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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 complexFootnote 1,Footnote 2.

CHARACTERISTICS: Leishmania spp. belong to the family Trypanosomatidae, order KinetoplastidaFootnote 1. Leishmania spp. are characterized by a flagellated promastigote stage in a sandfly, and a non-motile amastigote stage within macrophages in mammalsFootnote 3,Footnote 4. The amastigotes, known as Leishman-Donovan (LD) bodies, are small, round or oval, and measures 3 to 5 µmFootnote 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 nodulesFootnote 4,Footnote 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 periodontitisFootnote 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 anemiaFootnote 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 faceFootnote 7.

EPIDEMIOLOGY: Worldwide distribution. It is endemic in 88 countries, mostly developing countries, including parts of Europe, South America, Africa and AsiaFootnote 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 leishmaniasisFootnote 4,Footnote 8,Footnote 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 SyriaFootnote 4,Footnote 8.

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

INFECTIOUS DOSE: Unknown.

MODE OF TRANSMISSION: Transmitted by the bite of an infected female sandfly of the genus Phlebotemus or Lutzomyia Footnote 10,Footnote 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 reportedFootnote 1,Footnote 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 placenta (mother to child) is rareFootnote 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 marsupialsFootnote 2,Footnote 4,Footnote 14,Footnote 15.

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

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

SECTION IV – STABILITY AND VIABILITY

DRUG SUSCEPTIBILITY: Susceptibility has been observed for systemic agents such as antimony-based drugs, amphotericin, paromomycin, and oral miltefosineFootnote 8. Pentamidine is not preferred but has shown efficacy against relapse patients. A new agent, sitamaquine, has shown a 50% cure rateFootnote 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 consideredFootnote 16.

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

SUSCEPTIBILITY TO DISINFECTANTS: Susceptible to 1% sodium hypochlorite, 2% TriGene, 70% ethanol, 0.1% hand soap, 2% glutaraldehyde, formaldehydeFootnote 17,Footnote 18.

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

SURVIVAL OUTSIDE HOST: Does not survive outside host or culture, but remains viable for 35 days in whole blood kept at 4 °CFootnote 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 testFootnote 4. Species can be distinguished by targeting repetitive and polymorphic sequences by restriction enzymesFootnote 20.

FIRST AID/TREATMENT: Administer appropriate drug therapy.

IMMUNIZATION: None

PROPHYLAXIS: None

SECTION VI - LABORATORY HAZARD

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

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

PRIMARY HAZARDS: Accidental parenteral exposures, aerosols, vector-borne transmission, mucosal (mouth, nose, eyes), ingestionFootnote 21.

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

SECTION VII - EXPOSURE CONTROLS / PERSONAL PROTECTION

RISK GROUP CLASSIFICATION: Risk Group 2Footnote 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).

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 splashesFootnote 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 activitiesFootnote 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 upFootnote 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 disposingFootnote 23.

