Transcript
LEISHMANIASIS
Dr. Priya Arora
ACMS
kala azar, black fever, sandfly
disease, Dum-Dum fever and
espundia.
SYNONYMS
• Currently, leishmaniasis occurs in 4 continents and is considered to be endemic in 88 countries, 72 of which are developing countries:
90% of all VL: Bangladesh, Brazil, India, Nepal and Sudan
90% of all MCL: Bolivia, Brazil and Peru
90% of all CL : Afghanistan, Brazil, Iran, Peru, Saudi Arabia and Syria
• Annual incidence: 1- 1.5 million cases of CL
: 500,000 cases of VL
• Prevalence: 12 million people
• Population at risk: 350 million
(WHO, 2010)
SITUATION IN INDIA• 40-50% of global burden
(Bora 1999, Natl Med J India)
48 districts affected
• Surveillance being done by NVBDCP
• INDIA: 13869 cases and 20 deaths by VL (2013)
• Endemic states in Eastern India: Bihar, Jharkhand, West Bengal, Uttar Pradesh
• Estimated 165.4 million population at risk in 4 states
(NVBDCP, 2010)
TYPES OF LEISMANIASIS
• VISCERAL LEISHMANIASIS
• CUTANEOUS LEISHMANIASIS
• DIFFUSE CUTANEOUS LEISHMANIASIS
• MUCO CUTANEOUS LEISHMANIASIS
• Post kala azar dermal leishmaniasis
Visceral leishmaniasis
• irregular bouts of fever
• substantial weight loss
• swelling of the spleen and liver
• and anaemia
CUTANEOUS LEISHMANIASIS
• skin ulcers on the exposed parts of
the body, such as the face, arms and legs
MUCOCUTANEOUS LEISHMANIASIS OR
ESPUNDIA
• mucous membranes of the nose
• mouth
• and throat cavities
LIFE CYCLE
1. Leishmaniasis is transmitted by the bite of female
phlebotomine sandflies. The sandflies inject the
infective stage, promastigotes, during blood meals.
2. Promastigotes that reach the puncture wound are
phagocytized by macrophages.
3.They transform into amastigotes.
4. Amastigotes multiply in infected cells and affect
different tissues.
5. Sandflies become infected during blood meals on
an infected host when they ingest macrophages
infected with amastigotes.
6. In the sandfly's midgut, the parasites differentiate
into promastigotes.
7. They multiply and migrate to the proboscis.
GOAL OF NATIONAL HEALTH POLICY (INDIA) 2002
ELIMINATION OF KALA AZAR
2015
STRATEGY
• Vector control through IRS with DDT up to 6 feet height from the ground twice annually
• Early Diagnosis and Complete treatment
• Information Education Communication
• Capacity Building
1. To provide early diagnosis and prompt
treatment;
2. To control the sandfly population through
residual insecticide spraying of houses
and through the use of insecticide-
impregnated bed nets;
3. To provide health education and produce
training materials;
4. To detect and contain epidemics in the early
stages;
5. To provide early diagnosis and effective
management for Leishmania/HIV coinfections.
EARLY DIAGNOSIS
• L.D BODIES (SPLEEN, BONE
MARROW, LYMPH NODE)
• ALDEHYDE TEST
• ELISA
• Polymerize chain reaction (PCR)
• rk 39 Rapid antigen based dipstick test
TREATMENT• SODIUM ANTIMONY STIBO GLUCONATE
• PENTAMIDINE ISTHIONATE
• AMPHOTERICIN-B
• Miltefosine oral drug (approval by the Indian and German Regulatory Authorities (2003)
• Phase III Trials with a first-generation vaccine (killed Leishmania organism mixed with a low concentration of BCG as an adjuvant) have also yielded promising results
• Leishmania major mixed with BCG have been successful in preventing infection with Leishmaniadonovani.
VECTOR CONTROL
• 75% DDT – 1 KG IN 3 GALLONS OF
WATER OR
• 50% DDT – 1.5 KG IN 3 GALLONS OF
WATER
• 6000 Sq. feet ( 100 mgm/Sq.foot)
• Up to 6 feet from ground level
• 2 rounds/ year
• If it is resistant , BHC
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