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
 Visceral Leishmaniasis
(Kala-azar) in Kenya

♦ 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...
Active Cases
Sporadic
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)
 No. of Cases

16/02/09
12
/0
3
19 / 20

0
1
2
3
4
5
6
7
8
9
10
/ 0 08
3
26 / 20
/ 0 08
3
02 / 20
/ 0 08
4
09 / 20
/ 0 08
4
16 / 20
/ 0 08
4
23 / 20
/ 0 08
4
Epi-Curve

30 / 20
/ 0 08
4
07 / 20
/ 0 08
5
14 / 20
/ 0 08
5
21 / 20
/ 0 08
5
28 / 20
/ 0 08
5
04 / 20
/ 0 08
6
11 / 20
/ 0 08
6
18 / 20
/ 0 08
6
25 / 20
Da t e of Hea l t h Fa ci l i t y V i si t

/ 0 08
6
02 / 20
/ 0 08
7
09 / 20
/ 0 08
7
16 / 20
Epi-Curve of VL Cases in Wajir/Isiolo Outbreak 2008

/ 0 08
7
23 / 20
/ 0 08
7/
20
No of Cases

08
12
 Distribution of VL Cases by Gender
Distribution of VL Cases by Gender

Females

Males

Males 60% and Females

16/02/09 40% 13
 Distribution of VL Cases by Age

Age Distribution of VL Cases in Wajir/Isiolo

Outbreak in 2008

80
60
Cases

40
20
0
< 1 yr 1 - 4 Yrs 5 - 14 Yrs 15+ Yrs
A ge-grou ps

16/02/09 14
 Reservoir
o Humans – especially PKDL patients
o 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

Laboratory findings
♦ Pancytopenia, white, red bloodcells,
platelets
♦ Anaemia – norm chromic ,micro cytic
♦ BT &PT elevated
♦ Hyper gammaglobulinemia
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.