1. Leishmania Donovani
A brief overview

2. 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

3. Cutaneous Leishmaniasis Visceral Leishmaniasis
Prevalence
Cutaneous Leishmaniasis
Visceral Leishmaniasis

4. 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

5. 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

6. 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.”

7. 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.

8. 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.

9. 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

10. 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

11. 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

12. 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)

13. Treatment
March st 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

14. 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

15. 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

16. 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

17. Resources www.who.int/tdr/diseases/leishmaniasis/direction.htm