Epidemiology of LEISHMANIASIS.pptx................................
- 2. INTRODUCTION • The leishmaniases are a group of diseases caused by the protozoa parasite Leishmania. Over 20 Leishmania species known to be infective to humans are transmitted by the bite of infected female phlebotomine sandflies. There are three main types of leishmaniasis: i) Visceral , often known as kala-azar and the most serious form of the disease (VL); ii) Cutaneous , the most common (CL); and iii) Mucocutaneous
- 3. PROBLEM STATEMENT • As of January 2020, 56 VL-endemic countries (73%) and 59 CL-endemic countries (66%) reported data to the WHO Global Leishmaniasis programme for 2018. • Over 90% of global VL cases were reported from seven countries: Brazil, Ethiopia, India, Kenya, Somalia, South Sudan and Sudan.
- 4. Visceral leishmaniasis Visceral leishmaniasis (VL), also known as kala-azar is fatal if left untreated in over 95% of cases. It is characterized by irregular bouts of fever, weight loss, enlargement of the spleen and liver, and anaemia. Most cases occur in Brazil, East Africa and in India. An estimated 50 000 to 90 000 new cases of VL occur worldwide annually, with only between 25 to 45% reported to WHO. It remains one of the top parasitic diseases with outbreak and mortality potential. In 2018, more than 95% of new cases reported to WHO occurred in 10 countries: Brazil, China, Ethiopia, India, Iraq, Kenya, Nepal, Somalia, South Sudan and Sudan
- 5. Cutaneous leishmaniasis Cutaneous leishmaniasis (CL) The most common form of leishmaniasis and causes skin lesions, mainly ulcers, on exposed parts of the body, leaving life- long scars and serious disability or stigma. About 95% of CL cases occur in the Americas, the Mediterranean basin, the Middle East and Central Asia. In 2018 over 85% of new CL cases occurred in 10 countries: Afghanistan, Algeria, Bolivia, Brazil, Colombia, Iran (Islamic Republic of), Iraq, Pakistan, the Syrian Arab Republic and Tunisia. It is estimated that between 600 000 to 1 million new cases occur worldwide annually
- 6. Mucocutaneous leishmaniasis Mucocutaneous leishmaniasis Leads to partial or total destruction of mucous membranes of the nose, mouth and throat. Over 90% of mucocutaneous leishmaniasis cases occur in Bolivia (the Plurinational State of), Brazil, Ethiopia and Peru.
- 7. EPIDEMIOLOGICAL DETERMINANTS Leishmaniasis Is transmitted by the bite of infected female phlebotomine sandflies which can transmit the protozoa Leishmania.
- 8. Vector • Although only one genus transmitting Leishmania to humans (Lutzomyia). • Phlebotomus is considered the vector of leishmaniasis. Organisms • Visceral disease is caused by Leishmania donovani, L. infantum, or L. chagasi,but occasionally causes 15 species of Leishmania. Risk factors • Poverty , malnutrition, deforestation, lack of sanitation, suppressed immune system.
- 10. PATHOGENESIS
- 11. Signs and symptoms Cutaneous leishmaniasis • Unpleasant -looking scar • Widespread skin lesions which resemble leprosy
- 12. Mucocutaneous leishmaniasis Mucocutaneous leishmaniasis Skin and mucosal ulcers Damage primarily of the nose and mouth. Runny or stuffy nose Nosebleeds Difficulty breathing
- 13. Visceral leishmaniasis kala-azar ('black fever') Weight loss Weakness Fever that lasts for weeks Enlarged spleen Enlarged liver Decreased production of blood cells Bleeding Other infections Swollen lymph nodes
- 14. Post-kala-azar dermal leishmaniasis Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL); it is characterised by a macular, maculopapular, and nodular rash in a patient who has recovered from VL and who is otherwise well. Despite being called "post kala azar", 29% of cases appear from people who never had kala azar, and who had an asymptomatic infection previously.
- 15. DIAGNOSIS CLINICAL • Most infections are diagnosed clinically. • The patient has an irregular fever,anemia and leukopenia hepatosplenomegaly and bone marrow suppression are characteristics • LAB INVESTICATIONS • Haematogical findings viz anemia ,leukopenia, thrombocytopenia and hypergamaglobulinemia. • WBC : RBC ratio is 1:1500 or even 1:2000 • Raised ESR
- 16. CONTROL MEASURES • Control the reservoir • Treatment of the cases • Sand fly control • Personal prophylaxis • Active and passive reduction of the cases and treatment of those who found to be infected. • House to house visit. • Mass surveys in endemic areas for yearly reduction of the cases.
