寄生虫阿米巴

寄生虫阿米巴第一页，共一百三十二页，编辑于2023年，星期日GeneralPropertiesoftheProtozoa第二页，共一百三十二页，编辑于2023年，星期日Eukaryotic,unicellularanimalswithfullvitalfunctions.Smallestparasites,2-200µm,andbestseenwithahighpowerobjectivelensofagoodmicroscope.Growandreproduceveryfast.GeneralIntroductiontoProtozoa第三页，共一百三十二页，编辑于2023年，星期日

4.Widedistributioninnature.Totalspecies:about200,000;Free-living:majority;Parasitic:around10,000;Medicalprotozoa:minorityabout40.GeneralIntroduction5.MedicalProtozoa:residentinhumanfluid,tissueorcells,whichmaybeharmfultotheirhosts.第四页，共一百三十二页，编辑于2023年，星期日

3.Nucleusforreproduction;morphologicallymaybevesicularformorcompactform.BasicStructures:2.Cytoplasm:Ectoplasmforlocomotion&ingestion;Endoplasmformetabolism.1.Plasmamembrane:relatedtoindependence,invasion,physiologicalbalance.4.Locomotiveorganelle:pseudopodium,flagellum,cilium.第五页，共一百三十二页，编辑于2023年，星期日Locomotion:locomotiveorganelles:Pseudopodium:atemporaryectoplasmicextrusion,bymeansofwhichanamoebamovesaboutorengulfsfood(Amoeba)

PseudopodiumFlagellum:along,mobile,whiplikeprojectionfromthefreesurfaceofacell(Trichomonasvaginalis)Cilia:

aminutevibratile（可振动的）,hairlikeprocessprojectingfromthefreesurfaceofacell(Ciliates)PhysiologicalfunctionsFlagellumCilia第六页，共一百三十二页，编辑于2023年，星期日PhysiologicalfunctionsFeedinganddigestion:Pinocytosis----engulfingsolublematterindigestivevacuolesPhagocytosis----engulfingparticulatematterindigestivevacuolesInsomespecies,foodisingestedatadefinitesite(cytostome,e.g.Plasmodiumspp.)第七页，共一百三十二页，编辑于2023年，星期日ModeofreproductionBinaryfission–resultsin2daughtercells(almostall)Schizogony–multiplefissionsresultinginmultiplecells(malariaparasites)Budding:

Externalbudding-resultsinmulti-cells(sporoblastsporozoitebudssporozoites)Internalbudding–Endopolyogony(comparetoschizogony).Aspecialcaseisendodyogonywhichresultsin2cells(Toxoplasma)AsexualSexualConjugation–byconjugatingandexchangingnuclearmaterialsof2organismsandthenseparatingintonewindividuals(Balantidiumcoli),onlynucleiunite.

Gametogony–Theprocessofproducinggamets.Thisisfollowedbysexuallydifferentiatedcellsuniting,resultinginzygote(Plasmodia),bothcytoplasmandnucleiunite.第八页，共一百三十二页，编辑于2023年，星期日ModeofreproductionAlternationofgenerations:parasitesreproducebyalternativelygoingthroughasexualandsexualmeans,e.g.inPlasmodium,includingasexualmode(schizogony)inhumanlivercellsandredbloodcellsandsexualmode(gametogony)inmosquitoes.第九页，共一百三十二页，编辑于2023年，星期日LifecyclepatternsTwo-hostform

Mammalsmammals,e.g.ToxoplasmaMammalsvectorarthropods,e.g.Plasmodium

One-hostformOnestageform–Trophozoite,e.g.TrichomonasvaginalisTwo-stageforms–Trophozoite&Cyst,e.g.Amoeba第十页，共一百三十二页，编辑于2023年，星期日CharacteristicsofProtozoanInfections*In-hostproliferation–parasitism*Nolarvaandadultdifferentiationbutstagedifferences(e.g.trophozoite,cyst)*Maybeintracellularlodgment(e.g.Plasmodiuminhepatocytesorredbloodcells;Leishmaniainmacrophages)*Opportunisticinfection(theimmune-compromisedhost,e.g.AIDSpatientswhoareeasilyinfectedbysomeprotozoa,e.g.Pneumocystis,thatareharmlesstonormalhosts,

