Leshmaniasis or kala azar

ug class on leishmaniasis/ kala azar taken for 3rd MBBS students. also information in pictorial form on all types of leishmaniasis with epidemiology.
reference -Paniker's Parasitology and Manson's tropical diseases.

1. LEISHMANIASIS Dr. Mamta T.G. MD Community Medicine (JIPMER) Asst. Prof., Mamata Medical College

2. Leishmaniasis

3. Leishmaniasis It’s a communicable disease. Leishmaniasis are a group of protozoal diseases caused by parasites of genus “ Leishmania”. Genus Leishmania is named after Sir William Leishman, who discovered the flagellate protozoa causing Kala-azar, the Indian visceral leishmaniasis. Majority of leishmaniasis are zoonoses involving wild/ domestic mammals (rodents , canines). Kala-Azar/Dum-Dum fever in India

4. Various syndromes in humans Kala-azar/ visceral leishmaniasis (V.L) Cutaneous leishmaniasis (C.L) Muco-cutaneous leishmaniasis (M.C.L) Anthroponotic or urban cutaneous leishmaniasis(A.C.L) Zoonotic or rural cutaneous leishmaniasis (Z.C.L) Post-Kala-azar dermal leishmaniasis ( P.K.D.L ) Kala-azar=black sickness

5. PROBLEM STATEMENT

6. Visceral leishmaniasis or Kala-azar is a major public health problem in many parts of world. According to WHO, 5,00,000 cases of visceral leishmaniasis occur every year. Of these new cases, 90% are found in the Indian subcontinent and Sudan and Brazil. The disease occurs in endemic, epidemic, or sporadic forms. Major epidemics of the disease are currently found in India, Brazil, and Sudan . Problem Statement

7. The resurgence of Kala-azar in India , beginning in the mid1970s assumed epidemic proportions in 1977 and involved over 1,10,000 cases in humans. Initially, the disease was confined to Bihar . Since then, the cases are increasing and involving newer areas. The epidemic extended to West Bengal and first outbreak occurred in 1980 in Malda district. At present , the disease has established its endemicity in 31 districts in Bihar , 11 districts in West Bengal , 5 districts in Jharkhand , and 3 districts in Uttar Pradesh . Sporadic cases have been reported from Tamil Nadu, Maharashtra, Karnataka, and Andhra Pradesh. Problem Statement- India

8. Epidemiological determinants Agent factors The causative organisms are L.donovani for V.L L.tropica for C.L L.braziliensis for M.C.L Reservoir-animals : Dogs, Jackals, Foxes and Rodents.

9. 2. Host –Factors Age : Peak age incidence 5 to 9 years. Sex : Males are affected twice to females. Population movement : From endemic to non-endemic areas. Socio-economic status : Strikes poorest of poor. Occupation : Workers of forestry, mining, fishing Immunity : Gives lasting immunity.

10. 3. Environmental Factors Altitude : Confined to plains. Season : During and after rains(peak in November and april ). Rural areas : Suitable for breeding of sand fly. Vectors : Phlebotomus argentipes for V.L P.papatasi P.sergenti Development Projects : Cultivation projects, Colonization, migrants } C.L

11. Mode of transmission By bite and contact when insect is crushed during act of feeding. Transmission also takes place through contaminated blood transfusion. Extrinsic incubation period is 6-9 days. Incubation period is about 1-4 months.

12. 1 6 5 4 3 2

13. Clinical features VL : Fever Splenomegaly Hepatomegaly Anaemia Weight loss Darkening of skin of face, hand, feet, abdomen Lymphadenopathy PKDL : Multiple nodular infiltration of skin without ulceration.

14. CL : characterized by painful ulcers. These are restricted to skin. (DD- leprosy) Variant – diffuse C.L. MCL : Similar to CL but appears around margin of mouth and nose

15. Tapir nose

16. Lab diagnosis

17. 1) Parasitological diagnosis : Demonstration of LD Bodies in the aspirations of spleen, liver, bone marrow, lymph nodes or in the skin. 2) Aldehyde test of Napier : Used for diagnosis of VL. 1-2 ml of serum from a patient of VL and a drop or 2 drops of 40% formalin is added. +ve test Jellification to milk -It becomes positive 2-3 months after on set of disease and reverse to negative 6months after cure. -It also positive in reversed Ab/Gb ratio. →

18. 3) Serological test : DAT, ELISA,IFAT ELISA used for diagnosis as well as epidemiological field survey. 4) Leishmanin(montengro) test : It’s a skin test. Induration of 5mm or more is positive. Usually positive after 4-6 weeks after onset of case of C.L and M.C.L. -ve in active phase of V.L and becomes +ve in 75% of people after recovery. 5) Hematological findings : Progressive leucopenia, anaemia, reversed Ab/Gb ratio. E.S.R is increased.

19. MONTENIGRO TEST

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21. Control measures 1) control of reservoir : Active and passive case detection and treatment. House to house visits and mass surveys. Treatment : Pentavalent antimony compounds are used. Recommended schedule : Sodium stibogluconate 20mg/KG daily for 20 days. Second line drug: Pentamidine isethionate 3mg/KG for 10 days. Amphoterecin B 1mg/KG for 20 days. Milteforsine 2.5mg/KG for 4 weeks. Animal reservoir : Dogs & rodent control programme

22. 2) Sand fly control: DDT is first choice of insecticide. BHC is used for resistance cases. Sanitation measures : Elimination of breeding places and location of cattle shed at a far distance.

23. 3) Personal prophylaxis Health education. Individual protect measures like 1. Avoiding sleeping on the floor. 2.Using fine mesh nets. Insect repellants for temporary protection. Keeping environment clean.

24. Thank you

25. Assessing your understanding of Leishmaniasis

26. Kala-azar incidence & mortality in India (2000-2006) YEAR CASES DEATHS 2000 14753 150 2001 12239 213 2002 12140 168 2003 18214 210 2004 24479 155 2005 31217 115 2006(End of July) 18824 104