and Future A Review Dr. Kamal Kishore Ex. Dy. Director (Sr. Grade) - - PowerPoint PPT Presentation

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and Future A Review Dr. Kamal Kishore Ex. Dy. Director (Sr. Grade) - - PowerPoint PPT Presentation

Nov 08, 2023 98 likes •563 views

Kala-azar: Past, Present and Future A Review Dr. Kamal Kishore Ex. Dy. Director (Sr. Grade) & HOD VECTOR BIOLOGY AND CONROL & Officer In-charge, RMRIMS(ICMR),Patna-800 007 AND Ex. ICMR Kala-azar Consultant ,WHO/GOI Coordinator,

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Kala-azar: Past, Present and Future A Review

  • Dr. Kamal Kishore
  • Ex. Dy. Director (Sr. Grade) & HOD

VECTOR BIOLOGY AND CONROL & Officer In-charge, RMRIMS(ICMR),Patna-800 007 AND

  • Ex. ICMR Kala-azar Consultant ,WHO/GOI Coordinator,

Kal-azar Elimination Programme

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Kala-azar

  • A vector born disease
  • Confined to some of the tropical and sub-tropical regions
  • In India, it appeared first in Bengal Gangetic plains and

from there spread to Assam and Bihar, further to Tripura and eastern UP

  • Sporadic cases reported from Gujrat, Maharastra, Tamil

Nadu, Orissa, Himanchal Pradesh and Jammu & Kasmir

  • Transmitted by female sandfly
  • In India,

– female P.argentipes is the vector – Causative parasite: L.donovani

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Incidence of Kala-azar in Bihar

20 40 60 80 100 120 140 160 180 200 5000 10000 15000 20000 25000 30000 35000 40000 2007 2008 2009 2010 2011 2012 (July) Case Death

Year Case Death 2007 37819 172 2008 28489 142 2009 20519 80 2010 23084 95 2011 25175 76 2012 (July) 11190 19

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BIOTOPES OF ENDEMIC VILLAGES

Peridomestic Vegetation: predominance of deciduous and thorny bushes Water bodies Interaction of Human beings and Livestock Interaction of Human beings and Livestock

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Field Photographs

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Field Photographs

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SPLENOMEGALY

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HOSPITALIZED PATIENTS

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PKDL Patient

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Amastigote

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Promastigote

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General features of sandfly

  • Small in size

(less than 3.5 mm, about 1/3 of mosquito size)

  • Large conspicuous compound eye
  • Body covered with sandy or brown coat of hairs
  • Hind legs longer than body
  • Erected V-shaped wings
  • Wings are almost parallel in the resting position
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Life cycle of Sandfly

Egg Larva Adult Pupa

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Adult

  • Pupa emerges into adult.
  • Development from egg to adult takes about

20-36 days

  • Crepuscular in habit and endophilic in nature
  • Found in cracks & crevices in dark corners
  • f house/ cattle shed, caves, animal

burrows, termite hills, tree holes

  • Incapable of flying long distance, just hops
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Longevity

  • Very meager information available
  • Under lab. Condition,

– Gonotropic cycle of 4-5 days – Max. longevity 23-27 days

  • Triparous females are found in more

numbers between July – Sept.

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Distribution of P.argentipes

  • Prefers hot & humid climate
  • Found in VL endemic areas of Bihar, West

Bengal, Assam and Eastern UP

  • Also recorded in high densities in Southern

peninsula and Central India.

  • Vertical distribution has been recorded up to

1300 meters above the sea level in Garhwal (Uttaranchal) and 1100 meters in Nilgiri hills (Tamil Nadu)

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Disease transmission

  • Through bite of infected P.argentipes
  • Leishmanial form enters the gut of the vector,

when it feeds on infected host

  • In gut of sandfly, leishmanial form develops into

nectomonoid form

  • Nectomonoid form multiplies by binary fission and

large number of flagellates are produced.

  • When infected P.argentipes bites uninfected

people, disease may be transmitted.

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Disease transmission

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Parasite development in sandfly gut

  • Three types of development:

– Suprapylarian : L.donovani – Peripylarian : L.brazilliansis complex – Hypopylarian : Sauroleishmanial group

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Suprapylarian development

  • Nectomonoids migrate to anterior part of

foregut, undergo morphological changes and transform into stumpy electron light forms “heptomonoids”.

  • Heptomonoids migrate into pharynx,

undergo morphological changes and transformed into “Opisthomastigotes”.

  • Opisthomastigotes penetrates into the bucal

cavity and enters into next vertebrate host during blood sucking.

