18/7/2017 Leishmania spp.

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Leishmania spp.

LEISHMANIA SPP.

PATHOGEN SAFETY DATA SHEET - INFECTIOUS SUBSTANCES

SECTION I - INFECTIOUS AGENT

NAME: Leishmania spp.

SYNONYM OR CROSS REFERENCE: Leishmaniasis, kala-azar, Dum-Dum fever, black fever. The causative
agents are members of the L. donovani complex, L. tropica, L. major, L. aethiopica, L. Mexicana complex,
and Braziliensis complex 1, 2 .

CHARACTERISTICS: Leishmania spp. belong to the family Trypanosomatidae, order Kinetoplastida 1 .

Leishmania spp. are characterized by a flagellated promastigote stage in a sandfly, and a non-motile
amastigote stage within macrophages in mammals 3, 4 . The amastigotes, known as Leishman-Donovan
(LD) bodies, are small, round or oval, and measures 3 to 5 m 5 . Eastern hemisphere: L. tropica, L. major,
L. aethiopica. Western hemisphere: L. braziliensis and L. mexicana complexes.

SECTION II - HAZARD IDENTIFICATION

PATHOGENICITY/TOXICITY: The clinical presentation of leishmaniasis is dependent on immune status,
nutritional status, species, and strain. A spectrum of findings is observed within each of the three major
clinical syndromes: cutaneous, mucocutaneous and visceral leishmaniasis. Cutaneous leishmaniasis (CL),
due to L. tropica, L. mexicana, L. braziliensis or L. major, is characterized by ulcerative skin lesions. The
morphology of the cutaneous lesions may vary depending of the Leishmania species. The symptoms can be
pruritic, painful, and scarring is possible. Cutaneous leishmaniasis may include local/diffuse skin lesions,
ulceration, adenopathy, satellite lesions, and subcutaneous nodules 4, 6 . Systemic symptoms are often
absent. Mucocutaneous leishmaniasis (ML) caused by L. braziliensis and occasionally with other Leishmania
spp, occurs years after the onset of cutaneous leishmaniasis. ML is characterized by one or several
cutaneous lesions, and secondary infection is a risk, and progressive tissue destruction. Symptoms can
include mucosal lesions, nasal obstruction/bleeding, deformation of palates, gingival oedema, and
periodontitis 4 . Nasopharyngeal lesions can be fatal due to secondary infection or respiratory
complications. Visceral leishmaniasis, usually caused by the parasites of the L. donovani complex, is fatal if
left untreated. Symptoms include fever with two daily peaks, hepatosplenomegaly with pancytopenia,
wasting and weakness, darkening skin and anemia 4 . Post-kala-azar dermal leishmaniasis (also caused by
L. donovani) follows 6 months to 5 years after an attack and/or complete cure of VL, causing
hypopigmented macules, nodules and plaques, and erythema of the face 7 .

EPIDEMIOLOGY: Worldwide distribution. It is endemic in 88 countries, mostly developing countries,

including parts of Europe, South America, Africa and Asia 1 . It is estimated that 12 million are infected
worldwide, with 2 million new cases occurring every year, 1.5 million for cutaneous leishmaniasis and
500,000 for visceral leishmaniasis 4, 8, 9 . Ninety percent of visceral leishmaniasis cases occur in
Bangladesh, Brazil, India, Nepal, and Sudan; ninety percent of cutaneous leishmaniasis cases occur in
Afghanistan, Algeria, Brazil, Iran, Peru, Saudi Arabia, and Syria 4, 8 .

HOST RANGE : Humans, warm-blooded mammals including dogs, cats, and small rodents 2 .

INFECTIOUS DOSE: Unknown.

MODE OF TRANSMISSION: Transmitted by the bite of an infected female sandfly of the genus
Phlebotemus or Lutzomyia 10, 11 . The sand fly acquires the parasite from a zoonotic reservoir. Laboratory,
blood transfusion, congenital and sexual transmission are possible, and transmission by domestic or wild
mammals has also been reported 1, 12 .

INCUBATION PERIOD: At least a week but can be up to many months.

COMMUNICABILITY: Communicable via sandflies as long as parasites are circulating in blood or are
present in skin lesions, although person to person infection through blood transfusion, sexual contact or
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placenta (mother to child) is rare 1 . Parasites may still circulate in the blood after symptoms are no longer
apparent.

