Kala-Azar Presentation
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Transcript of Kala-Azar Presentation
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VL Kenya.Leishmaniasis Overview.
15th August 2008
Dr. James Teprey. WHO.
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General Over view of the Leishmaniasis Present in 88 countries. More prevalence
for VL in Bangladesh, India, Nepal, Brazil and Horn of Africa (Sudan, Ethiopia, Kenya, Uganda, Somalia)
2 million new cases / year; 500.000 from VL, probably under-reported cases.
Global mortality estimated 59.000/yr. WHA resolution 2007: call State Members
to support Leishmaniasis
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International Leadership in NTD
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Parasite: Leishmania donovani
Transmission: mainly anthroponotic
Vector: Phlebotomus martini. (Ph. Orientalis –Ethiopia)
Habitat: dry savannah, Acacia thorn bushes,
Balanites trees, craks of mud-covered dwellings, cow dung, rat burrows, anthills, termite hills...
Visceral Leishmaniasis (Kala-azar) in Kenya
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Active CasesSporadic
Cases
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Vector Disease is transmitted by sand fly (Phlebotomus)
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Vector
o Sand fly – Phlebotomus (70 especies) - females
o Transmitting period – before the main rainy season
o Different biting patterns (outdoors during the night, from sunset to sunrise, indoors or peri-domestic)
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08/04/23 12
Epi-CurveEpi-Curve
Epi-Curve of VL Cases in Wajir/ Isiolo Outbreak 2008
01
23
456
78
910
Date of Health Facility Visit
No. of C
ases
No of Cases
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08/04/23 13
Distribution of VL Cases by GenderDistribution of VL Cases by Gender
Distribution of VL Cases by Gender
Males
Females
Males 60% and Females 40%
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08/04/23 14
Distribution of VL Cases by AgeDistribution of VL Cases by Age
Age Distribution of VL Cases in Wajir/ Isiolo Outbreak in 2008
0
20
40
60
80
< 1 yr 1 - 4 Yrs 5 - 14 Yrs 15+ YrsAge-groups
Case
s
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Reservoir
o Humans – especially PKDL patientso Animals – dogs ( mainly Europe), fox, rats, jackals……
o Most commonly KA is spread human to human, however transmission from animal to human is possible but less common (Sudan)
o Others: congenital, needles (drug abuse), blood transfusion, sexual, bites from infected animal
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Prevention. Vector control: indoor residual spraying and use
of ITN Control of reservoir hosts: as antroponotic
transmission, early diagnosis and treatment is the most efective (decentralise diagnosis and support treatment centres). Treat PKDL
Individual protection measures: plastering of breeding places, avoid outdoor activities from dusk to down, wear socks, long trousers.
Health Education/Promotion PKDL treatment Surveillance and outbreak response.
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Clinical pictures
o Cutaneous Leishmaniasis - CL
o Muco Cutaneous Leishmaniasis - MCL
o Visceral Leishmaniasis -VL- kala-azar (KA)
o Post kala-azar dermatitis PKDL
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Differential diagnosis
Chronic malaria (TSS): usually long standing disease (do B/F if one considers acute malarial attack)
Shistosomiasis: chronic course, signs of portal hypertension ,epidemiology of the disease (exposure history) and no fever
Typhoid fever: acute / sub acute, severe headache, change of mental status (typhoid psychosis) as time goes on.
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Differential diagnosis
Tuberculosis: usually significant respiratory symptoms and signs; splenomegaly is rare unless milliary form.
Hematological malignancies (leukemia's): possible, but are rare.