LEISHMANIASIS AND GIARDIASIS

 

Hey people today we will talk about leishmaniasis and giardiasis . After the end of this article you will learn about definition of leishmaniasis and giardiasis diagnosis cause treatment and many more about leishmaniasis.

LEISHMANIASIS 

Leishmaniasis are a group of protozoal disease caused by parasite of the genus leshmania, it is transmitted by the bite of female phlebotomine sandfly.

TYPES OF LEISHMANIASIS 

• Visceral leishmaniasis 

• cutaneous leishmaniasis

• mucocutaneous leishmaniasis

• post - kala - Azar dermal leishmaniasis 

Kala - Azar ( visceral leishmaniasis) 

It is a chronic systemic disease caused by intracellular protozoa leishmania donovani and transmitted by the bite of phlebotomine sandfly. It is prevalent in terai area of the Nepal.

Mode of transmission

In nepal, through but of infected female phlebotomine sandflies. 

Incubation period 

Generally 2 months range is 10 days to years .

CLINICAL FEATURES

- onset of gradual with a low grade fever 

- high intermittent fever sometimes double rise of temperature 24 hours 

- weight loss in spite of good appetite 

- progressive emaciation

- anaemia 

- hepatosplenomegaly

- lymphadenopathy

- pigmentation on face hands feet and abdomen 

- cough and diarhhea 

INVESTIGATION 

a) indirect evidence 

      I) blood : leucopenia, anemia thrombocytopenia esr raised

      

      iI) serological test: aldehyde test 

      1ml serum + 1-2 drops of 40% formalin 20 mins. Opacification and jellification (positive).

      This test usually becomes positive 2 to 3 months after onset of the disease and revers to negative 6 months after cure. Therefore this test is good for serveliance but not for diagnosis.

      

      III) direct agglutination test (confirmatory)

      Vi) EILSA

      

b) direct evidence 

      • Demonstration of parasites in stained smears of aspirate of bone marrow.spleen liver and lymph nodes . LD bodies in macrophages or amastogote of parasite.

      • culture of the aspirates promastigate forms.

C) leishmania test 

       • Negative acute phase of kala Azar 

TREATMENT

I) sodium stibogluconate 10mg/kg fro 20days for adult and 20 mg/kg for children IV or IM.

iI) pentamidine isethionate 3mg/kg IV for 10days since this drugs is toxic the patient should be hospitalized while the drug is being administered. 

III) if resources permit : 

      Liposomal amphoteric is the drug of Choice. Dose 2-3 mg/kg/dose IV (21-24mg/kg total dose ) given in 7 dose over 10 days.

Iv) milefosine is oral preparation that has undergone trails in India 

(21 days course gave 100%cure)

General treatment 

Treatment of inter current infection

Blood transfusion if server anaemia 

Preventive measures 

Indoor residual spraying of insecticide

Environmental measures to eliminate breeding sites of sand flies

Giardiasis 

Giardiasis is a protozoal infection of the upper small intestine caused by the flagellate Giardia lambia ( also called G.intestinal and G.duodenalis ) . This parasite occurs worldwide, most abundantly in area with poor sanitation like Nepal, Bangladesh and India.

Agent: 

Only the cyst form is infectious by the oral route; trophozoite are destroyed by gastric acidity. Human are reservoir for the INFECTION

Mode of transmission 

Cysts are transmitted as a result of fecal contamination of water or food , by person- to- person contact or by anal - oral sexual contact.

Incubation period

1-3 weeks 

Clinical features 

 ⁃ Asymptomatic 

 ⁃ Acute diarrhea 

 ⁃ Chronic diarrhea 

 ⁃ Weight loss

 ⁃ Weakness 

 ⁃ Anorexia

 ⁃ Nausea ( vomiting)

 ⁃ Belching 

 ⁃ Mid epigastric discomfort 

 ⁃ Abdominal cramps

 ⁃ Abdominal distension

Investigations

 • Blood: Normal

 • Stool for trophozoite 

Differential Diagnosis 

 1. Intestinal Amoebiasis

 2. Acid peptic disease 

 3. Malabsorption 

Complications 

 • Acute Diarrhea 

 • Chronic diarrhea 

 • Malabsorption 

Treatment 

If patient present with acute diarrhea 

 • ORS or IV . Fluid 

 • Nutrition and electrolytes balance 

Drugs 

 ⁃ Metronidazole 400 mg 8 hourly * 10 days 

 ⁃ Tinidazole 2gm single dose

Other 

Furazolidone 100 mg 4 times daily for 7-10 days.

Mepacrine 100 mg 3 times daily for 5-7 days 

Albendazole 400 mg once a day for 5 days 

Prevention measures 

 • Safe disposal of human excreta.

 • Proper hand washing practices after defecation and before eating .

 • Protection of water 💦 supplies against faecal contamination .

 • Use filtered and boiling water .

 • Avoid uncooked raw foods .

 • Food landlers should be periodically examined , treated and educated in food hygiene practices such as hand washing.

 • Health education of public.

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