SECTION III - DISSEMINATION

RESERVOIR: Humans and warm-blooded mammals including dogs, foxes, rats, cats, small rodents, sloths,
and marsupials 2, 4, 14, 15 .

ZOONOSIS: Yes, by bite of sandfly that has fed off an infected mammalian host 1 .

VECTORS: Sand flies of the genus Phlebotemus or Lutzomyia 10, 11 .

SECTION IV STABILITY AND VIABILITY

DRUG SUSCEPTIBILITY: Susceptibility has been observed for systemic agents such as antimony-based
drugs, amphotericin, paromomycin, and oral miltefosine 8 . Pentamidine is not preferred but has shown
efficacy against relapse patients. A new agent, sitamaquine, has shown a 50% cure rate 8 . Combination
treatments may be used against pathogens with developed drug resistance. When administering parenteral
treatment such as sodium-stibogluconate, factors such as risk for mucosal leishmaniasis development, and
number, size, or complication of lesions of ulceration should be considered 16 .

DRUG RESISTANCE: Resistance against sodium antimony gluconate has been documented for all
species 4 .

SUSCEPTIBILITY TO DISINFECTANTS: Susceptible to 1% sodium hypochlorite, 2% TriGene, 70%

ethanol, 0.1% hand soap, 2% glutaraldehyde, formaldehyde 17, 18 .

PHYSICAL INACTIVATION: Leishmania spp. do not survive autoclaving condition of 121C for 15
minutes 17 . Their 100% lethal temperature is much lower than this (50C).

SURVIVAL OUTSIDE HOST: Does not survive outside host or culture, but remains viable for 35 days in
whole blood kept at 4 C 19 .

SECTION V - FIRST AID / MEDICAL

SURVEILLANCE: Monitor for symptoms. Diagnosis is made through microscopic identification of
amastigotes in stained specimens from lesions. Identify parasite with real-time PCR of biopsy specimens
from lesion fluid, western blot, rk39 immunochromatographic test, serological tests such as
immunofluorescence assay (IIFA) and ELISA, and direct agglutination test 4 . Species can be distinguished
by targeting repetitive and polymorphic sequences by restriction enzymes 20 .

FIRST AID/TREATMENT: Administer appropriate drug therapy.

IMMUNIZATION: None

PROPHYLAXIS: None

SECTION VI - LABORATORY HAZARD

LABORATORY-ACQUIRED INFECTIONS: Twelve reported laboratory acquired infections 21 .

SOURCE/SPECIMENS: Infective stages may be present in blood, faeces, lesion exudates, and infected
arthropods 21 .

PRIMARY HAZARDS: Accidental parenteral exposures, aerosols, vector-borne transmission, mucosal

(mouth, nose, eyes), ingestion 21 .

SPECIAL HAZARDS: Contact with lesion material, faeces, or blood, or receiving a bite from experimentally
or naturally infected mammals 21 .

SECTION VII - EXPOSURE CONTROLS / PERSONAL PROTECTION

RISK GROUP CLASSIFICATION: Risk Group 2 22 .

CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices

for work involving infectious or potentially infectious materials, animals, or cultures. (Please note that
containment requirements may differ depending on volume, production method, concentration, or
additional factors which may alter the risk of potential infection, exposure, and/or environmental release).
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PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is
unavoidable. Eye protection must be used where there is a known or potential risk of exposure to
splashes 23 .

OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large
volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other
sharp objects should be strictly limited. Additional precautions should be considered with work involving
animals or large scale activities 23 .

SECTION VIII - HANDLING AND STORAGE

SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and
apply an appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient
contact time before clean up 23 .

DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism
by autoclave, chemical disinfection, gamma irradiation, or incineration before disposing 23 .

STORAGE: The infectious agent should be stored in leak-proof containers that are appropriately
labelled 23 .

SECTION IX - REGULATORY AND OTHER INFORMATION

REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under
many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food
Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they
are compliant with all relevant acts, regulations, guidelines, and standards.

UPDATED: September 2011

PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada

Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are
compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or
reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are
frequent and this information may not be completely up to date.

Copyright

Public Health Agency of Canada, 2011

Canada

REFERENCES:
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Date Modified: 2011-09-08

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