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