65 years old presented with skin nodule with ulcerated
infected apex located in the RT leg. Direct smear & IHAT were negative for
Leishmania ,skin biopsy was made showing very scanty intracellular amastigote
forms of Leishmania.
Fig. A male patient, aged 22 years old, presented with two lesions;
one on the face and the second one at the wrist of his left arm .
Fig. A male patient, aged 19 years old from presented with
large ulcerative lesion on the dorsum of his left hand
A male patient aged 21 years, presented with an old healed cutaneous
Leishmaniasis in his left forearm
 2) Mucutaneous leishmaniasis (Espundia)

Infection will start off as a reaction at the

bite, & can do metastasis into the mucus
membranes & be fatal. (WHO, 1984).
 3) Visceral leishmaniasis

 VL is also known as Kala-azar (Hindi: Kala=

black, azar=sickness).
 The etiological agents belong to the
L.donovani complex, (L.d donovani, L.d
infantum & L.d. archibaldi) in the Old World &
L.d chagasi in the New World.
 VL is often recognized with fever, weight loss,
swelling of the liver & spleen & anaemia
(WHO, 1984).
Methods of
Diagnosis
(a)Direct smear method (Morsy et al,
1981):

 Two smear slides were taken from

each lesion & examined for leishmania
parasites (Amastigotes).

 After removal of the covering scales, a

punch of tissue was taken from the
indurated edge, using a disposable
sterile, medi–point blood lancet.

 Smear were fixed in methyl alcohol for

(b) Skin biopsies (Abdel wahab et al.,
1985):
oSkin biopsies were taken from the
edges of the lesions after sterilization
with 70% ethyl alcohol.

o Local anesthesia with procaine in the

recommended dose was given as
intradermal injection. The biopsed
specimens were fixed, sectioned &
stained.
Fig. Photomicrograph of histopathological section of skin lesion stained
with Giemsa stain showing high number of extracellular leishmania with
few intracellular leishmania inside the microphage (1000X).
(a) Clinical Diagnosis:

oPreliminary diagnosis is based on the

symptoms & clinical signs of VL such as
splenomegaly, hepatomegally & high
undulating fever.

o However these alone are not enough to

differentiate VL from other similar
conditions such as malaria, relapsing
fever, liver abscess & trypanosomiasis.
(b) Laboratory
i- Spleen & :Liver biopsy.
Diagnosis
o Looking for parasites in the spleen &
liver is one of the most accurate
methods available to determine
Leishmanial infections.
o90 % of the active cases show
parasites in splenic & liver aspirates
ii- Marrow & Lymph gland puncture.
(Manson-Bahr, 1987).
o Marrow obtained from sternal or iliac
crest puncture is much safer but a
painful method.
iii- Serological Test.
Serum samples were subjected to:
1- Formal gel (aldehyde) test.
2- Indirect Haemagglutination test
(IHAT).
iv- Culture on NNN (Novy-
MacNeal-Nicolle) Medium.
 Control of
Leishmanias
is
o Due to the diversity of hosts, vectors &
parasites which lead to different
epidermiological features, it has not
been possible to device a universal
control strategy applicable to all foci of
leishmaniasis.

o In epidemics large scale spraying is

required. Spraying should particularly
include animal shelters, inside of
buildings & the immediate surrounding
areas.
o Self protection is important, several
methods are available to avoid being
bitten by sandflies including
repellents such as diethyltoluamide
(DEET) applied to the exposed areas of
the body and clothing.

o Fine mesh screens (less than 16-mesh)

can be applied to doors & windows &
bed nets should be used impregnated
with insecticides such as permethrin &
deltamethrin.

o Mosquito nets are not effective since