Leishmania Donovani

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. 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 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

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 • http://www.who.int/leishmaniasis/en/