Epidemiology and Control of Zoonotic Infections

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Epidemiology and Control of Zoonotic Infections
Leishmaniasis
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History

• Cutaneous
• more than 650 years BC
• Avesina named it as KHeiroonie or Jeiroonie in
  Ghanoon in 10th century AC(5th century after
  Hejrat)
• Razi explained it for the first time in 11th
  century AC
• 1952
• For the first time microorganism was isolated
  from the spleen of soldires with visceral
  leishmaniasis by Leishman in Dun Dum region near
  Kalkate in India

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Importance

• A group of diseases with different clinical
  presentations, outcomes complications
• Estimated infected persons worldwide 12
  millions
• Persons living in regions at risk of getting
  infection 350 millions
• New cases each year 1.5 millions(500000 of them
  visceral)
• Endemic in 60-70 country
• CFR of visceral
• With Dx Rx 5 10
• Without Rx 100
• Cutaneous a cosmetic problem in endemic areas

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Infectious Agent

• Genus leishmania
• Cutaneous
• Eastern Hemisphere( old world)
• L. tropica( leishmaniasis recidivans cutaneous
  leisions ) L. major cause localized cutaneous
  sometimes visceral in India middle East
• L. aethiopica( localized diffuse cutaneous )
• Western Hemisphere( new world)
  L.braziliensis(mucosal leision) L. mexicana
  complexes
• Visceral
• Eastern Hemisphere L. donovani complex( Kenya,
  Sudan, India, China, Pakistan) , L. infantum(
  Central Asia, middle East, Mediterranean region)
• Western Hemisphere L. chagasi
• All 3 may cause cutaneous without concomitant
  visceral , and post- kala-azar dermal
  leishmaniasis

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Occurrence Cutaneous

• Pakistan, India, recently China, Middle East(
  including Iran, Afghanistan), southern regions of
  the former Soviet Union, sub-Saharan Africa,
  Sudan, Kenya, Namibia, Central America, South
  America( except Chile Uruguay), Mediterranean
  littoral
• Rural is more prevalent than urban

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Occurrence Visceral

• In rural regions of tropical sub-tropical
  areas, mostly as scattered cases among infants,
  children, adolescents but occasionally in
  epidemic waves
• India, Bangladesh, Pakistan, China, middle east(
  including Turkey), Central south America( esp.
  Brazil), Sudan, Kenya, Ethiopia, sub-Saharan
  Africa, southern regions of the former Soviet
  Union, Mediterranean basin
• Use of antimalarial insecticides dog population

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Occurrence EMRO

• Public health problem
• Iran, Iraq, Saudi Arabian, Sudan, Syria, Tunisia
• Visceral( kala-azar)
• L. infantum, zoonoses, rural, reservoir
  carnivore esp. dog
• Cutaneous
• Wet, rural, zoonoses L. major, reservoir
  rodents( esp. gerbils)
• Iran, Iraq, Saudi Arabia, Pakistan, Syria,
  Ordonez, Sudan
• Dry, urban, anthroponotic L. tropica

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OccurrenceIran Cutaneous

• common in many parts
• 1366 incidence 14/ 100000 decreasing untill
  1368.after that increasing the highest
  incidence in 1371 91/ 100000
• Isfahan Hormozgan
• Imposed war, immigration, decreased use of
  antimalarial insectisides
• Urban
• Tehran, Mashad, Shiraz, neishabour, Kerman, Bam
• Mostly in face, no seasonality
• Rural
• Isfahan, Fars(south), Khorasan, Mazandaran,
  Khoozestan, Ilam, Boushehr
• lower upper extremity,
• seasonalitySandfly bite in summer, clinical
  manifestation from the mid fall till mid winter

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1385-1376
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1386-1376
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1389-1376
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OccurrenceIran Visceral

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Life Cycle

• As nonmotile obligate intracellular (in
  macrophage) amastigote in vertebrate including
  human
• As motile fllagelated extracellular promastigote
  invitro in phlebotomines(sand flies)

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Reservoir

• Cutaneous
• Urban Human, Dog( accidental)
• Rural Rodents(gerbils,rats)
• Visceral
• Indian Human
• Mediteranean( Iran) Canidae( Dog, Fox)(from
  human to human is possible by sand fly)
• Africa Rodents

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Mode of Transmission

• Through bite of female sand fly from the infected
  zoonotic reservoir
• After feeding on an infected mammalian host,
  motile promastigote develop multiply in gut in
  8-20 days(10)
• Carnivore with eating the carcasses of infected
  animals
• Person to person, transfusion sexual reported
  but is rare
• Contact of eye mucosa or open wound with infected
  materials
• Transmission of cutaneous leishmaniasis can be
• Person to person
• Animal to animal
• Animal to human vice versa

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Vector Sand fly

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Ph Sergenti
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Ph Sergenti
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Ph Papatasi
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Ph Papatasi
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Ph Papatasi
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Ph Papatasi
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Ph Papatasi
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Ph Papatasi
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Ph Papatasi
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Ph Papatasi
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Incubation Period

• Cutaneous( at least one wk)
• Rural 1-4 wks
• Urban 2-8 mo( even 1-2 yrs)
• Visceral
• 2-6 mo( several wks to several mo, even 10 days
  to years)

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Period of Communicability

• Cutaneous not typically transmitted from person
  to person
• Infectious to sand fly as long as parasites
  remain in lesions( without Rx a few mo to 2 yrs)
• Visceral
• Infectious to sand fly as long as parasites
  remain in the circulating blood or skin of the
  mammalian reservoir
• Infectivity for sand fly may persist even after
  clinical recovery of patient

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Clinical presentationCutaneous

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Ph Sergenti
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Susceptibility Resistance

• Cutaneous
• Susceptibility is general
• Tropica, Major Lifelong immunity( not
  essentially with cross-immunity)
• Visceral
• Susceptibility is general
• Lasting homologus immunity
• Inapparent subclinical infections are common
• Malnutrition predispose to clinical dx
  activation of inapparent infections( AIDS
  reactivation of latent infection)

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Methods of Control Prevention

• Detection rapid Rx( esp if human is reservoir)
• Residual insecticide( periodic)
• Sand fly has a short flight range is highly
  susceptible to systematic spraying ( interior
  exterior of doorways)
• Eastern Spraying of breeding sites such as
  stone walls, animal houses rubbish heaps)

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• Insecticide impregnated bed nets are under trial
• Screening( size not more than 0.89 mm,10 -12
  holes per linear cm)
• Eastern Eliminate rubbish heaps other breeding
  places
• Western
• Dog control, destroy gerbils their burrows
• Avoid thickly forested areas esp. after sundown
• Use insect repellents protective clothing

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Control of Patientcutaneous

• Isolation quarantine none
• Concurrent disinfection none
• Treatment
• Pentavalent antimonials
• Meglumine antimonate( Glucantime)
• Na stibogluconate(pentostam)
• Pentamidine
• Imidazoles ketoconazole, itraconazole
• Amphotericin B (mucosal)

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Control of PatientVisceral

• Quarantine none
• Isolation Blood body fluid precautions
• Concurrent disinfection none
• Treatment
• Pentavalent antimonials
• Meglumine antimonate( Glucantime)
• Na stibogluconate(pentostam)
• Pentamidine
• Amphotericin B