anddevelopseveresymptoms,andmayresultindeath.)第十一页，共一百三十二页，编辑于2023年，星期日

ImportantmedicalprotozoaIncludingfourclasses:Zoomastigophorea:Theclass(theflagellates),hasoneormorewhip-likeflagellaandinsomecase,anundulatingmembrane(e.g.Trichomonas).Theseincludeintestinalandgenitourinaryflagellates(Giardia,Trichomonas),andbloodandtissueflagellates(Trypanosoma,Leishmania).Beingclassifiedintothreephyla:

Sarcomastigophora:e.g.

flagellatesandamoebae

Apicomplexa:Sporozoa(e.g.Plasmodium)

Ciliophora:ciliates(e.g.Balantidiumcoli)第十二页，共一百三十二页，编辑于2023年，星期日Lobosea:TheclassincludesEntamoeba,Naegleria,Acanthamoeba.Sporozoa:

TheclassincludesIsospora,Toxoplasma,Cryptosporidium,Plasmodiumspecies,

Babasiaspecies,Pneumocystis.Kinetofragminophorea(动基裂纲):

TheclassincludesBalantidiumcoli.Classification第十三页，共一百三十二页，编辑于2023年，星期日Medicallyimportantprotozoa:1.Amoebae2.Flagellates3.Sporozoa4.Ciliates第十四页，共一百三十二页，编辑于2023年，星期日1.MorphologyProtozoanisasinglecelleukaryoticanimalwithallnecessarybasicphysiologicalfunctionsthatitneeds.Medicalprotozoameanpathogenicornonpathogeniconeswhichliveinhumanbody,havingmorethan40specieswitharangeofabout2-200µminsizeandwithround,ovalorirregularshape.Thebasicstructureofprotozoaismadeupofcellmembrane,cytoplasmandnucleus.Functionally,theprotozoa'sorganellescanbedividedintothreetypes,i.e.cytoplasmorganelles,nutritionorganellesandlocomotiveorganelleswhichmainlyincludepseudopodium,flagellumandcilium.Theprotozoahavetwotypesofnuclei:vesicularnucleusandparenchymatousnucleus.Mainpointsofthesectionconcerningintroductiontomedicalprotozoa第十五页，共一百三十二页，编辑于2023年，星期日2.LifecycleProtozoahavetwokindsofreproductiveways,asexualandsexual,intheirlifecycle.Theasexualreproductionincludesbinaryfission,multiplefissionandbudding(buddingfission),andgametogonyandconjugationareinvolvedinthesexualreproduction.Thelifecycleofprotozoahasthreetypes,includinginterpersonalpropagatingtype,circulationpropagatingtypeandvector-mediatedspreadingtype.3.PathogenesisThemedicalprotozoacancausediseasesbythefollowingwaysthatincludebreaking,pressing,blocking,diffusing,etc.Inrecentyears,thepathogenesiscausedbyopportunisticprotozoasuchasPneumocystis,CryptosporidiumandToxoplasma,etc.isalreadypaidcloseattention.Mainpointsofthesectionconcerningintroductiontomedicalprotozoa第十六页，共一百三十二页，编辑于2023年，星期日LoboseaAmoeba第十七页，共一百三十二页，编辑于2023年，星期日AmoebaeinHumanEntamoebaE.histolytica(pathogenic)E.disparE.coliE.hartmaniE.gingivalis(oral)EndolimaxnanaIodamoebabutschlii第十八页，共一百三十二页，编辑于2023年，星期日Free-livingamoebaePathogenicfree-living

Amoebae:NaegleriaAcanthamoeba第十九页，共一百三十二页，编辑于2023年，星期日EntamoebahistolyticaGermanzoologist

SchaudinncorrectlydescribedthetrophozoitesandcystsofE.histolyticain1903.Schaudinndiedattheageof35(1871-1906)ofoverwhelmingamoebiasis,asaresultofselftestingwiththispathogen.

EntamoebadisparBrumpt,1925第二十页，共一百三十二页，编辑于2023年，星期日E.histolyticaisamedicalimportantpathogen1.

