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2.  Leishmaniasis are group of protozoal diseases
caused by parasite of genus Leishmania, and
transmitted to humans by the bite of female
phlebotomine sandfly.
 They are responsible for various syndromes in
humans-
i. Visceral Leishmaniasis (Kala azar)
ii. Cutaneous Leishmaniasis
iii. Muco-Cutaneous Leishmaniasis
iv. Anthroponotic Cutaneous Leishmaniasis
v. Zoonotic Cutaneous Leishmaniasis
vi. Post Kala-azar Dermal Leishmaniasis

3.  Cutaneous Leishmaniasis :
 Occurs in dry, semi desert rural areas of
central asia, middle east north and west
Africa, esp in Ethopia and Kenya.
 90% of cases occurs in Afghanistan,
Brazil, Iran, Peru and Saudi Arabia.
 Muco-cutaneous Leishmaniasis :
 More than 90% of cases occur in Brazil, Bolivia and
Peru

4. -

5.  Leishmania are intracellular parasites.
 They infect and divide within macrophages.

6.  Age – all age group including infants, peak age in
India is 5 to 9 years.
 Sex – Males are affected twice as often as females.
 Population movement – movement of population
between endemic and non-endemic areas can result
in spread of infection.
 Socio economic status – usually strikes the poorest
of the poor.
 Occupation – people working in farming practices,
forestry, mining and fishing have a great risk of
being bitten by sandflies.

7.  Immunity- recovery from kala-azar and oriental
sore give a lasting immunity.
 During active phase of disease there is impairment
of cell-mediated immunity, this is reflected in the
negative skin reaction to leishmanin test.

8.  Altitude – the disease is mostly confined to the
plains, it does not occur over 2000 ft.
 Season- the prevalance of disease is high during and
after rainfalls.
 Rural areas – more common in rural areas as
favorable conditions for breeding of sandflies exists.
 Vectors
 Development projects

9.  In india Kala Azar is transmitted from person to
person by the bite of the female Phlebotomine
Sandfly.
 Transmission may also take place by
contamination of the bite wound or by contact
when the insect is crushed during the contact of
feeding
 Blood transfussion
 Contaminted syringes and needles.

11.  Indian Kala-azar has a unique epidemiological
feature of being Anthroponotic; human is the only
known reservoir of infection
 Female sandflies pick up parasite (Amastigote or LD
bodies)while feeding on an infected human host.
 Parasite undergo morphological change to become
flagellate (Promastigote or Leptomonad),
development and multiplication in the gut of
sandflies and move to mouthparts.
 Healthy human hosts get infection when an infective
sandfly vector bites them

12.  Visceral leishmaniasis (VL), also known as kala-
azar is fatal if left untreated in over 95% of cases.
 It is characterized by irregular bouts of fever, weight
loss, enlargement of the spleen and liver, and
anaemia.
 Darkening of the skin of face, hands, feet and
abdomen is common in India (kala-azar=black
sickness)
 Lymphadenopathy may also occur.

13.  Cutaneous leishmaniasis (CL) causes skin lesions,
mainly ulcers, on exposed parts of the body, leaving
life-long scars and serious disability.
 The disease may be mistaken for leprosy.

14.  Mucocutaneous leishmaniasis leads to
partial or total destruction of mucous
membranes of the nose, mouth and throat.

15.  Recurrent fever
 loss of appetite, pallor and weight loss with
progressive emaciation,
 weakness.
 Skin - dry, thin and scaly and hair may be lost.
 persons show grayish discolouration of the skin of
hands, feet,abdomen and face which gives the
Indian name Kala azar meaning "Black fever"

16.  Splenomegaly.
 Hepatomegaly.
 Lymphadenopathy.
 Anaemia - develops rapidly.
 Anaemia with emaciation
& gross splenomegaly produces
a typical appearance of the patients.

17. Clinical
 Most infections are diagnosed clinically.
 The patient has an irregular fever, anemia, and
leukopenia; hepatosplenomegaly and bone marrow
suppression are characteristic.
Lab invest
 Haematological findings viz Anaemia, leucopenia,
thrombocytopenia & hypergammaglobulinemia.
 WBC : RBC ratio is 1:1500 or even 1:2000
 Raised ESR
.

18.  Parasitological
 Aldehyde (Napier) test
 Serological test
 Leishmanin (Montenegro) test
 Haematological findings

19.  1 to 2 ml of the serum from the case of kala-azar is
taken and a drop or two of 40% formalin is added.
 Jellification to milky white opacity (like the white of
hard boiled egg) so that in ordinary light newsprint
is invisible through it, is considered positive.
 This test is good for surveillance but not for
diagnosis.
 The test is non-specific as it becomes positive in
many other chronic infections in which albumin to
globulin ratio is reversed.

20.  Control the reservoir
 Treatment of the cases
 Sand fly control
 Personal prohylaxis
Active and passive detection of the cases and
treatment of those who found to be infected.
House to house visit.
Mass surveys in endemic areas for early detection of
the cases.

21. Treatment
Pentavalent antimony---- Sodium stibogluconate
10mg/kg body wt for 20 days in adults.
20mg/kg body w in childrens.
Pentamidine isethionate 3mg/kg body wt for 10
days.
Amphotericin B 1mg/kg body wt IV 15 to 20
Injections alt dys
Miltefosine, 2.5 mg/kg body wt in two divided doses for
4 week

22.  Sandfly control
DDT
Insecticide spraying at human dwellinngs and all
animal shelter and other resting places up to the
height of 6 feets from floor level
 Sanitation measures
 Personal prophylaxis

23. The strategy of kala azar contorl broadly includes
three major activities
 Interruption of transmission for reducing vector
population by undertaking indoor insecticidal spry
twice annual major activities
 Early diagnosis and treatment of the kala azar cases
 Health education for the community awareness

24.  Kala-azar Control Efforts in India
 An organized centrally sponsored Control
Programme launched in endemic areas in 1990-91.
 Government of India provided kala-azar medicines,
insecticides and technical support.
 State governments implemented the programme
through primary health care system and
district/zonal and State malaria control
organizations and provided other costs involved in
strategy implementation.