1. INDIAN RAILWAY MEDICAL SERVICE
KALA AZAR
DR. I. SELVARAJ I.R.M.S
B.SC., M.B.B.S.,D.P.H., D.I.H.,(M.D) Community Medicine.,P.G.C H&HW(NIHFW)New Delhi
Sr.D.M.O/ON STUDY LEAVE
INDIAN RAILWAY MEDICAL SERVICE

2. kala azar, black fever, sandfly disease, Dum-Dum fever and espundia.
SYNONYMS
kala azar, black fever, sandfly disease, Dum-Dum fever and espundia.

8. PROMASTIGOTES
AMASTIGOTES

9. GEOGRAPHICAL DISTRIBUTION
The leishmaniasis is endemic in 88 countries on five continents—Africa, Asia, Europe, North America and South America.
350 million people at risk.
12 million people are affected by leishmaniasis
1.5-2 million new cases of leishmaniasis estimated to occur annually.
new cases of VL which occur annually

10. INDIA
WEST BENGAL,ANDRA PRADESH,BIHAR, ASSAM, EASTERN UTTAR PRADESH, COASTAL REGION OF TAMIL NADU, & JHARHAND
HIGHEST NUMBER OF KALA-AZAR CASES IN MADRAS CITY (18682) OCCURRED DURING THE DECADE 1951 TO THEREAFTER IT HAS SHOWN A CONTINUOUS DOWNWARD TREND. A TOTAL OF 223 CASES OF KALA-AZAR WERE REPORTED FROM 1971 TO 1983 IN MADRAS AND THE MEAN INCIDENCE OF 28 CASES WERE REPORTED BETWEEN 1971 AND FROM 1978 TO 1983 AN AVERAGE OF 4 CASES WERE REPORTED. (RECENT TRENDS IN THE INCIDENCE AND EPIDEMIOLOGY OF KALA-AZAR IN MADRAS CITY SIVAPARAKASAM, P; PADMANABHAN, B; SADANAND, AV

11. 1756;Russel:The first description in English
1898;Borovsky noted the protozoal nature of the organism
1903;Leishman identified the parasite
1903;Donovan described identical organisms in a splenic puncture

12. TYPES OF LEISMANIASIS
VISCERAL LEISHMANIASIS (Bangladesh, Brazil, India, Nepal and Sudan)
CUTANEOUS LEISHMANIASIS (Afghanistan, Brazil, Iran, Peru, Saudi Arabia and Syria)
DIFFUSE CUTANEOUS LEISHMANIASIS
MUCO CUTANEOUS LEISHMANIASIS (Bolivia, Brazil and Peru.
Post kala azar dermal leishmaniasis (Endemic to India and the Sudan)

13. Visceral leishmaniasis
irregular bouts of fever
substantial weight loss
swelling of the spleen and liver
and anaemia

14. CUTANEOUS LEISHMANIASIS
skin ulcers on the exposed parts of the body, such as the face, arms and legs

15. MUCOCUTANEOUS LEISHMANIASIS OR ESPUNDIA
mucous membranes of the nose
mouth
and throat cavities

16. LIFE CYCLE

17. 1. Leishmaniasis is transmitted by the bite of female phlebotomine sandflies. The sandflies inject the infective stage, promastigotes, during blood meals.
2. Promastigotes that reach the puncture wound are phagocytized by macrophages.
3.They transform into amastigotes.
4. Amastigotes multiply in infected cells and affect different tissues.
5. Sandflies become infected during blood meals on an infected host when they ingest macrophages infected with amastigotes.
6. In the sandfly's midgut, the parasites differentiate into promastigotes.
7. They multiply and migrate to the proboscis.

18. GOAL OF NATIONAL HEALTH POLICY (INDIA) 2002
ELIMINATION OF KALA AZAR 2010

19. STRATEGY
Interruption of transmission by reducing vector population – Indoor Residual Insecticides
Early diagnosis & treatment
Health education programme

20. 1. To provide early diagnosis and prompt treatment;
2. To control the sandfly population through residual insecticide spraying of houses
and through the use of insecticide-impregnated bed nets;
3. To provide health education and produce training materials;
4. To detect and contain epidemics in the early stages;
5. To provide early diagnosis and effective management for Leishmania/HIV coinfections.

21. EARLY DIAGNOSIS L.D BODIES (SPLEEN, BONE MARROW, LYMPH NODE)
ALDEHYDE TEST
ELISA
& Polymerize chain reaction (PCR)

22. TREATMENT SODIUM ANTIMONY STIBO GLUCONATE PENTAMIDINE ISTHIONATE
AMPHOTERICIN-B
Miltefosine (Impavido ®) (approval by the Indian and German Regulatory Authorities (2003)
Phase III Trials with a first-generation vaccine (killed Leishmania organism mixed with a low concentration of BCG as an adjuvant) have also yielded promising results
Leishmania major mixed with BCG have been successful in preventing infection with Leishmania donovani.

24. VECTOR CONTROL 75% DDT – 1 KG IN 3 GALLONS OF WATER OR
6000 Sq. feet ( 100 mgm/Sq.foot)
Up to 6 feet from ground level
If it is resistant , BHC

25. Ref: http://www.who.int/leishmaniasis/en/
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