Visceral Leishmaniasis in India

Prepared By Nishant Srivastava, 3rd group , 5th year, T.S.M.U

Kala Azar Introduction History Geographical Distribution and trends Prominent vectors in India India and V.Leishmaniasis 1.Program Development 2.Model of Elimination Program 3.Diagnostic Guidelines 4.Treatment Guidelines 5.Monitoring 6.Immunotherapy Conclusion References

KALA AZAR
Leishmaniasis is a disease caused by protozoan parasites of to the genus Leishmania and is transmitted by the bite of sand fly. This disease is also known as kala azar, black fever, sandfly disease, Dum-Dum fever. Leishmania is also called as kala-azar which in sanksrit means black fever. They called it black fever due to the hyper pigmentation of the skin in the abdomen and neck regions which is a common symptom of the disease. Human infection is caused by about 21 of 30 species that infect mammals. These include the L. donovani complex with three species (L. donovani, L. infantum, and L. chagasi)

Sir William Leishman

1900 Sir William Leishman discovered L. donovani in spleen smears of a soldier who died of fever at Dum-Dum, India. The disease was known locally as Dum-Dum fever or kala-azar.
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Charles Donovan
Charles Donovan also recognized these symptoms in other kala-azar patients and published his discovery a few weeks after Leishman. After examining the parasite using Leishman's stain, these amastigotes were known as LeishmanDonovan bodies.

Geographical Distribution & Trends

Vectors

Phlebotomus argentipus

Lutzomyia longipalpis

India and V.Leishmaniasis

Early Leishmania eradication program began in 1970s . The pilot project started in 5 districts of BIHAR.The project was successful with regard to treatment but was a failure in eradication mission. Then in 1992 pertaining to high incidence there was a central program- Kala azar elimination program formed.

 In 2002 the Kala Azar elimination set as national health policy. 2005 , Nepal ,India and Bangladesh launched a joint venture which included their national Kala Azar elimination program with joint expert committee from three nations supervising it with parallel Strategies. In the same year Government of India launched a National Rural Health Mission , Under this mission was a national project called National Vector Borne Diseases Control Program , Malaria And Kala azar elimination programs were shifted under this project.

MODEL OF KALA AZAR ELIMINATION PROGRAM

Ministry of Family Welfare and Health

National Rural Health Mission

NVBDCP

National Epidemiology Institute

State Program Supervision Centre Infectious and Communicable disease department in District Hospital Regional Clinics and Hospital

Diagnostic Guidelines
All the suspected cases on grounds of elimination of other case scenario are referred to District Hospital. In District hospital, as per set guidelines there are two established diagnostic procedure 1. Bone-marrow and splenic aspiration and smearing 2. RK-39 Test

TREATMENT GUIDELINES
LINE OF TREATMENT (Severity/responsivi ty ) DRUG ROUTE/DOSE I II III

Sodium stibogluconate IM / 20 mg/kg (20 days)

Amphotericin B IV + 5% Dextrose / 1 mg/kg (6 weeks) Liver disease

Miltefosine Oral Children-2.5mg/kg Adult- 100 mg (28 days) Pregnancy

CONTRAINDICATIO N CRITERIA FOR CURE

Severe kidney,liver,heart disease Absence of LD bodies in aspiration fluid

Absence of amastigotes in aspiration material.

Absence of splenomegaly,fever, anemia

Immunotherapy
Leishmaniasis is a disease that is most likely to be controlled by a successful vaccination program. The relatively uncomplicated leishmanial life cycle and the fact that recovery from a primary infection renders the host resistant to subsequent infections indicate that a vaccine is feasible.

Vaccine Development
In a WHO vaccine development program India is active participant along with few African nations,Brazil and Peru , where the disease is prominent . In India the project is being handled by THSTI Under Ministry of Health and family welfare.

Principle of Vaccine

Conclusion :The Program Summary

Kala Azar elimination program works under objective of 1. Early detection and treatment 2. Eradication of parasite 3. Eradication of vector Translational health science and Technology institute(THSTI) is dedicated to research in the field for various molecular solution to the above 3-pronged approach. The tri-nation memorandum is targeting towards statistical elimination of the disease by 2015.

References
1.Leishmaniasis Research Society of India : www.leishmaniasisresearchsociety.in 2.Ministry of health and family welfare,India(Guidelines)www.mohfw.nic.in 3.National Medical Journal Of India , Volume 12issue 2 4.Journal of tropical Medicine 5. Google & Wikipedia