Leishmaniasis PDF 2019-2020

LEISHMANIASIS Dr. Mohamed Sryh FACULTY OF MEDICINE ELMERGIB UNIVERSITY Dr. Mohamed Sryh 1  LEISHMANIASIS Leishmaniasis are a group of protozoal diseases. caused by parasites of the genus Leishmania. transmitted to man by the bite of female phl...

LEISHMANIASIS Dr. Mohamed Sryh FACULTY OF MEDICINE ELMERGIB UNIVERSITY Dr. Mohamed Sryh 1  LEISHMANIASIS Leishmaniasis are a group of protozoal diseases. caused by parasites of the genus Leishmania. transmitted to man by the bite of female phlebotomine sandfly. The majority of the leishmaniasis are zoonoses. An estimated 700 000 to 1 million new cases and some 26 000 to 65 000 deaths occur annually. Dr. Mohamed Sryh 2  LEISHMANIASIS various syndromes in humans kala-azar or visceral leishmaniasis (VL), cutaneous leishmaniasis (CL), muco-cutaneous leishmaniasis (MCL), Dr. Mohamed Sryh 3  LEISHMANIASIS Geographical distribution Leishmaniasis is endemic in many countries in tropical and subtropical regions, including Africa, Central and South Americas, Asia and the Mediterranean region. More than 90 per cent of all cases of cutaneous leishmaniasis occur in Afghanistan, Algeria, Brazil, Colombia, the Islamic Republic of Iran, Peru, Saudi Arabia and the Syrian Arab Republic. More than 90 per cent of all cases of mucosal leishmaniasis occur in Brazil, Ethiopia, Peru and Bolivia. About 90 per cent of the global incidence of kala-azar (visceral leishmaniasis) are reported in Six countries, namely India, Bangladesh, Brazil, Nepal, Ethiopia, South Sudan and Sudan. Dr. Mohamed Sryh 4  LEISHMANIASIS Geographical distribution Dr. Mohamed Sryh 5  LEISHMANIASIS Geographical distribution Dr. Mohamed Sryh 6  ‫‪LEISHMANIASIS‬‬ ‫‪In Libya‬‬ ‫‪1. Infantile visceral leishmaniasis‬‬ ‫يقتصر وجودها علي بعض مناطق الجبل االخضر‬ ‫ومنطقة اوباري جنوب ليبيا‬ ‫‪2. Zoonotic cutaneous leishmaniasis‬‬ ‫متوطن في مناطق شمال غرب ليبيا بإستثناء مدينة‬ ‫طرابلس وضواحيها‪ ,‬اغلب البؤر تتركز في مناطق خط‬ ‫الجبل الغربي والمناطق الممتدة في سهل الجفارة و>لك‬ ‫من وازن والغزايا علي الحدود التونسية غربا الي‬ ‫ترهونة وبني وليد شرقا‪.‬اال انه في السنوات االخيرة‬ ‫ازدادت رقعة انتشار المرض لتشمل مناطق جديدة مثل‬ ‫القداحية والهيشة والوشكة وتاورغاء وانتشاره مستمر‬ ‫شرقا في اتجاه مصراته وزليتن والخمس‪.‬‬ ‫‪Dr. Mohamed Sryh‬‬ ‫‪7‬‬  Fig 5. Spatiotemporal analysis of the Libyan CL. Amro A, Al-Dwibe H, Gashout A, Moskalenko O, Galafin M, et al. (2017) Spatiotemporal and molecular epidemiology of cutaneous leishmaniasis in Libya. PLOS Neglected Tropical Diseases 11(9): e0005873. https://doi.org/10.1371/journal.pntd.0005873 https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0005873 Dr. Mohamed Sryh 8  LEISHMANIASIS Epidemiological determinants Agent factors (a) AGENTS : The leishmania are intracellular parasites. They infect and divide within macrophages. At least nineteen different leishmania parasites have been associated with human infection. Leishmania donovani is the causative agent of kala-azar (VL); L. tropica is the causative agent of cutaneous leishmaniasis (oriental sore); L. braziliensis is the causative agent of muco-cutaneous leishmaniasis. Dr. Mohamed Sryh 9 Dr. Mohamed Sryh 10  LEISHMANIASIS Epidemiological determinants Agent factors (b) RESERVOIRS OF INFECTION : There is a variety of animal reservoirs, e.g., dogs, jackals, foxes, rodents and other mammals. Dr. Mohamed Sryh 11  LEISHMANIASIS Epidemiological determinants Agent factors ‫ يسبب هدا المرض في ليبيا طفيلي اللشمانيا نوع‬ Leishmania Major MON-25 Phlebotomus ‫ ينقل مرض اللشمانيا ذبابة الرمل نوع‬ papatasi ‫ وجرذ‬Psammomys Obesus ‫ جرذ الرمل السمين‬ ‫تعمل كعوائل‬Meriones libycus ‫المريونس الليبي‬.