VL Kenya.Leishmaniasis Overview.

15th August 2008

Dr. James Teprey. WHO.

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

International Leadership in NTD

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

Active CasesSporadic

Cases

Vector Disease is transmitted by sand fly (Phlebotomus)

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)

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

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%

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

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

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.

Clinical pictures

o Cutaneous Leishmaniasis - CL

o Muco Cutaneous Leishmaniasis - MCL

o Visceral Leishmaniasis -VL- kala-azar (KA)

o Post kala-azar dermatitis PKDL

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.

Differential diagnosis

Tuberculosis: usually significant respiratory symptoms and signs; splenomegaly is rare unless milliary form.

Hematological malignancies (leukemia's): possible, but are rare.