Leishmania

Leishmania

Q. 1

Nasopharyngeal leishmaniasis is caused due to?

 A

Leishmania brazilensis

 B

Leishmania tropica

 C

Leishmania chagasis

 D

Leishmania donovanii

Q. 1

Nasopharyngeal leishmaniasis is caused due to?

 A

Leishmania brazilensis

 B

Leishmania tropica

 C

Leishmania chagasis

 D

Leishmania donovanii

Ans. A

Explanation:

Ans. is `a’ i.e., Leishmania brazilensis

.    Leishmania braziliensis causes mucocutaneous or nasopharyngeal leishmaniasis in Amazonian South America. It is known by many local names. The lesions are slow-growing but extensive (sometimes 5-10 cm). From these sites, migration appears to occur rapidly to the nasopharyngeal or palatine mucosal surfaces, where no further growth may take place for years.


Q. 2

Visceral leishmaniasis –

 A

Caused by L. tropica

 B

Post-leishmaniasis dermatitis is common

 C

Antimonials are useful drugs

 D

All

Q. 2

Visceral leishmaniasis –

 A

Caused by L. tropica

 B

Post-leishmaniasis dermatitis is common

 C

Antimonials are useful drugs

 D

All

Ans. C

Explanation:

Ans. is ‘c’ i.e., Antimonials are useful drugs

Visceral leishmoniasis (kala – azar)

.   Caused by L. donovani

.   Phlebotomus argentipes is responsible for the transmission of visceral leishmaniasis. (Phlobotomus sergenti and papatasi are responsible for the transmission of cutaneous leishmaniasis).

.   Post – kala-azar dermal leishmaniasis develop in 10% of kala-azar patients generally one or two years after completion of antimonial treatment for the original disease.

.   Diagnosis can be made by blood smear. A microscopical examination of a stained blood film may demonstrate amastigote forms of the parasite in the peripheral blood.

Pentavalent antimonial compounds are the first line drugs for treatment of visceral leishmaniasis;

  1. Sodium stibogluconate
  2. Meglumine antimonate

Q. 3

The following are true of kala-azar except ‑

 A

Persistent hypergammaglobulinemia

 B

Pancytopenia

 C

Cancrum oris can occur

 D

Full treatment prevents post kala-azar dermal leishmaniasis

Q. 3

The following are true of kala-azar except ‑

 A

Persistent hypergammaglobulinemia

 B

Pancytopenia

 C

Cancrum oris can occur

 D

Full treatment prevents post kala-azar dermal leishmaniasis

Ans. D

Explanation:

Ans. is ‘d’ i.e., Full treatment prevents post kala azar dermal leishmaniasis

Post kala-azar dermal leishmaniasis

.        Full treatment does not prevent post kala – azar dermal leishmaniasis (PKDL), infact it develops in about 10 percent of kala – azar patients after complete treatment of kala – azar, when the visceral infection disappears but the skin infection persists.

.        The clinical manifestations of PKDL may be of three types

1. Depigmented macules

–           Earliest lesion

–           Trunk and extremities (face less common)

2. Erythmatous patches

–           On nose, cheeks and chin, often having a butterfly distribution (butterfly erythema).

–           Very photosensitive

3. Yellowish pink nodules

Mostly on the face

–     Absence of ulceration of the nodules is a characteristic feature as distinct from oriental sore and espundia. About other options

Option a & b

Laboratory findings in kala azar

  • Pancytopenia ‑

Anemia

Leukopenia (neutropenia, marked eosinopenia, relative lymphocytosis and monocytosis)

Thrombocytopenia

.       Hypergammaglobulinemia (chiefly involving IgG)

.        Hypoalbuminemia

.        Reversed albumin globulin ratio.

Option C

Cancrum oris can occur as a complication of kala – azar especially in patients with severe neutropenia.


Q. 4

Leishmania is cultured in ….. …media‑

 A

Chocolate agar

 B

NNN

 C

Tellurite

 D

Sabourauds

Q. 4

Leishmania is cultured in ….. …media‑

 A

Chocolate agar

 B

NNN

 C

Tellurite

 D

Sabourauds

Ans. B

Explanation:

Ans. is ‘b’ i.e., N.N.N.

.  L. donovani can be cultured in N.N.N. (Novy, Macneal and Nicolle) medium.

.   In N.N.N. medium amastigote form changes into promastigote form.