Intestinalamoebiasis:AmoebicdysenteryAmoebiccolitis2.Extra-intestinalamoebiasis:Amoebicabscess&UlcersCauseamoebiasis:第二十一页，共一百三十二页，编辑于2023年，星期日Medicalimportance4thleadingcauseofdeathsfromparasiticdiseasesworldwideOrganism

#ofdeaths/yr

#infectedEntamoeba 40,000~100,000 ~300millionAscaris~200,000~480millionSchistosoma ~750,000 ~200millionPlasmodium 2-3million ~500million(Malaria)第二十二页，共一百三十二页，编辑于2023年，星期日Contaminatedwaterisasourceofinfection.第二十三页，共一百三十二页，编辑于2023年，星期日Infectioniscommonindevelopingcountrieswheresanitationispoor.第二十四页，共一百三十二页，编辑于2023年，星期日MorphologyofE.histolyticaIngestedRBCNucleuswithcentralkaryosomeandfinelydividedperipheralchromatinPseudopodTrophozoiteEctoplasmEndoplasm第二十五页，共一百三十二页，编辑于2023年，星期日TrophozoitesofE.histolyticaSinglenucleuswithacentral,dot-likekaryosome第二十六页，共一百三十二页，编辑于2023年，星期日1-4ring-likenuclei

withfinelydivided

peripheralchromatinCystwallandroundshapeMatureE.histolyticaCyst(quadrinucleatecyst)MorphologyofE.histolytica第二十七页，共一百三十二页，编辑于2023年，星期日CystsofE.histolyticaChromatoidalbodyChromatoidalbodyGlycogenvacuole第二十八页，共一百三十二页，编辑于2023年，星期日Thesephotographstakenatanintervalof4secondsillustratestepwisetheprocessofphagocytosis(starchgranule)inEntamoeba.Phasecontrast×1000Phagocytosisandmotivationstarchgranule第二十九页，共一百三十二页，编辑于2023年，星期日Micrographofatrophozoiteingestingaredbloodcellderivedfromitshost.UroidRBC第三十页，共一百三十二页，编辑于2023年，星期日Morphologiccomparisonoftrophozoiteandcyst(Eh)第三十一页，共一百三十二页，编辑于2023年，星期日E.coli

trophozoite

NucleusCytoplasmaKaryosomeEhEc第三十二页，共一百三十二页，编辑于2023年，星期日E.Coli

cystsEcEh第三十三页，共一百三十二页，编辑于2023年，星期日Lifecycle

Basicform:

ReproductioninhumanintestineCyst—LumenTrophozoite—Cyst

第三十四页，共一百三十二页，编辑于2023年，星期日1.ThelifecycleofE.histolyticaiscomparativelysimple,andincludesacyststageandamultiplyingtrophozoitestage.Asthecystmatures,thenumberofnucleichangesfromonetofour,andthisistheinfectiveform.Thecystsareingestedwithcontaminatedfoodorwaterandtheypassthroughthestomachandintestine.Thematurecysts,whichareresistanttoacidicdigestivejuicesofthestomach,passtolowerpartofthesmallintestine.Inthealkalinemediumofthecaecumorlowerpartofthesmallintestine,thecystwallisdamagedbyneutraloralkalinedigestivejuicesortrypsin,liberatingfour-nucleatedtrophozoitethatundergoesthreeroundsofcytokinesisandoneroundofnucleardivisionintoeightmetacystictrophozoites.MainpointsofthelifecycleofEntamoebahistolytica第三十五页，共一百三十二页，编辑于2023年，星期日3.

