1. Anatomy
    2. 1. Mediastinum
    2. The Heart Development
    3. Pericardium
    4. Features of the Heart
    5. Arterial Supply of Heart
    6. Venous Drainage of the Heart
    7. Conducting System of Heart
    8. Nervous System of Heart
    9. Foetal Circulation and Changes at Birth
    10. Microscopic Structure of Heart
    11. Arteries
    12. Arch of Aorta
    13. Descending Thoracic Artery
    14. Abdominal Aorta
    15. Subclavian Artery
    16. Axiallary Artery
    17. Internal Thoracic Artery
    18. Brachial Artery
    19. Radial Artery
    20. Ulnar Artery
    21. Palmar Arches
    22. External Iliac Artery
    23. Internal Iliac Artery
    24. Femoral Artery
    25. Popliteal Artery
    26. Posterior Tibial Artery
    27. Anterior Tibial Artery
    28. Dorsalis Pedia Artery
    29. Common Carotid Artery
    30. External Carotid Artery
    31. Internal Carotid Artery
    32. Veins
    33. Internal Jugular Vein
    34. External Jugular Vein
    35. Superior Venacava
    36. Inferior Venacava
    37. Brachiocephali vein
    38. Subclavian vein
    39. Axillary vein
    40. Cephalic vein
    41. Basilic vein
    42. Azygous vein
    43. Hemiazyous vein
    44. Accessory Hemiazyoug Vein
    45. Internal Hemiazygous Vein
    46. Internal Iliac Vein
    47. Femoral Vein
    48. Popliteal Vein
    49. Long Saphenous Vein
    50. Small or Short Saphenous Vein
    51. Hepato-portal System
    52. Lymphatic System
    53. Spleen
    54. Thymus
    55. Thoracic duct
  2. Pharmacology
    3. 56. Congestive Heart Failure
    57. Therapy of Arrhythmiasis
    58. Angina pectoris
    59. Therapy of Hypertension
    60. Therapy of Shock
    61. Haemostatic Agents
    62. Therapy of Thromboembolic Disorder
    63. Thrombolytic or Fibrinolytics
    64. Antifibrinolytics
    65. Antiplatelet Drugs
    66. Therapy of Iron Deficiency Anemia
    67. Therapy of Megaloblastic Anaemia
    68. Hypolipidemic Drugs and Plasma Expanders
  3. Physiology
    4. 69. Properties of Myocardial Cells
    70. Heart - A Mechanical Pump
    71. Cardiac Cycle
    72. Electrocardiogram (ECG)
    73. Cardiac Output (CO)
    74. Haemodynamics of Circulation
    75. Heart Sounds
    76. Arterial Pulse
    77. Blood pressure
    78. Regional circulation
    79. Cardiovascular chanes during exercise
    80. Edema Dropsy of fluid retention
    81. Shock
    82. Hematology
  4. Pathology
    5. 83. Anaemia
    84. Hypertension
    85. Hypertensive Heart Disease
    86. Ischemic Heart Disease
    87. Angina pectoris
    88. Myocardial infarction
    89. Rheumatic Fever and Rheumatic Heart Disease (RHD)
    90. Acute Pericarditis
    91. Myocarditis
    92. Infective Endocarditis (IE)
    93. Congenital Heart Disease
    94. Cardiomyopathies
    95. Arteriosclerosis
    96. Atherosclerosis
    97. Inflammatory Disease of Blood Vessels
    98. Aneurysms and Dissection
    99. Congestive Heart Failure
    100. Iron Deficiency Anaemia
    101. Megaloblastic anaemia
    102. Pancytopenia
    103. Leucocytosis and Leucopenia
    104. Aplastic anaemia
    105. Haemolytic anaemia
    106. Hereditary Spherocytosis
    107. Haemoglobinipathies
    108. Thalassemia syndrome
    109. Sickle Cell Disease
    110. Leukaemia
    111. Leukemoid reaction
    112. Lymphadenitits
    113. Hodgkin lymphoma
    114. Non-hodgkin lymphoma
    115. Myeloproliferative disorders
    116. Myelofibrosis
    117. Multiple myeloma
    118. Bleeding disorders
    119. Coagulation disorders
    120. any
    121. Blood grouping
  5. Microbiology
    6. 122. Introduction of Blood borne infections
    123. Infective Endocarditis
    124. Brucella
    125. Rickettsiae
    126. Leishmania donovani
    127. Plasmodium
    128. Wuchereria bancrofti
  6. Biochemistry
    7. 129. Metabolism in Blood Cells
    130. Iron metabolism
    131. Haemoglobin
    132. Lipoprotein metabolism
    133. Biochemical aspect of MI
Microbiology
126. Leishmania donovani

1.

Describe life cycle of Plasmodium. Describe value of thick and thin smears for the diagnosis of malaria.

[12072]

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2.

Describe detection of microfilaria and diagnostic methods including amastigote form of Leishmania.

[2071, 2070, 2053, 2075]

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3.

List four blood parasites. Describe laboratory diagnosis of Malaria.

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4.

List any three blood parasites. Describe the value of thick and thin smear to diagnose malaria parasite.

[81062, 0561]

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5.

List the different types of malarial parasites found in Nepal. Explain the morphology of Plasmodium falciparum.

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6.