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Peripylarian development

  • Development of parasite in the hindgut and

migrate to anterior region for transmission through bite

  • Observed in case of L.brazilliansis complex
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Hypopylarian development

  • Development of parasite in the hindgut and

transmission through engulfment

  • Observed in case of Sauroleishmania Group
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Detection of natural infection

  • Direct Method

– Traditional dissection method and steroscopic examination

  • Indirect Method

– Using non-radioactive probe based on the total DNA

  • f the parasite.

– The probe was labeled with Diagoxigenin and used to detect L.donovani in P.argentipes. – Sample size: 428 sandflies collected from infected households – Positive signal detected in 12 (32%) of the 38 pools (2-30 sandflies) – Others are monoclonal antibody test and PCR

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Transmission season

  • Several views by several workers
  • Sanyal et al:

– Peak incidence of VL is June-August, which coincides with peak density of sandfly

  • Dhiman and Sen:

– Two transmission season; one before monsoon and another after winter

  • Kishore et al:

– Transmission occurs round the year

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Control of sandfly

Best method to interrupt any vector borne disease is to reduce man-vector contact.

Chemical method Environmental method Prophylactic method Biological Method DDT Malathion

Methods

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Chemical Control Method: DDT

  • DDT (50% w.d.p.) spray up to a height of 6 feet
  • PHC area as unit of the spray
  • Supply of DDT by Govt. of Bihar & West Bengal

in their respective endemic areas.

  • Two rounds of DDT spray

States

1st Round 2nd Round – Bihar

  • Feb. – March

May- June – West Bengal May – July

  • Aug. – Oct
  • Insecticide susceptibility test in Vaishali (Bihar)

reveals DDT resistant foci as only 18-53% susceptibility was observed

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SUSPENSION PREPARATION

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DDT SPRAY OPERATION

Suspension making Suspension Quality Check Spray Preparation Discharge rate

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Spraying Sprayed wall Stencil on wall Leakage

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Chemical Control Method: Malathion

  • SRES (Slow Release Emulsified Suspension)
  • A WHO sponsored project undertaken by RMRI
  • In study village, 5% malathion suspension was used in the

dose of 2 gm/m2.

  • Control village sprayed with recommended dose of DDT
  • Study reveals the effectiveness of malathion for 24 months

in comparison to only 3 months for DDT.

  • No toxicity was observed.
  • P-value for Plasma cholinesterase level conducted are as

below:

– For spray men within one week <0.01* – For exposed individuals after one month <0.01* – For exposed individuals after one year >0.01 (* Significant, but within the normal range)

  • A cost effective approach
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Environmental Control Method

  • Aimed at source reduction
  • A study on Techno-ecological control was

undertaken by RMRI

  • Pre evaluation of sandfly density carried out in

study area

  • All cracks & crevices of human dwellings and

cattle-sheds were plastered with mud and lime

  • Post operation evaluation of sandfly density

revealed successful interruption of sandfly breeding.

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MUD PLASTERING

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APPLICATION OF LIME

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Biological Control Method

Palit et al. (RMRI) demonstrated that mites are helpful in checking the population of sandfly

Prophylactic Control Method

  • Self protection by use of bed nets and repellants
  • Nets of 36-42 mesh will definitely prevents from sandfly

biting

  • Effective repellants compounds are Deet, DMO,

Citronella

  • 2% neem oil mixed with coconut or mustard oil provides

100% protection against P.argentipes.

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Identification and characterization of

  • L. donovani (promastigote) antigen of

naturally infected P. argentipes

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  • Demonstration of natural infection in P. argentipes for

the infectivity status with the help of immuno dot- Blot.

  • Determination of peptide responsible for parasite

infection in P. argentipes by SDS-PAGE.

  • Identification of immuno- reactive poly peptide band by

Western blotting &

  • Development of polyclonal as a diagnostic tool.

Identification and characterization of

  • L. donovani (promastigote) antigen of naturally

infected P. argentipes

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Evaluation of impact of DDT indoor residual spraying being used in Kala-azar control programme on the disease prevalence.

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Efficacy of impregnated bed-nets as a vector control measure

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USE OF BEDNETS

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  • i. To assess the efficacy of impregnated

bed-net use as vector control measure .

  • ii. To assess the impact of the intervention

measure at the community level.

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COMMUNITY PARTICIPATION

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CL Patients in Bikaner

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Future scope for Elimination of Kala-azar

  • Inclusion in middle lass curriculum for

awareness in the coming generation

  • Self Help Group at village/ panchayat level
  • Social mobilization
  • Improved IEC activities
  • Thorough two round spray for at least 3

consecutive years

  • Monitoring & evaluation of the programme with

commitment at all levels

  • Strict vigil on maintenance phase
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