Thetrophozoitesingestbacteriaandmultiplybybinaryfissionwhilemovingdownwardtothecolon,wheretheyrespondtounknownstimulianddevelopintoprecysticformandre-encyst.Thetrophozoitesareresponsibleforclinicalsyndromes,rangingfromclassicaldysenterytoextraintestinaldiseases.4.Cystsareevacuatedperiodicallyintothestool,completingtheirdevelopmentcycle,andaredischargedintoenvironment.Cystsremainviableandinfectiveforseveraldaysinfecesandwater,butcanbeeasilykilledbydesiccation.MainpointsofthelifecycleofEntamoebahistolytica第三十六页，共一百三十二页，编辑于2023年，星期日PathogenesisFactorsthatdetermineinvasionofamoebas:Factorsfavorparasite’sinvasivenessthenumberofamoebaeingested,thepathogeniccapacityoftheparasitestrain[pathogenic&non-pathogenicspecies(E.dispar)]hostfactorssuchasgutmotilityandimmunecompetence,thepresenceofsuitableentericbacteriathatenhanceamoebicgrowth.第三十七页，共一百三十二页，编辑于2023年，星期日Pathogenesis(cont.)GeneraltypesofvirulencefactorsandthecourseofinvasionAdherencefactors:

surfacelectin,260kDagalactose/N-acetyl-O-galactosamine(Gal/galNAC)mediatesadherenceamoebatrophozoitetotheintestinalmucosaAmoebapores:

formporesinhostcellmembranesInvasionfactors:

cysteineproteinasesarecytopathicforhosttissue,resultingindegradationofmucosalmembraneofthecolon第三十八页，共一百三十二页，编辑于2023年，星期日Pathogenesis(cont.)Thelesioncausedbytrophozoites:Trophozoitesattachtomucosalepithelialcells(MEC)LyseMECUlcerateandinvademucosa

Causedysentery(diarrhea+blood)Metastasizeviablood&/orlymphtoformabscessesinextraintestinalsites(e.g.liver,brain,lung)...第三十九页，共一百三十二页，编辑于2023年，星期日ClinicalClassificationofAmoebiasis

(WorldHealthOrganization)

Asymptomatic(intestinal)—"CystPassers”

SymptomaticInfection:Extra-intestinalAmoebiasis:

Amoebicliverabscess(ALA)

Amoebicpulmonaryabscess

Othersites(brain,skin…)

IntestinalAmoebiasis:(colonandrectum)

AcuteDysenteric(dysentery)

ChronicNon-Dysenteric(“self-cured”)第四十页，共一百三十二页，编辑于2023年，星期日AsymptomaticAmoebiasis

"CystPassers”MostcommonInfectionmaycontinuewithoutclinicalsymptomsforweekstomonths...Cause:itmayspontaneouslyresolve(selfcure)orTwospeciesofEntamoebamayexistE.dispar(non-pathogenic)E.histolytica(pathogenic)第四十一页，共一百三十二页，编辑于2023年，星期日IntestinalAmoebiasisTwotypesAcutedysenteric

(dysentery)Chronicnon-dysenteric

(“self-cured”orcarrierstate)第四十二页，共一百三十二页，编辑于2023年，星期日AcuteDysentericAmoebiasisAmoebicDysenterySymptoms:BloodymucoiddiarrheaRBCsandfewWBCsinstoolsAbdominalpainweightlossBloating,*tenesmusandcramps*Afterbowelmovementsonestillwantbowelmovements,butthereisnostooltobeexcreted.

Apainfullyurgentbutineffectualattempttourinateordefecate.

第四十三页，共一百三十二页，编辑于2023年，星期日AmoebicDysenterySigns:Fever(33%)Tender(enlarged)liverInliquidstools,positivefortrophozoites,Nocysts.第四十四页，共一百三十二页，编辑于2023年，星期日AmoebicDysenteryNormalmucosaexceptfor...Adherentpseudomembraneoverlyingtheulcers,butclassic“Flask-Shaped”ulcercanberarelyseenSub-mucosalinvolvementisrarewithearlytreatmentSigmoidoscopic(乙状结肠镜)appearance:第四十五页，共一百三十二页，编辑于2023年，星期日

Flask-shapedulcerinthelargeintestineofamoebiasispatient第四十六页，共一百三十二页，编辑于2023年，星期日ChronicNon-DysentericAmoebiasis:“self-cured”carrierstate37%symptomatic,>5yearsSymptomsandsigns:Intermittentdiarrheawithmucus,abdominalpain,flatulence(肠胃胀气）and/orweightlossNoE.histolyticatrophozoites(rarelycysts)insemi-formedorformedstoolsPositiveserologyandulcerations第四十七页，共一百三十二页，编辑于2023年，星期日Extra-IntestinalAmoebiasisA.Hepaticamoebiasis(Amoebicliverabscess)

