1. ALZAIEM ALAZHARI UNIVERSITY Faculty of public & Environmental health Seminar on BY: ZAKIA ELGALI MAY 2005

2. Local names DOPAL (الدوبال) KALA- ZAR (كلازار) ABO SIFEER (ابو صفير) MARD ELSSEED (مرض الصعيد) Elsemah (السميح)

3. Identification of the disease suspect case: Any patient who live in or has travelled to an endemic area presenting Fever of more than two weeks duration and malaria was ruled out, with one of the following signs: Splenomegaly, or lymphadenopathy Confirmed case1: There are two ways of confirming Kala-azar Parasitological serological

4. Sign & symptoms Prolonged irregular fever Enlarged spleen Weight lost Enlarged lymph nodes Anemia Cough Nasal bleeding (Jaundice Odema)

5. Vl pt

6. occurrence The Leishmaniasis are a group of diseases endemic in 88 countries they are the third most important vector-borne disease after malaria and lymphatic filariasis with an estimated 2.1 million disability adjusted life years

7. occurrence Endemic in 88 countries. More than 90% of cutaneous leishmaniasis cases occur in Iran, Afghanistan, Syria, Saudi Arabia, Brazil and Peru. More than 90% of visceral leishmaniasis cases occur in Bangladesh, Brazil, India and sudan

8. Disruption of disease in the world

9. Epidemiology of visceral leishmaniasis in Sudan: Visceral leishmaniasis (VL, kala-azar) is endemic in the Sudan and has been reported since 1904 endemic area is in Gedarif S,Uper Nile S,SinarS, Nourth Darfour, Blue Nile, Unity, South kordofan.

10. Kala Azar distribution in Sudan

11. % distribution of Kala Azar cases/ state 2003

13. Distribution of Kala-azar by months Gedaref state

14. Distribution of Kala-azar by months Upper Nile

15. ENDEMICITY OF THE DISEASE East African Countries and India Among children (male more affected than female)

16. Agent/ host / environment Worldwide, over 20 pathogenic species of leishmania parasite are known, the 7 important are: L. donovani L.tropica L.mexicana; L.peruviana L. maior, L.aethiopica, and L.braziliensis

17. Causative agent Parasitic protozoa of the genus Leishmania, transmitted to humans by sandflies. Over 20 species and subspecies infect humans, each causing a different spectrum of symptoms. These range from simple, self-healing skin ulcers (e.g. due to infection with Leishmania major), to severe, life-threatening disease (e.g. visceral leishmaniasis caused by L. donovani s.l.).

18. Agent/ host / environment Asociated with: Cotton Black soil(Soil cracks)… Acaccia groop trees such as : A.balanitis,A.syeal,A.aegyptica….. (Males of the Phelebotomus prefer the necator of this trees and it occupied as a good habitat for wild resting adult…

19. Vector  More than 30 spp of Phelebotomus Genus incriminated as vectors..  40 spp are potential.

20. Vector classification Phylum: Sarcomastigophora Order: Kinetoplastida Family: Trypanosmatidae Genus: Leishmania

21. Life cycle

22. promastigate

23. HIV/Leishmania Co infection Specific Problems Absence of usual clinical features Associated opportunistic infections make diagnosis difficult Serological test is frequently negative Treatment failures,relapses due to drug Resistance and drug toxicities are common.Many drugs are expensive.

24. reservoir In rodent’s In carnivores Anthroponotic not ruled yet

25. L.donovani Reservoir: Mediterranean, S.W.Asia: dogs foxes China: dogs India: humans Sudan, Chad: wild rodents and carnivores Kenya: dogs Central and South America: dogs,foxes

26. Incubation period 3weeks -------2 years after exposure

27. Susceptibility & resistance IN VECTOR The only study carried out in Italy give resistant ratio to DDT 1.08 And to Permethrin 1.41 IN PARASITE Recently, resistance to drugs has been reported.

28. Method of control PRIMARY VECTOR CONTROL Chemica & environmental control Personal protiction (itns mesh screening in houses ) Health education Reservoir control: elimination of feral dogs and screening of domestic dogs. SECONDARY Early Diagnosis & Prompt Treatment TAIRTARY 1. Qualified The Disability

29. Drug resistance Recently, resistance to drugs has been reported, requiring the use of more toxic drugs, such as amphotericin B. Most available drugs are costly,

30. Research area Pathogenesis and host interactions Understanding mechanisms for drug resistance Impact of inequity of access to services and health sector reform Socioeconomic, environmental, and behavioural risk factors for infection and disease, especially in refugee populations in complex emergencies Development of Leishmania diagnostic tests Development of vaccine Cost-effective delivery strategies for new drugs against visceral leishmaniasis Development of strategies for use of insecticide treated materials (ITNs)