KALA AZAR

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KALA AZAR
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
HHW(NIHFW)New Delhi Sr.D.M.O/ON STUDY
LEAVE INDIAN RAILWAY MEDICAL SERVICE
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SYNONYMS
kala azar, black fever, sandfly disease, Dum-Dum
fever and espundia.
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PROMASTIGOTES
AMASTIGOTES
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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

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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

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• 1756RusselThe first description in English
• 1898Borovsky noted the protozoal nature of the
  organism
• 1903Leishman identified the parasite
• 1903Donovan described identical organisms in a
  splenic puncture

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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)

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Visceral leishmaniasis

• irregular bouts of fever
• substantial weight loss
• swelling of the spleen and liver
• and anaemia

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CUTANEOUS LEISHMANIASIS

• skin ulcers on the exposed parts of the body,
  such as the face, arms and legs

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MUCOCUTANEOUS LEISHMANIASIS OR ESPUNDIA

• mucous membranes of the nose
• mouth
• and throat cavities

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LIFE CYCLE
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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.
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GOAL OF NATIONAL HEALTH POLICY (INDIA) 2002

• ELIMINATION OF KALA AZAR 2010

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STRATEGY

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

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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.
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EARLY DIAGNOSIS

• L.D BODIES (SPLEEN, BONE MARROW, LYMPH NODE)
• ALDEHYDE TEST
• ELISA
• Polymerize chain reaction (PCR)

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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.

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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

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