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Leishmaniasis: Disease of the New World Research Paper

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Updated: Apr 1st, 2022

Abstract

This study is an analysis of Leishmaniasis Disease New World as a protozoan disease. To provide a critical analysis of the disease, this study provides a differential diagnosis and an epidemiology of the disease, to provide a clear understanding of the symptoms of the disease and its transmission. In the diagnostic testing process, this study notes that, special expertise needs to be included as part of the diagnosis testing process, and in comparison to other diagnostic methods, the process is expensive. This is one drawback of the diagnosis process. However, this study outlines the standards of care to be undertaken in the diagnosis process and establishes that the disease can be treated through drug administration.

Differential Diagnosis

Leishmaniasis is a disease spread through protozoan infection, when a patient is bitten by a sand fly. New world leishmaniasis is realized when a patient is bitten by new world sand flies as a special strain of the disease (Badaro, 2006). Once a patient is infected, he or she may show different strains of severity of the disease, but the most severe form of Leishmaniasis is the visceral leishmaniasis, and the most common strain is the cutameous leishmaniasis (Badaro, 2006). Leishmaniasis presents different forms of diagnosis.

Leishmaniasis is normally diagnosed in the haematology lab, where amastigotes are observed through careful examination to determine a patient’s status (with regards to the disease). Other diagnostic elements of the disease involve the observation of skin rashes, or in extreme cases, skin cancer. In extreme cases (when the patient has been severely affected), the patient may exhibit signs of vital organ complications, with symptoms such as lung dysfunction (to resemble tuberculosis and liver dysfunction) or liver dysfunction being prominent (Badaro, 2006). In order of priority, the observation of amastigotes in the laboratory sample is the first course of diagnosis. Skin rashes or skin infection, is the second factor in the line of diagnosis, while vital organ dysfunction is the last course of diagnosis.

To support this diagnosis criterion, we should critically look at the stages of leishmaniasis development. When a patient is affected with leishmaniasis protozoa, the first sign that, the patient is infected is normally exhibited in the patient’s tissues because the amastigotes are directly visible in the patient’s tissues upon infection (Trudel, 2008, p. 1292). Skin rashes may occur almost at the same time, but the reason for prioritizing laboratory check as the first diagnostic element is the accuracy of the laboratory checks performed. Skin rashes can be caused by several factors and this is why it is placed second in the diagnostic list. Lastly, during long periods of infection, leishmaniasis disease easily spreads to affect the functions of the vital organs, but this diagnosis takes very long to detect. This is the reason this line of diagnosis is the third.

Epidemiology of the Diagnosis

The epidemiology of the diagnostic processes described above stems from the fact that leishmaniasis is pathogenic and it is transmitted by the insect new world sand fly. Since the insect greatly depends on the protein compounds found in human blood, for its reproduction, the “first” blood it sucks from the human body mixes with its own, to produce eggs, whereby, if it bites its second victim, the reproduction cycle is completed. At this point, a patient is affected by the parasite (Ivens, 2005). Normally, this bite is painful and parasitic, and this is why it causes skin rashes. The eggs which are transmitted into the human blood stream can be easily detected as amastigiotes, and this is the reason why a diagnosis of the disease is greatly reliant on the observation of this parasite (Trudel, 2008, p. 1292). The skin rash which is perceived as the second factor of the diagnostic sequence is explained by the painful bite from the new world sand fly, and it represents the point of contact between the insect and the human being. If the parasite stays in the human blood for long, it is transported to the vital organs of the human being, and from this point, vital organ dysfunction can be observed. This is the third diagnosis in the list of diagnostic items to be observed.

Diagnostic Testing

Diagnostic testing for amastigotes in the human tissue is normally not an easy process. Though the testing process is sensitive to the disease-causing factor (protozoa), the process normally requires high expertise to be effectively undertaken (Sundar, 2009). Moreover, it is very expensive to carry out such a test. The skin-test is normally observable to the naked eye, and depending on the extensiveness of the skin rash, subsequent laboratory test can be undertaken to establish if the cause of the skin rash is as a result of the leishmaniasis disease, or not. With regards to the detection of the disease, as a result of the dysfunction of a patient’s vital organs, a X-ray may be done to establish the nature of the infection and similarly, a laboratory test will be undertaken to determine if the infection is as a result of the leishmaniasis disease. The observation of a skin rash is obviously free, but the analysis of a patient’s vital organs may cost a small amount of money. The most expensive cost is therefore only realized during laboratory testing. The sensitivity of the skin-test to the disease is not strong because skin rashes can be caused by several factors. In comparison to the vital organ test, the vital organ test is more sensitive to the detection of the disease because there are fewer factors that affect organ function, when compared to the number of factors affecting skin rashes. The skin and organ tests are only indicators of the occurrence of the disease, but the laboratory test, aimed at determining the existence of amastigotes is the test used to rule out the occurrence of other types of diseases.