- 17. VISCERAL LEISHMANIASIS • Microscopic examination • Blood cultures • Serological test- ELISA • Strip test- Using K39(Re-combinent protein)
- 18. CUTANEOUS AND MUCOCUTANIOUS LEISHMANIASIS • Staining method-Giemsa-Stain(Smears of dermal scrappings) • In vitro cultures(Using Aspirates from lymph nodes and skin lesions) • Bioxy Specimens for culture and PCR methods • LEISHMANIN TEST • +ve in 6-8 weeks after recovery • Delayed hyper sensitivity • +ve in African kala-asar not in Indian kala-asar • -ve in PKDL , untreated cases
- 19. TREATMENT Visceral Lieshmaniasis Penta valent antimonial compounds – inj.sodium stibogluconate(pentostam)IV/IM 20mg/kg body wt for 28 days • Inj pentamidine IM 2-4mg/kg body wt ofr 10-15 days • Inj Liposomal amphotericine B IV 2-5mg/kg qd(total 2- 3gm given) • Allopurinol oral /IV 20mg/kg for 3 days
- 20. Cutaneous Leishmaniasis Self healing (within 6 months) Penta valent antimonial compounds IV/IM 20mg/kg qd for 10-20 days pentamidine IV/IM 3mg/kg for 4 doses 2mg/kg for 7 doses oral fuconazole 200mg qdbd for 6 weeks ketoconazole 600mg/day 28days vi) Itraconazole 200mg bd for 28 days Dapsone 100mg bd for 6 weeks local topical – Drug therapy Non drug therapy-local Cryo
- 21. Mucocutaneous leishmaniasis i)Penta valent antimony IVIM 20mg/kg qd for 28 days ii)Amphotericine B (Deoxy cholate) IV 1mg/kg qd (Total 20-40 mg) iii)Penta midine IVIN 2-4mg/kg thrice/weekly for >15 doses
- 22. Preventive measures Early diagnosis and effective prompt treatment Reduces the prevalence of the disease and prevents disabilities and death. It helps to reduce transmission and to monitor the spread and burden of disease. Currently there are highly effective and safe anti- leishmanial medicines particularly for visceral leishmaniasis, although they can be difficult to use. Social mobilization and strengthening partnerships
- 23. Preventive measures • Vector control helps to reduce or interrupt transmission of disease by decreasing the number of sandflies. Control methods include insecticide spray, use of insecticide–treated nets, environmental management and personal protection. • Effective disease surveillance is important to promptly monitor and act during epidemics and situations with high case fatality rates under treatment. • Control of animal reservoir hosts is complex and should be tailored to the local situation.
- 24. RESEARCH Leishmaniasis vaccine • vaccine which would prevent leishmaniasis. As of 2017, no vaccine for humans was available. Currently some effective leishmaniasis vaccines for dogs exist. • Parasite which causes leishmaniasis is Leishmania, which is a Trypanosomatida. The disease spreads from sandflies. Animals such as dogs can be a vector having the parasite, spreading it to sandflies, and from sandflies to humans. A vaccination strategy to control or eliminate Leishmaniasis might include developing a vaccine.
- 25. REFERENCES 1. Park.K (2017) , Textbook of preventive and social medicine, 24th ed, Banarrsidas Bhanot public, Jabalpur 2. Marcia stanhope (2008), public Health Nursing, 7th ed, social medicine, 1st ed, Jaypee brothers public, New delhi. 3. WHO(1984).Strategies for the prevention of blindness in National Programmes. A Primary health care approach. 4. Internet(2006);National Vector Borne Disease Control Programme, DGHS, Ministry of Health and Family Welfare, New Delhi.
- 26. Expected questions I. Essay:(10 marks) 1. Draw the diagram of life cycle of leishmaniasis and explain briefly. II. Short notes:(5 marks) 1. Mode of transmission of leishmaniasis 2. Control and elimination of leishmaniasis III.Short answers:(2 marks) 1. Draw the diagram of pathogenesis 2. Mention the treatment stratergies of leishmaniasis.