B.Cutaneousamoebiasis

C.Amoebiclungabscess

D.AmoebicbrainabscessFromtheulcer,theamoebaemayenterbloodvesselsandbecarriedtoliver,viahepaticportalsystemtootherorgans,suchaslung,skin,orevenbrain,etc.toformtheabscessesasfollowings:第四十八页，共一百三十二页，编辑于2023年，星期日AmoebicLiverAbscess(ALA)SymptomsSignsHistoryofdysentery,weightloss,abdominalpain,chestor(right)shoulderpainfever,hepatomegalyDiagnosticaspiration:non-odorous,reddish-brownincoloraspirate(chocolatejam)–notcommonSkininflammation第四十九页，共一百三十二页，编辑于2023年，星期日UlcerscausedbyinvasionofE.histolyticaintotheliver第五十页，共一百三十二页，编辑于2023年，星期日PathologicsampleofahumanamoebicliverabscessThepathologicalsampleofahumanamoebicliverabscess第五十一页，共一百三十二页，编辑于2023年，星期日

ApatientwithamoebicliverabscessThepatientwithliverabscessShowsskininflammationreaction(skinulceration).第五十二页，共一百三十二页，编辑于2023年，星期日X-rayofAmoebicLiverAbscess

第五十三页，共一百三十二页，编辑于2023年，星期日Stoolexamination:

DirectFecalSmear:trophozoites(usingnormalsaline)andcysts(usingiodinestaining)SigmoidoscopyImaging:X-ray;CTSerologicTests(forchronicdisease):ELISA,IHA(indirecthemagglutination)DiagnosisofIntestinalAmoebiasisTechniques:Fecalconcentrationtechniques-(cysts)ZnSO4(Zincsulfate)orformalin-ethersedimentationCultivationinmedium第五十四页，共一百三十二页，编辑于2023年，星期日Moleculardiagnosis:PCR第五十五页，共一百三十二页，编辑于2023年，星期日LaboratoryDiagnosisofHepaticAmoebiasisExaminestools

fortrophozoites/cysts(suggestive)Bloodcellcounts-leukocytosis?RadiologicStudies(X-ray,CT)Serologictests(IHAorELISA),LiverenzymeprofileisusuallynormalCatheterize（将导管插入）abscessandaspirate:Examinereddish-brownaspiratefortrophozoitesanddoserologictestingforamoebicantigensCulturetrophozoitesinaspirate

ChemotherapeuticTrial第五十六页，共一百三十二页，编辑于2023年，星期日TreatmentofAmoebiasis第五十七页，共一百三十二页，编辑于2023年，星期日Prevention/ControlofAmoebiasisDiagnosisandtreatmentofE.histolyticapatientsanimalreservoirs(otherthanhumans)areknown?(dog,cat,pigandmonkeycanbeinfectedbyE.histolytica,buttherearesomedifferencesinshapeinanimalsfromthatinhuman.)Safedrinkingwater(boilingor0.22µmfiltration)CleaningofuncookedfruitsandvegetablesPreventionofcontaminationoffoodsIndividualmeasures:第五十八页，共一百三十二页，编辑于2023年，星期日Prevention/ControlofAmoebiasisPublicservicesandutilitiesAdequatedisposalofhumanstoolsSafeandadequatewatersupplyPrimaryhealthcaresystemsHealtheducation(washinghands,cleaningandprotectingfood,controllinginsects)Specificsurveillanceprogramsandcontrolprogramsintegratedintoongoingsanitation&diarrheacontrolHealthRegulationsControloffoodvendorsandfoodhandlersControloffliesandcockroachesCommunitymeasures:第五十九页，共一百三十二页，编辑于2023年，星期日1.MorphologyandlifecycleThedevelopmentstagesofE.histolyticainthefecesincludethetrophozoite,precyst(transitionalform),andcyst.Thetrophozoitehasawide,clear,refractile,hyalineectoplasm,sharplyseparatedfromtheendoplasm.Locomotionofthetrophozoitedependsonasinglewell-definedpseudopodium,extendingrapidly,withoutcleardifferentiationbetweenectoplasmandendoplasm.Thecystisingestedwithfeces-contaminatedfoodorwaterandpassesthroughthestomachandintestine.Thetrophozoiteemergesintheterminalileumorasthecystformsinthelumenofthelargeintestine,passesoutinthefeces,andisimmediatelyinfectivewhenthecysthasdevelopedtomaturity.Cystsareevacuatedperiodicallyintothestool,completingtheirdevelopmentcycle,anddischargedintotheenvironment.HumansarethehostforE.histolyticaandcantransmittheinfectiontootherhumans,primatesandsoon.