Standards of Care

Each diagnosis measure is normally handled with its own standard of care. With regards to handling the patient’s skin, as a primary procedure of determining if the patient is infected by leishmaniasis or not, it is important to analyze the patterns of the rashes, the color of the skin and the shape of the rashes. This procedure is normally considered essential to determine the type of skin rashes being dealt with (Thiel, 2010, p. 80). To protect the caregiver, it is important for the caregiver to wear protective clothing such as gloves, to prevent chances of infection. These standards have been established by the dermatological society.

In carrying out laboratory tests to establish the presence or absence of amastigotes, precision should be observed to identify the parasitic components in the patient’s tissues. The detection of the parasitic element is usually difficult, and this is the reason why highly skilled labor is normally needed in such kind of procedures. During the laboratory testing procedure, the safety of the equipments used should be high and the appropriateness of the building (laboratory) for the testing procedure also ought to be high. These standards are normally observed by the accreditation body in question.

When undertaking a test to determine the functionality a patient’s vital organs, it is important to use certified surgical procedures if the organs affected have to be surgically analyzed. In cases where an external examination procedure needs to be undertaken, it is important for the patients to be supplied with appropriate clothing. These procedures should be observed always, before the checking of vital organ functions.

Lines of Treatment

In treating new world leishmaniasis, the energy production of the disease-causing parasite is normally disrupted through drug administration. However, before treatment is administered, there are many factors to be considered regarding the development stages of the disease. For example, the morbidity level is normally of high importance. Normally, there are two courses of treatment: glucantime and pentostam. In the US, the first line of treatment is often administered through amphotericin (Soto, 2007, p. 7). Miltefosine is also used to treat certain strains of the disease such as visceral and cutaneous. This line of treatment has an efficacy rate of more than 95% (Soto, 2007, p. 7). Not only is this treatment method highly recommended in the US, it has also received similar commendations in Germany and India (Sundar, 2007). Nonetheless, extensive efficacies have been observed in Colombia. The only side effect associated with this drug is intestinal discomfort, but this does not affect the drug’s efficacy.

The drug, paramomycin, has been advanced as the second course of treatment for new leishmaniasis (Arevalo, 2007). Its approval is recent. This drug majorly works by strengthening the patient’s immunity system to fight the parasite. Though the drug has been recently approved by the institute for one world health, it traces its origins to the 1960s when its discovery was not pursued by experts because it was thought to be less profitable since people affected by the disease majorly came from poor backgrounds.

With regards to the patient’s care and treatment, the lines of treatment identified above seem to have no significant bearing because the lines of treatment do not require high patient care. This is because these drugs are orally admitted and they do not have any significant side effects. However, it is interesting to note that, the treatment courses for the disease is relatively inexpensive when compared to the high cost associated with disease diagnosis.

References

Arevalo, J. (2007). Influence of Leishmania (Viannia) species on the response to antimonial treatment in patients with American tegumentary leishmaniasis. Journal of Infection Diseases, 195(12), 1846–51.

Badaro, R. (2006). Immunotherapy for drug-refractory mucosal leishmaniasis. Journal of Infection Diseases, 194(8), 1151–9.

Ivens A. (2005). The genome of the kinetoplastid parasite, Leishmania major. Science, 309(5733), 436–42.

Soto, J. (2007). Oral miltefosine to treat new world cutaneous leishmaniasis. Journal of Lancet Infection Diseases, 7(1), 7.

Sundar S. (2007). Amphotericin B treatment for Indian visceral leishmaniasis: response to 15 daily versus alternate-day infusions. Journal of Clinical Infection Diseases, 45(5), 556–61.

Sundar S. (2009). Short‐course paromomycin treatment of visceral leishmaniasis in India: 14‐day vs 21‐day treatment. Journal of Clinical Infection Diseases, 49(6), 850–851.

Thiel, P. (2010). Miltefosine treatment of Leishmania major infection: an observational study involving Dutch military personnel returning from northern Afghanistan. Journal of Clinical Infection Diseases, 50(1), 80–3.

Trudel, N. (2008). Intracellular survival of Leishmania species that cause visceral leishmaniasis is significantly reduced by HIV-1 protease inhibitors. Journal of Infectious Diseases, 198(9), 1292–1299.

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