ALZAIEM ALAZHARI UNIVERSITYFaculty of public & Environmental health

Seminar on

BY: ZAKIA ELGALIMAY 2005

Local names

DOPAL (الدوبال)

KALA- ZAR (كالزار)

ABO SIFEER ( صفير (ابو

MARD ELSSEED ( الصعيد (مرض

Elsemah (السميح)

Identification of the disease

suspect case: Any patient who live in or has travelled to an

endemic area presenting Fever of more than two weeks duration and malaria was ruled out, with one of the following signs:

Splenomegaly, or lymphadenopathy Confirmed case1: There are two ways of confirming Kala-azar Parasitological serological

Sign & symptoms

Prolonged irregular fever

Enlarged spleen Weight lost Enlarged lymph nodes Anemia Cough Nasal bleeding

(Jaundice Odema)

Vl pt

occurrence

The Leishmaniasis are a group of diseases endemic in 88 countries

they are the third most important vector-borne disease after malaria and lymphatic filariasis with an estimated 2.1 million disability adjusted life years

occurrence

Endemic in 88 countries. More than 90% of cutaneous leishmaniasis cases occur in Iran, Afghanistan, Syria, Saudi Arabia, Brazil and Peru.

More than 90% of visceral leishmaniasis cases occur in Bangladesh, Brazil, India and sudan

Disruption of disease in the world

Epidemiology of visceral leishmaniasis in Sudan:

Visceral leishmaniasis (VL, kala-azar) is endemic in the Sudan and has been reported since 1904 endemic area is in Gedarif S ,Uper Nile S,SinarS, Nourth Darfour, Blue Nile , Unity, South kordofan .

Kala Azar distribution in Sudan

% distribution of Kala Azar cases/ state 2003

% d is t r ib u t io n o f k a la - a z a r c a s e s / s t a t e y e a r 2 0 0 3

G e d a r e f7 6 %

S e n n a r5 %

U p p e r N i l e1 3 %

U n i t y4 %

O t h e r s 2 %

kala-azar cases year for year 2002 and 2003

340

293

230

830

684

767

0 100 200 300 400 500 600 700 800 900

January

February

March

mon

ths

cases

2003

2002

Distribution of Kala-azar by months Gedaref state

D i s t r i b u t i o n o f k a l a - a z a r c a s e s b y m o n t h s f o r y e a r s 2 0 0 1 / 2 0 0 2 / 2 0 0 3 , G e d a r e f S t a t e

01 0 02 0 03 0 04 0 05 0 06 0 07 0 08 0 09 0 0

M o n t h s

No.ca

ses

2 0 0 1

2 0 0 2

2 0 0 3

Distribution of Kala-azar by months Upper Nile

D i s t r i b u t i o n o f k a l a - a z a r c a s e s b y m o n t h s fo r y e a r s 2 0 0 1 / 2 0 0 2 / 2 0 0 3 , U p p e r N i l e S t a t e

0

5 0

1 0 0

1 5 0

2 0 0

2 5 0

M o n t h s

No.ca

ses

2 0 0 1

2 0 0 2

2 0 0 3

ENDEMICITY OF THE DISEASE

East African Countries and India

Among children (male more affected than female)

Agent/ host / environment

Worldwide, over 20 pathogenic species of leishmania parasite are known, the 7 important are:

L. donovani

L.tropica

L.mexicana; L.peruviana

L. maior, L.aethiopica,

and L.braziliensis

Causative agent

Parasitic protozoa of the genus Leishmania, transmitted to humans by sandflies.

Over 20 species and subspecies infect humans, each causing a different spectrum of symptoms. These range from simple, self-healing skin ulcers (e.g. due to infection with Leishmania major), to severe, life-threatening disease (e.g. visceral leishmaniasis caused by L. donovani s.l.). 

Agent/ host / environment

Asociated with: Cotton Black soil(Soil cracks)… Acaccia groop trees such as :

A.balanitis,A.syeal,A.aegyptica….. (Males of the Phelebotomus prefer

the necator of this trees and it occupied as a good habitat for wild resting adult…

Vector

More than 30 spp of Phelebotomus Genus incriminated as vectors..

40 spp are potential.

Vector classification

Phylum: Sarcomastigophora Order: Kinetoplastida Family: Trypanosmatidae Genus: Leishmania

Life cycle

promastigate

HIV/Leishmania Co infection

Specific Problems Absence of usual clinical features Associated opportunistic infections make

diagnosis difficult Serological test is frequently negative Treatment failures,relapses due to drug

Resistance and drug toxicities are common.Many drugs are expensive.

reservoir

In rodent’s

In carnivores

Anthroponotic not ruled yet

L.donovani

Reservoir:

Mediterranean, S.W.Asia: dogs foxes

China: dogs

India: humans

Sudan, Chad: wild rodents and carnivores

Kenya: dogs

Central and South America: dogs,foxes

Incubation period

3weeks -------2 years after exposure

Susceptibility & resistance

IN VECTOR The only study carried out in Italy give

resistant ratio to DDT 1.08 And to Permethrin 1.41

IN PARASITE Recently, resistance to drugs has been

reported.

Method of control

PRIMARY

VECTOR CONTROLChemica & environmental controlPersonal protiction (itns mesh screening in houses ) Health education Reservoir control: elimination of feral dogs and screening of

domestic dogs.

SECONDARY Early Diagnosis & Prompt Treatment

TAIRTARY 1. Qualified The Disability

Drug resistance

Recently, resistance to drugs has been reported, requiring the use of more toxic drugs, such as amphotericin B. Most available drugs are costly,

Research area

Pathogenesis and host interactions Understanding mechanisms for drug resistance Impact of inequity of access to services and health

sector reform Socioeconomic, environmental, and behavioural risk

factors for infection and disease, especially in refugee populations in complex emergencies

Development of Leishmania diagnostic tests Development of vaccine Cost-effective delivery strategies for new drugs

against visceral leishmaniasis Development of strategies for use of insecticide

treated materials (ITNs)