Q. 5

The most important reservoir of Leishmaniasis in India is –

 A

Dogs

 B

Rodents

 C

Acute visceral leishmaniasis

 D

Cases of post kalaazar dermal leishmaniasis

Q. 5

The most important reservoir of Leishmaniasis in India is –

 A

Dogs

 B

Rodents

 C

Acute visceral leishmaniasis

 D

Cases of post kalaazar dermal leishmaniasis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Acute visceral leishmaniasis


Q. 6

Visceral leishmaniasis causes –

 A

Membranous glomerulonephritis

 B

Mesangio-poliferative glomerulonephritis

 C

Focal segmental glomerulonephritis

 D

Rapidly progressive glomerulonephritis

Q. 6

Visceral leishmaniasis causes –

 A

Membranous glomerulonephritis

 B

Mesangio-poliferative glomerulonephritis

 C

Focal segmental glomerulonephritis

 D

Rapidly progressive glomerulonephritis

Ans. B

Explanation:

Ans. is ‘b’ i.e., Mesangio-proliferative glomerulonephritis

In visceral leishmaniasis, there may be an immune-complex-mediated mesangioproliferative glomerulonephritis and in advanced cases, there may be amyloid deposition.


Q. 7

Which of the following drug is NOT used to treat Leishmaniasis –

 A

Cyclosporine

 B

Ketoconazole

 C

Pentamidine

 D

Amphotericin B

Q. 7

Which of the following drug is NOT used to treat Leishmaniasis –

 A

Cyclosporine

 B

Ketoconazole

 C

Pentamidine

 D

Amphotericin B

Ans. A

Explanation:

Ans. is ‘a’ i.e., Cyclosporine

Drugs used for Leishmaniasis (Kala azar) – Sodium stibogluconate (DOC), Pentamidine, Amphotericin B, Ketoconazole, Miltefosine, Paromomycin, Allopurinol.


Q. 8

20 year old male from Jaipur with erythermatous lesion on cheek with central crusting likely diagnosis is:

 A

SLE

 B

Lupus Vulgaris

 C

Chillblain

 D

Cutaneous Leishmaniasis

Q. 8

20 year old male from Jaipur with erythermatous lesion on cheek with central crusting likely diagnosis is:

 A

SLE

 B

Lupus Vulgaris

 C

Chillblain

 D

Cutaneous Leishmaniasis

Ans. D

Explanation:

D i.e. Cutaneous Leishmaniasis

Cutaneous Leishmaniasis                 

Chillblains      

Lupus Vulgaris            

                 SLE

– Found in North Africa, South America,

– Occur in damp

– Slowly progressive

– More common in

North West RajasthanQ

cold

single, erythematous

femalesQ

– After incubation pd. of 2 months, a

– Mostly affects

irregularly indurated

– M.C. involve area

boil appears on exposed site (Baghdad

finger toesQ

plaque which may

exposed to sunlight i.e.

BoilQ); which breaks down to produce

– Dusky red or

ulcerate in some areas

involvement of bridge of

ulcer (oriental soreQ), which heals

mauve swelling

– Healing with scar

nose cheecks is a

spontaneously in few months

may be painful

formation in some areas &

characteristic featureQ

–   Characterstic lesion has central

itchy

progression in other areas

– Associated with

depression, crusting surrounded by

 

– Slowly increases in size

involvement of other

raised indurated borderQ

 

over one, two or three

decadesQ

organ systemQ



Q. 9

All of the following helps in the diagnosis of leishmaniasis except:         

September 2008

 A

Aldehyde test

 B

Blood smear

 C

Immobilisation test

 D

Examination of the bone marrow

Q. 9

All of the following helps in the diagnosis of leishmaniasis except:         

September 2008

 A

Aldehyde test

 B

Blood smear

 C

Immobilisation test

 D

Examination of the bone marrow

Ans. C

Explanation:

Ans. C: Immobilisation test

There are several tests to diagnose Kala-azar like serological tests, demonstration of Leishmania, aldehyde test, Leishmanin test and supportive hematological tests. The only way to confirm the diagnosis of Kala-azar is demonstration of Leishmania in aspirates of bone marrow, spleen, liver or lymph nodes.

After isolation of Leishmania the parasite should be cultured to confirm the identity of the Leishmania.

The direct visualization of Leishmania amastigotes in peripheral blood smears is an easy method for the diagnosis of symptomatic VL.

Among the serological tests ELISA (enzyme linked immunosrbent assay) is the most popular because it is a simple test to perform after collecting the whole blood in a filter paper and used for diagnosis as well as epidemiological studies.

Other serological tests used for diagnosis of Kala-azar are Direct Agglutination test (DAT), Indirect Fluorescent Antibody test (IFAT) and rk39 dipstick test.

