Leshmaniasis Kala Azar

1. LEISHMANIASIS
Mr. Kuldeep Vyas
M.Sc. Community Health Nursing
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2. Leishmaniasis
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3.  It’s a communicable disease.
 Leishmaniasis are a group of protozoal diseases caused
by parasites of genus “ Leishmania”.
 Genus Leishmania is named after Sir William Leishman,
who discovered the flagellate protozoa causing Kala-azar,
the Indian visceral leishmaniasis.
 Majority of leishmaniasis are zoonoses involving wild/
domestic mammals (rodents , canines).
Kala-Azar/Dum-Dum fever in India 3Kuldeep Vyas M.Sc. N. CHN

4.  Various syndromes in humans
1. Kala-azar/visceral leishmaniasis (V.L)
2. Cutaneous leishmaniasis (C.L)
3. Muco-cutaneous leishmaniasis (M.C.L)
4. Anthroponotic or urban cutaneous leishmaniasis(A.C.L)
5. Zoonotic or rural cutaneous leishmaniasis (Z.C.L)
6. Post-Kala-azar dermal leishmaniasis (P.K.D.L)
• Kala-azar=black sickness
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6. • Visceral leishmaniasis or Kala-azar is a major public health problem in
many parts of world.
• According to WHO, 5,00,000 cases of visceral leishmaniasis occur
every year.
• Of these new cases, 90% are found in the Indian subcontinent and
Sudan and Brazil.
• The disease occurs in endemic, epidemic, or sporadic forms. Major
Problem Statement
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8. • The resurgence of Kala-azar in India, beginning in the mid1970s
assumed epidemic proportions in 1977 and involved over 1,10,000 cases
in humans.
• Initially, the disease was confined to Bihar. Since then, the cases are
increasing and involving newer areas.
• The epidemic extended to West Bengal and first outbreak occurred in
1980 in Malda district.
• At present, the disease has established its endemicity in 31 districts in
Bihar, 11 districts in West Bengal, 5 districts in Jharkhand, and 3
districts in Uttar Pradesh. Sporadic cases have been reported from Tamil
Problem Statement- India
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10.  Epidemiological determinants
1. Agent factors
The causative organisms are
• L.donovani for V.L
• L.tropica for C.L
• L.braziliensis for M.C.L
Reservoir-animals: Dogs,
Jackals,
Foxes and Rodents.
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12. 2. Host –Factors
• Age: Peak age incidence 5 to 9 years.
• Sex: Males are affected twice to females.
• Population movement: From endemic to non-endemic areas.
• Socio-economic status: Strikes poorest of poor.
• Occupation: Workers of forestry, mining, fishing
• Immunity: Gives lasting immunity. 12Kuldeep Vyas M.Sc. N. CHN

13. 3. Environmental Factors
Altitude: Confined to plains.
Season: During and after rains(peak in November and april).
Rural areas: Suitable for breeding of sand fly.
Vectors: Phlebotomus argentipes for V.L
P.papatasi
P.sergenti
Development Projects: Cultivation projects, Colonization, migrants
} C.L
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15.  Mode of transmission
•By bite and contact when insect is crushed during act
of feeding.
•Transmission also takes place through contaminated
blood transfusion.
• Extrinsic incubation period is 6-9 days.
• Incubation period is about 1-4 months.
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16. 1
6
5
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3
2
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18. Clinical features
• VL:
1. Fever
2. Splenomegaly
3. Hepatomegaly
4. Anaemia
5. Weight loss
6. Darkening of skin of face,
hand, feet, abdomen
7. Lymphadenopathy
• PKDL: Multiple nodular infiltration
of skin without ulceration.
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21. • CL: characterized by painful ulcers.
These are restricted to skin. (DD- leprosy)
Variant – diffuse C.L.
• MCL: Similar to CL but appears around margin of mouth and nose
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26. Tapir nose
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29. 1) Parasitological diagnosis: Demonstration of LD
Bodies in the aspirations of spleen, liver, bone
marrow, lymph nodes or in the skin.
2) Aldehyde test of Napier: Used for diagnosis of VL.
1-2 ml of serum from a patient of VL and a
drop or 2 drops of 40% formalin is added.
+ve test→Jellification to milk
-It becomes positive 2-3 months after on
set of disease and reverse to negative 6months after
cure.
-It also positive in reversed Ab/Gb ratio.
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30. 3) Serological test : DAT, ELISA,IFAT
ELISA used for diagnosis as well as
epidemiological field survey.
4) Leishmanin(montengro) test: It’s a skin
test.
Induration of 5mm or more is positive.
Usually positive after 4-6 weeks after onset
of case of C.L and M.C.L.
-ve in active phase of V.L and becomes +ve
in 75% of people after recovery.
5) Hematological findings: Progressive
leucopenia, anaemia, reversed Ab/Gb ratio.
E.S.R is increased.
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31. MONTENIGRO TEST
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2
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33.  Control measures
1)control of reservoir: Active and passive case
detection and treatment.
House to house visits and mass surveys.
Treatment: Pentavalent antimony compounds
are used.
Recommended schedule: Sodium stibogluconate
20mg/KG daily for 20 days.
Second line drug: Pentamidine isethionate
3mg/KG for 10 days.
Amphoterecin B 1mg/KG for 20 days.
Milteforsine 2.5mg/KG for 4 weeks.
Animal reservoir: Dogs & rodent control
programme
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34. 2) Sand fly control:
• DDT is first choice of insecticide.
• BHC is used for resistance cases.
• Sanitation measures: Elimination of
breeding places and location of
cattle shed at a far distance.
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35. 3)Personal prophylaxis
• Health education.
• Individual protect measures like
1. Avoiding sleeping on the
floor.
2.Using fine mesh nets.
• Insect repellants for temporary
protection.
• Keeping environment clean.
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36. Thank you
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37. Assessing your understanding of
Leishmaniasis
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