MainpointsofthesectionconcerningEntamoebahistolytica第六十页，共一百三十二页，编辑于2023年，星期日IngestionofthequadrinucleatecystofE.histolyticafromfecallycontaminatedfoodorwaterinitiatesinfection.Inthecaecumorlowerileum,thecystwallisdamagedbytrypsin,leadingtoexcystation.Excystationintheintestinallumenproducestrophozoites.Ininvasiveamoebiasis,trophozoitesareresponsiblefortheclinicalsyndrome,rangingfromclassicaldysenterytoextraintestinaldisease,andtheyhavethecapacitytodestroyalmostallthetissuesofhumanbody.Severalvirulencefactorscontributetopathogenesisofthisparasite.Threepathogenicfactorshavebeenextensivelystudiedandcharacterizedatthemolecularlevel,thegalactose/N-acetyl-O-galactosamine(Gal/GalNAc)lectinthatmediatesadherencetohosttargetcells,theamoebaporesthatformporesinhostcellmembranes,andthecysteineproteinasesthatarecytopathicforhosttissue.Patientswithamoebiccolitistypicallypresentwithaseveralcrampingabdominalpain,flatulence,anorexia,weightloss,chronicfatigue,andwateryorbloodydiarrhea.Hepaticinvolvementisoverwhelminglythemostcommonextraintestinalmanifestationofamoebiasis.2.Pathogenesisandclinicalmanifestations第六十一页，共一百三十二页，编辑于2023年，星期日Traditionally,definitivediagnosisofamoebiasisismadebydetectionofE.histolyticaintissuesordischargefromthelesionsusingmicroscopy-cytologicaldiagnosis.TheidentificationofhematophagoustrophozoitesischaracteristicofE.histolyticainfection.Aniodinestainedfilmshowsthatthecysthasasmoothandhyalineappearance;isclearandhasnomorethanfournuclei.Trophozoitesarerarelydetectedbyaspiration.Anamoebicliverabscessisdifficulttodiagnosebymicroscopicexaminationoftheabscessfluid.Cystsareneverseeninextraintestinallesions.Serologictestingisstillamajortestforthediagnosisofinvasiveamoebiasis.AnumberofDNAamplificationbasedtesthavebeendevelopedfordetectionofE.histolyticainstool.ItisimportanttodistinguishthedifferentialcharactersofotherintestinalEntamoebaspecies.3.Laboratorydiagnosis第六十二页，共一百三十二页，编辑于2023年，星期日E.histolyticaistheintestinalprotozoanparasiteresponsibleforanestimated50millioncasesofinvasiveamoebiasisannually,includingamoebiccolitisandliverabscessinhumans,andresultingin40,000to100,000deathseachyear.Amoebiasisisprevalentworldwideinpeopleresidinginortravelingtoendemicareas,althoughitismorecommoninthetropicalareas.Asymptomaticcystpassersorcarriersareofutmostimportanceinthetransmissionofthedisease.Contaminatedfoodandwaterconstitutethemostimportantvehiclesofinfection.Thecontrolofinvasiveamoebiasiscanbeachievedthroughanimprovementoflivingstandardsandtheestablishmentofadequatesanitaryconditionsincountrieswhereamoebiasisisendemic.Incaseofinvasiveamoebiasis,whichincludesseverecolitiswithulcerationsanddysentery,hepaticabscess,andotherextraintestinalsites,thepatientsshouldreceivemetronidazole,tinidazole,ornidazoleasfirst-lineagents.Fornoninvasiveinfections,treatmentmaynotbestrictlynecessary,ormaybetreatedwithparomomycin.4.Epidemiologyandcontrol第六十三页，共一百三十二页，编辑于2023年，星期日LeishmaniaDepartmentofPathogenBiologyNanjingMedicalUniversity第六十四页，共一百三十二页，编辑于2023年，星期日IntroductionLeishmaniaisakinetoplastidflagellate.Severalstrainscaninfecthumans.Theyareallmorphologicallysimilar,differentiationthereforeisbasedonanumberofbiochemical(zymodemepattern)andepidemiologiccriteria,kinetoplastDNArestrictionanalysis,lectinconjugationpatternsontheparasitesurface,useofmonoclonalantibodyprobestodetectspecificantigens,vectors,reservoirhost,andsoon.Leishmaniacausesleishmaniasisinhumanandanimals.Leishmaniasisisazoonosis,transmittedbythebiteofsandflies.Leishmaniasisaffects12millionpeoplein88countries,4millionnewcasesperyear.第六十五页，共一百三十二页，编辑于2023年，星期日Visceralleishmaniasis(kala-azar):involvingliver,spleen,andbonemarrow–Leishmaniadonovani,etc.Mucocutaneousleishmaniasis(naso-oralleishmaniasis):involvingmucousmembranesofthemouthandnoseafterspreadingfromanearbycutaneouslesion(veryrare)–Leishmaniabraziliensis,etc.Cutaneous