Hematological findings of Kala-azar are progressive leucopenia, low hemoglobin, reverse albumin:globulin ratio, increased ESR (erythrocyte sedimentation rate) and increased IgG.


Q. 10

Promastigote form of Leishmania is found in which part of sandfly:    

March 2005

 A

Lymph node

 B

GIT

 C

Spleen

 D

Bone marrow

Q. 10

Promastigote form of Leishmania is found in which part of sandfly:    

March 2005

 A

Lymph node

 B

GIT

 C

Spleen

 D

Bone marrow

Ans. B

Explanation:

Ans. B: GIT


Q. 11

Causative agent for kala-azar/ visceral leishmaniasis:

September 2011

 A

Leishmania donovani

 B

Leishmania tropica

 C

Leishmania braziliensis

 D

None of the above

Q. 11

Causative agent for kala-azar/ visceral leishmaniasis:

September 2011

 A

Leishmania donovani

 B

Leishmania tropica

 C

Leishmania braziliensis

 D

None of the above

Ans. A

Explanation:

Ans. A: Leishmani Donovani

Leishmania donovani is the causative agent of kala-azar (VL)

Visceral leishmaniasis/ VL/ kala-azar/ black fever/ Dumdum fever

  • It is the most severe form of leishmaniasis.
  • Leishmaniasis is a disease caused by protozoan parasites of the Leishmania genus.
  • This disease is the second-largest parasitic killer in the world (after malaria)
  • The parasite migrates to the internal organs such as liver, spleen (hence ‘visceral’) and bone marrow
  • Several species of Leishmania are known to give rise to the visceral form of the disease.
  • The “Old World” (Africa, Asia, Europe) species are L. donovani and L. infantum and the “New World” (South America) species is L. chagasi.

Life-cycle of the parasite

  • Visceral leishmaniasis (Kala-azar) is spread through an insect vector, the sandfly of the Phlebotomus genus in the Old World and the Lutzomyia genus in the New World.
  • Sandflies are tiny creatures, 3-6 millimeters long by 1.5-3 millimeters in diameter, and found in tropical or temperate regions throughout the world.
  • Sandfly larvae grow in warm, moist organic matter, such as old trees, house walls or waste — making them hard to eradicate.
  • The adult female sand fly is a bloodsucker, usually feeding at night on sleeping prey.
  • When the fly bites an animal infected with L. donovani, the pathogen is ingested along with the prey’s blood.
  • At this point the protozoan is in the smaller of its two forms, called an amastigote — round, non-motile, and only three to seven micrometers in diameter.
  • Taken into the stomach of the sandfly, the amastigotes quickly transform into a second L. donovani form, called the promastigote.
  • This form is spindle-shaped, triple the size of the amastigote, and has a single flagellum that allows for motility.The promastigotes live extracellularly in the sandfly’s alimentary canal, reproducing asexually, then migrate to the proximal end of the gut where they become poised for a regurgitational transmission.
  • This is their means of transmission back into a mammalian host, as the fly injects its saliva into prey when it bites.
  • The promastigotes are introduced locally at the bite site along with the fly’s saliva.
  • Once inside the new host, promastigotes invade macrophages.
  • Once inside, they transform back into the smaller amastigote form.
  • As an amastigote, L. donovani can only reproduce intracellularly — and the amastigotes replicate in the most hostile part of the macrophage cell, inside the phagolysosome, whose normal defensive response they are able to prevent. After they have reproduced to a certain extent, the L. donovani lyse their host cell by sheer pressure of mass, but there is some recent speculation that they are able to leave the cell by triggering the exocytosis response of the macrophage. The daughter cell protozoans then migrate through the bloodstream to find new macrophage hosts.
  • In time, L. donovani becomes a systemic infection, spreading to all the host’s organs, particularly the spleen and liver

Q. 12

Mucocutaneous leishmaniasis is caused by

 A

L-braziliensis

 B

L. tropica

 C

L. donovani

 D

L-orientalis

Q. 12

Mucocutaneous leishmaniasis is caused by

 A

L-braziliensis

 B

L. tropica

 C

L. donovani

 D

L-orientalis

Ans. A

Explanation:

Ans. is ‘a’ i.e., L. braziliensis


Q. 13

Amastigote form is seen in‑

 A

Leishmania

 B

Plasmodium

 C

Babesia

 D

Ascaris

Q. 13

Amastigote form is seen in‑

 A

Leishmania

 B

Plasmodium

 C

Babesia

 D

Ascaris

Ans. A

Explanation:

Ans. is ‘a’ i.e., Leishmania

Leshmania are hemoflagellates which occur in two forms :‑

Amastigote (aflagellar stage) : It occurs in RE system (reticuloendothelial system) of vertebrates (Man, dog).