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

Footnote 1
Dey, A., & Singh, S. (2006). Transfusion transmitted leishmaniasis: a case report and review of literature. Indian Journal of Medical Microbiology, 24(3), 165-170.
Footnote 2
Petersen, C. A. (2009). Leishmaniasis, an emerging disease found in companion animals in the United States. Topics in Companion Animal Medicine, 24(4), 182-188. doi:10.1053/j.tcam.2009.06.006
Footnote 3
Li, Q., Zhou, Y., Yao, C., Ma, X., Wang, L., Xu, W., Wang, Z., & Qiao, Z. (2009). Apoptosis caused by Hsp90 inhibitor geldanamycin in Leishmania donovani during promastigote-to-amastigote transformation stage. Parasitology Research, 105(6), 1539-1548. doi:10.1007/s00436-009-1582-y
Footnote 4
Sinha, P. K., Pandey, K., & Bhattacharya, S. K. (2005). Diagnosis & management of leishmania/HIV co-infection. The Indian Journal of Medical Research, 121(4), 407-414.
Footnote 5
Murray, P. R., Baron, E. J., Jorgensen, J. H., Landry, M. L., Pfaller, M. A., & Yolken, R. H. (Eds.). (2003). Manual of Clinical Microbiology (8th ed.). Herdon, VA, United States of America: American Society for Microbiology.
Footnote 6
Kedzierski, L. (2010). Leishmaniasis Vaccine: Where are We Today? Journal of Global Infectious Diseases, 2(2), 177-185. doi:10.4103/0974-777X.62881
Footnote 7
Rathi, S. K., Pandhi, R. K., Chopra, P., & Khanna, N. (2005). Post-kala-azar dermal leishmaniasis: a histopathological study. Indian Journal of Dermatology, Venereology and Leprology, 71(4), 250-253.
Footnote 8
Moore, E. M., & Lockwood, D. N. (2010). Treatment of visceral leishmaniasis. Journal of Global Infectious Diseases, 2(2), 151-158. doi:10.4103/0974-777X.62883
Footnote 9
Clem, A. (2010). A current perspective on leishmaniasis. Journal of Global Infectious Diseases, 2(2), 124-126. doi:10.4103/0974-777X.62863
Footnote 10
Rocha, L. S., Falqueto, A., Dos Santos, C. B., Ferreira, A. L., da Graca, G. C., Grimaldi, G.,Jr, & Cupolillo, E. (2010). Survey of natural infection by Leishmania in sand fly species collected in southeastern Brazil. Transactions of the Royal Society of Tropical Medicine and Hygiene, doi:10.1016/j.trstmh.2010.02.005
Footnote 11
Gonzalez, M., Benito, F., Garcia, L., & Iglesias, A. (2009). Mucocutaneous Leishmaniasis: an imported illness with ENT repercussions. [Leishmaniasis mucocutanea: una enfermedad importada con repercusion en ORL] Acta Otorrinolaringologica Espanola, 60(4), 298-300. doi:10.1016/j.otorri.2009.01.006
Footnote 12
Quinnell, R. J., & Courtenay, O. (2009). Transmission, reservoir hosts and control of zoonotic visceral leishmaniasis. Parasitology, 136(14), 1915-1934. doi:10.1017/S0031182009991156
Footnote 13
Weiss, F., Vogenthaler, N., Franco-Paredes, C., & Parker, S. R. (2009). Leishmania tropica-induced cutaneous and presumptive concomitant viscerotropic leishmaniasis with prolonged incubation. Archives of Dermatology, 145(9), 1023-1026. doi:10.1001/archdermatol.2009.181
Footnote 14
Dougall, A., Shilton, C., Low Choy, J., Alexander, B., & Walton, S. (2009). New reports of Australian cutaneous leishmaniasis in Northern Australian macropods. Epidemiology and Infection, 137(10), 1516-1520. doi:10.1017/S0950268809002313
Footnote 15
Christensen, H. A., Arias, J. R., de Vasquez, A. M., & de Freitas, R. A. (1982). Hosts of sandfly vectors of Leishmania braziliensis guyanensis in the central Amazon of Brazil. The American Journal of Tropical Medicine and Hygiene, 31(2), 239-242.
Footnote 16
Zaghi, D., Panosian, C., Gutierrez, M. A., Gregson, A., Taylor, E., & Ochoa, M. T. (2010). New World cutaneous leishmaniasis: Current challenges in diagnosis and parenteral treatment. Journal of the American Academy of Dermatology, doi:10.1016/j.jaad.2009.08.045
Footnote 17
Wang, X., Jobe, M., Tyler, K. M., & Steverding, D. (2008). Efficacy of common laboratory disinfectants and heat on killing trypanosomatid parasites. Parasites & Vectors, 1(1), 35. doi:10.1186/1756-3305-1-35
Footnote 18
World Health Organization. (1993). Laboratory Biosafety Manual (2nd ed.)
Footnote 19
Grogl, M., Daugirda, J. L., Hoover, D. L., Magill, A. J., & Berman, J. D. (1993). Survivability and infectivity of viscerotropic Leishmania tropica from Operation Desert Storm participants in human blood products maintained under blood bank conditions. The American Journal of Tropical Medicine and Hygiene, 49(3), 308-315.
Footnote 20
Goto, H., & Lindoso, J. A. (2010). Current diagnosis and treatment of cutaneous and mucocutaneous leishmaniasis. Expert Review of Anti-Infective Therapy, 8(4), 419-433. doi:10.1586/eri.10.19
Footnote 21
Herwaldt, B. L. (2001). Laboratory-acquired parasitic infections from accidental exposures. Clinical Microbiology Reviews, 14(4), 659-88, table of contents. doi:10.1128/CMR.14.3.659-688.2001
Footnote 22
Human pathogens and toxins act. S.C. 2009, c. 24, Second Session, Fortieth Parliament, 57-58 Elizabeth II, 2009. (2009).
Footnote 23
Public Health Agency of Canada. (2004). In Best M., Graham M. L., Leitner R., Ouellette M. and Ugwu K. (Eds.), Laboratory Biosafety Guidelines (3rd ed.). Canada: Public Health Agency of Canada.