Leishmania Donovani A brief overview

Prevalence Leishmaniasis currently infects 350 million men, women, and children in 88 countries around the world and there are three kinds: Cutaneous Mucocutaneous Visceral Some estimate that 12 million people are presently infected

Cutaneous Leishmaniasis Visceral Leishmaniasis Prevalence Cutaneous Leishmaniasis Visceral Leishmaniasis

Leishmania throughout the ages… Dates as far back as the 15th and 16th centuries with the Incas During Spanish colonization, seasonal workers would suffer from “valley sickness” or “Andean sickness”. Also known as “white leprosy” for its disfigurements of the face

Leishmania throughout the ages… Indian physicists called it kala azar, meaning “black fever” Pre-Incan pottery from Ecuador and Peru also show individuals with facial deformities and skin lesions

How it was discovered… 1756- Alexander Russell gives first clinical description of the disease after examining a Turkish patient. Called it the “Aleppo boil” after Aleppo, Syria. “After it is cicatrised, it leaves an ugly scar, which remains through life, and for many months has a livid colour. When they are not irritated, they seldom give much pain.”

How it was discovered… 1901-Leishman identified the organisms that caused “dum-dum” fever. This disease caused debility, fevers, anemia, muscular atrophy and splenomegaly. Leishman thought these were trypanosomes. 1903-Captain Donovan discovered that the organisms causing “dum-dum” fever were new.

How it was discovered… Major Ross discovered the link between the organisms that caused “dum-dum” fever and kala azar. He named them Leishmania donovani.

Leishmania in action… Sudan In 1997, there was a 400% increase in cases over the previous year caused by the migration of seasonal workers and individuals moving to escape civil unrest Disease also migrated to Eritrea and Ethiopia

Leishmania in action Brazil Has seen a large increase in cases since 1999. Drought, dwindling farm land, and famine causes people to move the to cities where little infrastructure and sanitation allows the disease to flourish Children under are the group with the greatest risk

Leishmania in action Afghanistan War and civil unrest makes the disease hard to control. An epidemic in 2002 killed an estimated 100,000 people in Kabul Returning refugees and other displaced persons have low levels of resistance to the disease

Diagnosis Antigen detection in urine Dipsticks K39/K26 For Visceral Leishmaniasis: enzyme liked immunosorbent assay (ELISA) direct agglutination test (DAT) indirect fluorescent antibody test (IFAT)

Treatment March 2002- 1st oral drug for visceral leishmaniasis registered (milefosine) currently used in India safe and effective  up to 98% cure rate mild side-effects  vomiting and diarrhea does not require refrigeration Other drugs- sitamaquine and aminosidine

How we can help… Facilitate early diagnosis and prompt treatment Control sandfly populations through insecticide spraying and the uses of bednets Provide health education Detect and contain epidemics in the early stages

What helps the disease spread … Poor sanitation the sandfly population breeds more frequently in places where sanitation is poor such as ruined buildings, dead animals, household rubbish, etc. Dense populations sandflies have a greater population to infect Mass migration of individuals The movements of individuals to new area introduces the disease to people who have no immunity to it

What helps the disease spread… Social stigmas of the disease People suffering from the disease are often left untreated and may be ostracized from their community Under-reporting of the disease to health organizations The true impact of the disease is not known Lack of medication Cannot properly control outbreaks

Resources www.who.int/tdr/diseases/leishmaniasis/direction.htm http://www.who.int/leishmaniasis/en/