Promastigote (flagellar stage) : It is infective form and occurs in gut of sandfly or in artificial cultures.

Promastigote form is transmitted by sandfly (vector is female sand fly).


Q. 14

A patient suffering from Leishmaniasis presented with the following.What can be the causative agent?

 A

L-braziliensis


 B

L. tropica

 C

L. donovani

 D

L-oriental

Q. 14

A patient suffering from Leishmaniasis presented with the following.What can be the causative agent?

 A

L-braziliensis


 B

L. tropica

 C

L. donovani

 D

L-oriental

Ans. A

Explanation:

Ans. is ‘a’ i.e., L. braziliensis 

Leishmaniasis

Visceral leishmaniasis (Kala azar)     L. donovani o Cutaneous Leishmaniasis

a)       Oriental sore   L. tropica

b)      Mucocutaneous leishmaniasis (Espundia)   L. brasiliensis


Q. 15

The most important type of the disease caused by the parasite which is transmitted by sand fly shown in the picture below in India is ? 

 A

Dogs.

 B

Rodents.

 C

Visceral leishmaniasis.

 D

Cases of post kalaazar dermal leishmaniasis.

Q. 15

The most important type of the disease caused by the parasite which is transmitted by sand fly shown in the picture below in India is ? 

 A

Dogs.

 B

Rodents.

 C

Visceral leishmaniasis.

 D

Cases of post kalaazar dermal leishmaniasis.

Ans. C

Explanation:

Ans:C.) Visceral leishmaniasis.

The parasite shown in the image is Promastigote phase of Leishmania in the culture.

Leishmaniasis

  • It is a disease caused by protozoan parasites of the genus Leishmania and spread by the bite of certain types of sandflies.
  • The disease can present in three main ways: cutaneous, mucocutaneous, or visceral 
  • Visceral leishmaniasis (VL), also known as kala-azar is fatal if left untreated in over 95% of cases. It is characterized by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia. It is highly endemic in the Indian subcontinent and in East Africa. The kala-azar elimination programmes in South-East Asia are making sustained progress towards elimination, and cases are declining in the three major endemic countries: Bangladesh, India and Nepal.
    • In India Leishmania donovani is the only parasite causing this disease.
    • Endemic in eastern States of India namely Bihar, Jharkhand, Uttar Pradesh and West Bengal
  • Cutaneous leishmaniasis (CL) is the most common form of leishmaniasis and causes skin lesions, mainly ulcers, on exposed parts of the body, leaving life-long scars and serious disability. About 95% of CL cases occur in the Americas, the Mediterranean basin, the Middle East and Central Asia. 
  • Mucocutaneous leishmaniasis leads to partial or total destruction of mucous membranes of the nose, mouth and throat. Almost 90% of mucocutaneous leishmaniasis cases occur in Bolivia (the Plurinational State of), Brazil and Peru.
  • Culture:Growth of Promastigotes in days to weeks.Promastigotes are characterized by a flagellum and a kinetoplast anterior to the nucleus. They are the infective stage to humans.

Q. 16

A patient presented with skin ulcers , fever, low red blood cells, and enlarged spleen and liver after the bite of a Sand fly.Culture shows the following picture.Identify the infecting parasite. 

 A

Giardia.

 B

Leishmania.

 C

Trypanosoma.

 D

Plasmodium.

Q. 16

A patient presented with skin ulcers , fever, low red blood cells, and enlarged spleen and liver after the bite of a Sand fly.Culture shows the following picture.Identify the infecting parasite. 

 A

Giardia.

 B

Leishmania.

 C

Trypanosoma.

 D

Plasmodium.

Ans. B

Explanation:

Ans:B.)Leishmania

The parasite shown in the image is Promastigote phase of Leishmania in the culture.

The patient in question is suffering from Visceral Leishmaniasis.

Leishmaniasis

  • It is a disease caused by protozoan parasites of the genus Leishmania and spread by the bite of certain types of sandflies.
  • The disease can present in three main ways: cutaneous, mucocutaneous, or visceral leishmaniasis(Kala azar/Black fever).
  • The cutaneous form presents with skin ulcers, while the mucocutaneous form presents with ulcers of the skin, mouth, and nose, and the visceral form starts with skin ulcers and then later presents with fever, low red blood cells, and enlarged spleen and liver.
  • Microscopic examination:direct visualization of the intracellular Amastigotes (Leishman-Donovan bodies).Amastigotes( formed after the macrophage phagocytizes an infective promastigote) are seen within blood and spleen monocytes or, less commonly, in circulating neutrophils and in aspirated tissue macrophages. They are small, round bodies 2–4 μm in diameter with indistinct cytoplasm, a nucleus, and a small, rod-shaped kinetoplast.
  • Culture:Growth of Promastigotes in days to weeks.Promastigotes are characterized by a flagellum and a kinetoplast anterior to the nucleus. They are the infective stage to humans.