Describe the pathogenesis of filariasis.

[41058]

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7.

List the different blood parasites. Describe in brief the laboratory diagnosis of kala azar.

[51057]

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8.

Illustrate the life cycle of Wuchereria bancrofti and describe the pathogenesis of filariasis.

[61056]

➤

9.

Laboratory diagnosis of Leishmaniasis.

[074, 077]

➤

10.

Laboratory diagnosis of malaria.

➤

11.

Write briefly life cycle of Plasmodium vivax.

[207]

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LEISHMANIA DONOVANI
Image 1
Fig. Leishmania donovani
Location in Human body
  1. Reticulo-endothelial system of Viscera i.e.,
  2. Liver
  3. Spleen
  4. Bone marrow
  5. Blood
  6. Lymph
  7. Lymph nodes
  8. Pathogenic endoparasite and may be found in:
  9. Cerebrospinal fluid (CSF)
  10. Meninges
  11. Renal capsule
Diseases
  1. Visceral Leishmaniasis
  2. Kala-azar
  3. Black fever
  4. Death fever
  5. Dum-dum fever
Vector
Its vector is Sand-fly (Phlebotomus argentipus).
Life cycle
Image 1
Fig. Life cycle of Leishmania donovani
General Information
Leishmania donovani is Uniflagellate and has two forms, i.e., dimorphic.
Promastigote form/Leptomonad form
Amastigote form/Leishmanial form
i. Cylindrical and
i. Oval or Round and
ii. Flagellate (Uniflagellate)
ii. Non-flagellate
Contains Axonema and Kinetoplast.
Axonema and Kinetoplast are absent.
Promastigote form is Infective stage as it enters the human body.
Amastigote form is Feeding stage.
Promastigote form is found in Salivary glands and Guts of Sandfly.
Amastigote form is found in Reticulo-endothelial system of man.
Promastigote changes into amastigote form in man.
Amastigote changes into promastigote form in Sandfly (Phlebotomus argentipus).
Additional Information
  1. Leishmania donovani is Digenetic.
  2. Primary/ Definitive host: Man
  3. Secondary/ Intermediate host: Sand fly (Phlebotomus argentipus)
  4. Infected sand fly bites a normal man and inoculates promastigote stage into the bloodstream.
  5. From the bloodstream, the promastigote form enters the viscera, loses flagella, becomes round, and changes into the amastigote form.
  6. Amastigote stage can multiply until the cell is packed with the parasite.
  7. Amastigote attacks macrophages and disseminates to the Reticulo-endothelial system (blood, lymph, lymph nodes, bone marrow, liver, spleen).
Lab diagnosis
  1. K39 test
  2. Leishmania donovani body test (L.D. body test)
Post Kala-azar Dermal Leishmaniasis (PKDL)
Sometimes Leishmania donovani also causes Post Kala-azar Dermal Leishmaniasis (PKDL).
Treatment
  1. Antimony compound
  2. Recent drugs: Multifossine
LEISHMANIA TROPICA
Location
  1. Skin (face and neck)
Disease causes
  1. Dermal Leishmaniasis/Cutaneous Leishmaniasis
  2. Skin ulcers
  3. Oriental sore
  4. Delhi boils
  5. Baghdad boils
LEISHMANIA BRAZILIENSIS
Location
Naso-oral cavity
Disease causes
  1. Naso-oral Leishmaniasis
  2. Muco-cutaneous Leishmaniasis
  3. Espundia
LABORATORY DIAGNOSIS
Microscopy
Demonstration of amastigotes inside the macrophages (also known as Leishman-Donovan bodies or LD bodies) is the gold standard method for the diagnosis of VL.
Sample collection
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Splenic aspiration
Bone marrow aspiration
Lymph node aspiration
Liver biopsy
Peripheral blood
Biopsy specimens of various organs
  1. Oropharynx
  2. Stomach
  3. Intestine
    4. These are useful in AIDS patients.
Staining
    It should be stained with either of the following.
  1. Leishman stain
  2. Giemsa stain
  3. Wright stains
Culture
Specimens
    Aspiration from
  1. Spleen
  2. Bone marrow and
  3. Buffy coat
Culture media
NNN medium
Novy-MacNeal-Nicolle (NNN) medium is the culture medium of choice.
Schneider's Drosophila insect medium
It can also be used alternatively.
Steps
  1. Inoculated specimens are incubated at ambient temperature (24-26°C) and examined weekly for 4 weeks before declared as negative.
  2. Amastigotes transform into promastigotes in the culture fluid which are detected by staining with Giemsa stain.
  3. Culture is found to be positive in 75% of cases.
  4. Culture is useful for
    1. Species identification and
    2. Drug sensitivity testing
Serological test
Antibody detection in Serum
Direct agglutination test (DAT)
Immunochromatographic test (ICT)
ELISA
Indirect fluorescent antibody (IFA) test
Antigen detection
Latex agglutination test
Molecular methods
PCR
nested PCR
real-time PCR
Leishmanin test/ Montenegro test
Animal inoculation
Nonspecific tests
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Complete blood count
To detect pancytopenia
Elevated liver enzymes
Reversal of albumin globulin ratio
Reflects hypergammaglobulinemia
Napier's Aldehyde test and Chopra's antimony test
They were used in past to detect hypergammaglobulinemia.

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