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*promastigote - 10-25 μm
**with flagellum
**transform from amastigote inside sandfly midgut
**proliferate inside midgut
**introduced into human skin directly from sandfly midgut during sandfly bite
**phagocytized by macrophage
*amastigote - 2-4 μm
*vector: sandfly
*host: human, dog, rodent
===sand flly===
*''Phlebotomus'' spp.
**Eurasian
*''Lutzomya'' spp.
**Latin America
*Feed during night
==clinical manifestation==
**Mediterranean, China, South America
**dog is reservoir
====diagnosis of visceral leishmania====
*smear of bone marrow aspiration, lymph node or spleen aspiration
**sensitivity 93-99% in spleen aspirate, 53-86% in bone marrow aspirate, 53-65% in lymph node aspirate
*culture in NNN media
*immunochromatographical detection of rk39 antigen
**dip stick form
====post kala-azar dermal leishmanisis (PKDL)====
*cutaneous leishmaniasis by ''L. donovani'' is reported in Sri Lanka
====diagnosis of cutaneous leishmaniasis====
*smear of fine needle aspirate or biopsy of skin lesion
*serological test is of no use; low sensitivity and variable specificity
===mucocutaneous leishmania===
*progressive ever without treatment
*secondary bacterial infection
====diagnosis of mucocutaneous leishmaniasis====
*leishmania is scarce in mucosal lesion
**strong local immune response
*serology or molecular
==emerging novel leishmaniasis==
*in Thailand
*''L. siamensis'', ''L. martiniquensis''