Q. 17

Diagnose the infection based on organism shown in the photograph below ? 

 A

Leishmaniasis.

 B

Amoebiasis.

 C

Giardiasis.

 D

Acanthamoeba.

Q. 17

Diagnose the infection based on organism shown in the photograph below ? 

 A

Leishmaniasis.

 B

Amoebiasis.

 C

Giardiasis.

 D

Acanthamoeba.

Ans. A

Explanation:

Leishmaniasis is a disease caused by an intracellular protozoan parasite (genus Leishmania) transmitted by the bite of a female phlebotomine sandfly. The clinical spectrum of leishmaniasis ranges from a self-resolving cutaneous ulcer to a mutilating mucocutaneous disease and even to a lethal systemic illness. Therapy has long been a challenge in the more severe forms of the disease, and it is made more difficult by the emergence of drug resistance. With the exception of Australia, the Pacific Islands, and Antarctica, the parasites have been identified throughout large portions of the world.


Q. 18

A 40 year old male patient ,residing in Bihar,presented with the following skin lesions as shown in the image.He had a history of a disease with hepatosplenomegaly 2 years before.What is the most probable diagnosis?

 A

Tuberculoid Leprosy

 B

Lepromatous Leprosy

 C

Post Kala Azar Dermal Leishmaniasis

 D

Histoid Hansen’s Disease

Q. 18

A 40 year old male patient ,residing in Bihar,presented with the following skin lesions as shown in the image.He had a history of a disease with hepatosplenomegaly 2 years before.What is the most probable diagnosis?

 A

Tuberculoid Leprosy

 B

Lepromatous Leprosy

 C

Post Kala Azar Dermal Leishmaniasis

 D

Histoid Hansen’s Disease

Ans. C

Explanation:

Ans:C.)Post Kala Azar Dermal Leishmaniasis.

Leishmaniasis

  • It is a disease caused by an intracellular protozoan parasite (genus Leishmania) transmitted by the bite of a female phlebotomine sandfly.
  • Types:
    • Cutaneous leishmaniasis :
      • Localized cutaneous leishmaniasis: Crusted papules or ulcers on exposed skin.
      • Diffuse (disseminated) cutaneous leishmaniasis: Multiple, widespread nontender, nonulcerating cutaneous papules and nodules.
      • Leishmaniasis recidivans: Presents as a recurrence of lesions at the site of apparently healed disease years after the original infection, typically on the face and often involving the cheek; (lesions in the center or periphery of an old healed leishmaniasis scar).
      • Post–kala-azar dermal leishmaniasis: It is mainly seen in Sudan and India where it follows treated VL(Visceral Leishmaniasis) in 50% and 5-10% of cases, respectively.
        • Thus, it is largely restricted to areas where Leishmania donovani is the causative parasite. The interval at which PKDL follows VL is 0-6 months in Sudan and 2-3 years in India.
        • Kala azar is endemic in eastern States of India namely Bihar, Jharkhand, Uttar Pradesh and West Bengal
        • Cutaneous lesions ranges from hypopigmented macules to erythematous papules and from nodules to plaques.
        • Nerve involvement is common in African variety but rare in Indian subcontinent.
    • Mucocutaneous leishmaniasis consists of the relentless destruction of the oropharynx and nose, resulting in extensive midfacial destruction.
    • Visceral and viscerotropic leishmaniasis include the following features:
      • Visceral leishmaniasis (kala-azar): Potentially lethal widespread systemic disease characterized by darkening of the skin as well as the pentad of fever, weight loss, hepatosplenomegaly, pancytopenia, and hypergammaglobulinemia
      • Viscerotropic leishmaniasis: Nonspecific abdominal tenderness; fever, rigors, fatigue, malaise, nonproductive cough, intermittent diarrhea, headache, arthralgias, myalgias, nausea, adenopathy, transient hepatosplenomegaly.
  • Management
    • Sodium stibogluconate ,Liposomal amphotericin B,Oral miltefosine,Intramuscular pentamidine,Orally administered ketoconazole, itraconazole, fluconazole, allopurinol, and dapsone,Topical paromomycin


Leave a Reply

%d bloggers like this:
Malcare WordPress Security