‫خازنة للمرض‬ Dr. Mohamed Sryh 12 Dr. Mohamed Sryh 13  LEISHMANIASIS Epidemiological determinants Host factors (a) AGE: Kala-azar can occur in all age groups including infants below the age of one year (b) SEX: Males are affected twice as often as females. (c) POPULATION MOVEMENT : Movement of population (migrants, labourers, tourists) between endemic and non-endemic areas can result in the spread of infection. (d) SOCIO-ECONOMIC STATUS: Poverty increases the risk for kala-azar. Human behaviour, such as sleeping outside or on the ground, may increase risk. Dr. Mohamed Sryh 14  LEISHMANIASIS Epidemiological determinants Host factors (e) MALNUTRITION: Diets lacking protein-energy; iron, vitamin A and zinc increases the risk. (f) OCCUPATION: farming practices, forestry, mining and fishing have a great risk of being bitten by sandflies. (g) IMMUNITY : Recovery from kala-azar and oriental sore gives a lasting immunity. Dr. Mohamed Sryh 15  LEISHMANIASIS Epidemiological determinants Environmental factors (a) ALTITUDE : Kala-azar is mostly confined to the plains; it does not occur in altitudes over 2000 feet (600 metres). (b) SEASON : In the past epidemics, two peaks, one in November and another in March-April were reported. Generally there is high prevalence during and after rains. (c) CLIMATE CHANGES : by changes in rainfall, temperature and humidity. effects on vector and reservoir hosts by altering their distribution and influence their survival. Drought famine and flood resulting from climate changes can lead to massive displacement and migration of people to areas with transmission of kala-azar, and poor nutrition could compromise their immunity. Dr. Mohamed Sryh 16  LEISHMANIASIS Epidemiological determinants Environmental factors (d) RURAL AREAS : The disease is generally confined to rural areas, where conditions for the breeding of sandflies readily exist compared to urban areas. (e) VECTORS: Overcrowding, ill-ventilation and accumulation of organic matter in the environment facilitate transmission. Their habits are primarily nocturnal. Only the females bite. (f) DEVELOPMENT PROJECTS: Forest clearing, and cultivation projects, large water resource schemes, and colonization and resettlement programmes are bringing human beings into areas of high vector and reservoir concentration. Dr. Mohamed Sryh 17  LEISHMANIASIS Mode of transmission leishmaniasis is transmitted from person to person by the bite of the female phlebotomine sandfly, P. papatasi Transmission may also take place by contamination of the bite wound By contact when the insect is crushed during the act of feeding. Transmission of kala-azar has also been recorded by blood transfusion and is also possible by contaminated syringes and needles. Dr. Mohamed Sryh 18 Dr. Mohamed Sryh 19  LEISHMANIASIS Incubation period The incubation period in man is quite variable, Generally 1 to 4 months; range is 10 days to 2 years. Dr. Mohamed Sryh 20  LEISHMANIASIS Clinical features 1. Kala-azar (VL) fever splenomegaly and hepatomegaly anaemia and weight-loss family history of the disease Darkening of the skin of the face, hands, feet and abdomen Atypical features of the disease (e.g., lymphadenopathy) Kala-azar, if left untreated, has