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.
 PROMASTIGOTES
AMASTIGOTES
 GEOGRAPHICAL DISTRIBUTION

•The leishmaniasis is endemic in 88 countries

on five continents—Africa, 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 KALA-AZAR 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/