alzaiem alazhari university faculty of public & environmental health seminar on by: zakia elgali...
TRANSCRIPT
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ALZAIEM ALAZHARI UNIVERSITYFaculty of public & Environmental health
Seminar on
BY: ZAKIA ELGALIMAY 2005
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Local names
DOPAL (الدوبال)
KALA- ZAR (كالزار)
ABO SIFEER ( صفير (ابو
MARD ELSSEED ( الصعيد (مرض
Elsemah (السميح)
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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
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Sign & symptoms
Prolonged irregular fever
Enlarged spleen Weight lost Enlarged lymph nodes Anemia Cough Nasal bleeding
(Jaundice Odema)
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Vl pt
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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
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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
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Disruption of disease in the world
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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 .
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Kala Azar distribution in Sudan
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% 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 %
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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
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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
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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
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ENDEMICITY OF THE DISEASE
East African Countries and India
Among children (male more affected than female)
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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
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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.).
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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…
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Vector
More than 30 spp of Phelebotomus Genus incriminated as vectors..
40 spp are potential.
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Vector classification
Phylum: Sarcomastigophora Order: Kinetoplastida Family: Trypanosmatidae Genus: Leishmania
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Life cycle
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promastigate
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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.
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reservoir
In rodent’s
In carnivores
Anthroponotic not ruled yet
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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
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Incubation period
3weeks -------2 years after exposure
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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.
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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
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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,
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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)