DR. I. SELVARAJ I.R.M.

S
B.SC., M.B.B.S.,D.P.H., D.I.H.,(M.D) Community Medicine.,P.G.C H&HW(NIHFW)New Delhi

Sr.D.M.O/ON STUDY LEAVE

INDIAN RAILWAY MEDICAL SERVICE

SYNONYMS

kala azar, black fever, sandfly

disease, Dum-Dum fever and
espundia.

AMASTIGOTES

PROMASTIGOTES

GEOGRAPHICAL DISTRIBUTION
The leishmaniasis is endemic in 88 countries
on five continentsAfrica, Asia, Europe, North
America and South America.
350 million people at risk.
12 million people are affected by leishmaniasis
1.5-2 million new cases of leishmaniasis
estimated to occur annually.
500 000 new cases of VL which occur annually

INDIA
WEST BENGAL,ANDRA PRADESH,BIHAR, ASSAM,
EASTERN UTTAR PRADESH, COASTAL REGION OF TAMIL
NADU, & JHARHAND
HIGHEST NUMBER OF KALA-AZAR CASES IN MADRAS
CITY (18682) OCCURRED DURING THE DECADE 1951 TO
1960. THEREAFTER IT HAS SHOWN A CONTINUOUS
DOWNWARD TREND. A TOTAL OF 223 CASES OF KALAAZAR WERE REPORTED FROM 1971 TO 1983 IN MADRAS
AND THE MEAN INCIDENCE OF 28 CASES WERE
REPORTED BETWEEN 1971 AND 1977. FROM 1978 TO 1983
AN AVERAGE OF 4 CASES WERE REPORTED. (RECENT
TRENDS IN THE INCIDENCE AND EPIDEMIOLOGY OF
KALA-AZAR IN MADRAS CITY SIVAPARAKASAM, P;
PADMANABHAN, B; SADANAND, AV

1756;Russel:The first description in

English
1898;Borovsky noted the protozoal
nature of the organism
1903;Leishman identified the parasite
1903;Donovan described identical
organisms in a splenic puncture

TYPES OF LEISMANIASIS
VISCERAL LEISHMANIASIS (Bangladesh,
Brazil, India, Nepal and Sudan)
CUTANEOUS LEISHMANIASIS (Afghanistan,
Brazil, Iran, Peru, Saudi Arabia and Syria)
DIFFUSE CUTANEOUS LEISHMANIASIS
MUCO CUTANEOUS LEISHMANIASIS
(Bolivia, Brazil and Peru.
Post kala azar dermal leishmaniasis
(Endemic to India and the Sudan)

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
2010

STRATEGY
Interruption of transmission by
reducing vector population Indoor
Residual Insecticides
Early diagnosis & treatment
Health education programme

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)

TREATMENT

SODIUM ANTIMONY STIBO GLUCONATE

PENTAMIDINE ISTHIONATE
AMPHOTERICIN-B
Miltefosine (Impavido ) (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 Leishmania donovani.

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
If it is resistant , BHC

Ref: http://www.who.int/leishmaniasis/en/