a high mortality. Dr. Mohamed Sryh 21  LEISHMANIASIS Clinical features 2. Cutaneous leishmaniasis The disease may be mistaken for leprosy. Painful ulcers in the parts of the body exposed to sandfly bites (e.g., legs, arms or face) reducing the victim's ability to work. Dr. Mohamed Sryh 22  LEISHMANIASIS Clinical features 3. Muco-cutaneous leishmaniasis Ulcers similar to the oriental sore (CL) appear around the margins of mouth and nose. It can mutilate the face so badly that victims may become social outcasts. Dr. Mohamed Sryh 23  LEISHMANIASIS Laboratory diagnosis 1. Parasitological diagnosis The demonstration of the parasite LD bodies in the aspirates of the spleen, liver, bone marrow, lymph nodes or in the skin (in the case of CL) is the only way to confirm VL or CL conclusively. The parasite must be isolated in culture to confirm the identity of the parasite. Dr. Mohamed Sryh 24  LEISHMANIASIS Laboratory diagnosis 2. Serological tests Direct Agglutination test (DAT), rk39 dipstick test, ELISA indirect fluorescent antibody test (IFAT) Dr. Mohamed Sryh 25  LEISHMANIASIS Laboratory diagnosis 3. Leishmanin (Montenegro) test This test is based on skin reaction. Leishmanin is a preparation of 106 per ml washed promastigotes of leishmania, suspended in 0.5 per cent phenol saline or merthiolate. Sterile and standardized preparations are available commercially. An intradermal injection of 0.1 ml on the flexor surface of the forearm is given and examined after 48 to 72 hours. Induration is measured and recorded. An induration of 5 mm or more is considered positive. Dr. Mohamed Sryh 26  LEISHMANIASIS Control Measures 1. Control of reservoir active and passive case detection and treatment of those found to be infected may be sufficient to abolish the human reservoir and control the disease. House-to-house visits and mass surveys may be undertaken in endemic areas for early detection of cases. Dr. Mohamed Sryh 27  LEISHMANIASIS Control Measures TREATMENT 1. First line drugs- short-term sodium stibogluconate (SSG) IM or IV Amphotericin B intravenous 2. First line drugs- long-term SSG IM or IV Miltefosine Dr. Mohamed Sryh 28  LEISHMANIASIS Control Measures TREATMENT 3. Cryotherapy local application of liquid nitrogen (N2) at a temperature of -196 °C, is used in cryotherapy of CL Dr. Mohamed Sryh 29  LEISHMANIASIS Control Measures Animal reservoirs extensive dog and rodent control programmes have contributed greatly to the reduction in the number of human cases. Dr. Mohamed Sryh 30  LEISHMANIASIS Control Measures 2. Sandfly control The application of residual insecticides has proved effective in the control of sandflies. Insecticide spraying should be undertaken in human dwellings, animal shelters and all other resting places up to a height of 6 feet (2 metres) from floor level. Sanitation measures elimination of breeding places (e.g., cracks in mud or stone walls, rodent burrows, removal of firewood, bricks or rubbish around houses), location of cattle sheds and poultry at a fair distance from human dwellings, improvement of housing and general sanitation. Dr. Mohamed Sryh 31  LEISHMANIASIS Control Measures 3. Personal prophylaxis Health education individual protective measures: such as avoiding sleeping on floor, using fine-mesh nets around the bed. Insect repellents (in the form of lotions, creams, or sticks) There are no drugs for personal prophylaxis. Dr. Mohamed Sryh 32 Dr. Mohamed Sryh 33