leishmaniasis(orientalsore,Baghdadboil,wetcutaneoussore,drycutaneoussore,chicleroulcer,uta,andothernames):involvingtheskinatthesiteofasandflybite–L.tropica,L.mexicana.IntroductionThreemainformsofleishmaniasis第六十六页，共一百三十二页，编辑于2023年，星期日VISCERALLEISHMANIASIS(Bangladesh,Brazil,India,NepalandSudan)CUTANEOUSLEISHMANIASIS(Afghanistan,Brazil,Iran,Peru,SaudiArabiaandSyria)DIFFUSECUTANEOUSLEISHMANIASISMUCOCUTANEOUSLEISHMANIASIS(Bolivia,BrazilandPeru)Postkalaazardermalleishmaniasis(EndemictoIndiaandtheSudan)TYPESOFLEISHMANIASISANDDISTRIBUTION第六十七页，共一百三十二页，编辑于2023年，星期日MajorLeishmaniaspeciesandtheclinicaldiseasestheycauseClinicaldiseaseLeishmaniaspeciesGeographiclocationCutaneousleishmaniasisL.tropicacomplex

oldworld

L.tropica

L.aethiopicaL.majorL.mexicanacomplexnewworldL.mexicanaL.amazonensisL.braziliensiscomplexL.peruvianaL.guyanensisL.panamensis

L.colombiensisoldworld

L.infantumnewworld第六十八页，共一百三十二页，编辑于2023年，星期日MucocutaneousleishmaniasisL.braziliensiscomplex

L.braziliensisnewworldL.guyanensisL.panamensisL.mexicana

L.tropicaoldworld

L.majoroldworldVisceralleishmaniasisL.donovanicomplex

L.donovanioldworld

L.infantunoldworld

L.tropicaoldworld

L.chagasinewworld

L.amazonensisnewworldClinicaldisease

LeishmaniaspeciesGeographiclocationMajorLeishmaniaspeciesandtheclinicaldiseasestheycause第六十九页，共一百三十二页，编辑于2023年，星期日Theleishmaniasisisendemicin88countriesonfivecontinents—Africa,Asia,Europe,NorthAmericaandSouthAmerica.350millionpeopleatrisk.12millionpeopleareaffectedbyleishmaniasis.1.5~2millionnewcasesofleishmaniasisestimatedtooccurannually.500000newcasesofVLwhichoccurannually.第七十页，共一百三十二页，编辑于2023年，星期日EndemicAreasforLeishmaniasis

BMJ2003;326:378第七十一页，共一百三十二页，编辑于2023年，星期日LeishmaniadonovaniIn1903,LeishmanandDonovanseparatelydescribedLeishmaniadonovaniinsplenictissuefromthepatientsinIndiawithlife-threateningdiseasenowcalledvisceralLeishmaniasis.Leishmaniasisis