Atypical leishmaniasis: A global perspective with emphasis on the Indian subcontinent (original) (raw)
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Leishmaniasis: An Emerging Disease in Mumbai, Maharashtra, India
Leishmaniasis is caused by the infection of haemoparasite " Leishmaniadonovani'. Clinically it can present as Cutaneous Leishmaniasis (CL), Mucocutaneous Leishmaniasis (MCL) and Visceral Leishmaniasis (VL). In India it is a major health problem in the North & Central regions of India and is infrequently reported from western India. However, we encountered two clinically suspected cases of Leishmaniasis over a period of six months in the 2009. First case presented with Post Kala Azar Dermal Leishmaniasis (PKDL) and second presented as VL with secondary septicemia. In first case laboratory diagnosis was made by demonstration of LD bodies on histopathological examination and in second case anti-leishmanial antibodies were also detected. The reason for the emergence of the disease in an area from where it had not been reported earlier could be due to migration of people from areas where the disease is endemic to hubs of development in urban areas for their livelihood.
Asymptomatic leishmaniasis in kala-azar endemic areas of Malda district, West Bengal, India
PLOS Neglected Tropical Diseases, 2017
Asymptomatic leishmaniasis may drive the epidemic and an important challenge to reach the goal of joint Visceral Leishmaniasis (VL) elimination initiative taken by three Asian countries. The role of these asymptomatic carriers in disease transmission, prognosis at individual level and rate of transformation to symptomatic VL/Post Kala-azar Dermal Leishmaniasis (PKDL) needs to be evaluated. Asymptomatic cases were diagnosed by active mass survey in eight tribal villages by detecting antileishmanial antibody using rK39 based rapid diagnostic kits and followed up for three years to observe the pattern of sero-conversion and disease transformation. Out of 2890 total population, 2603 were screened. Antileishmanial antibody was detected in 185 individuals of them 96 had a history of VL/PKDL and 89 without such history. Seventy nine such individuals were classified as asymptomatic leishmaniasis and ten as active VL with a ratio of 7.9:1. Out of 79 asymptomatic cases 2 were lost to follow up as they moved to other places. Amongst asymptomatically infected persons, disease transformation in 8/77 (10.39%) and sero-conversion in 62/77 (80.52%) cases were noted. Seven (9.09%) remained sero-positive even after three years. Progression to clinical disease among asymptomatic individuals was taking place at any time up to three years after the baseline survey. If there are no VL /PKDL cases for two or more years, it does not mean that the area is free from leishmaniasis as symptomatic VL or PKDL may appear even after three years, if there are such asymptomatic cases. So, asymptomatic infected individuals need much attention for VL elimination programme that has been initiated by three adjoining endemic countries.
Parasitology, 2018
SUMMARYLeishmania donovani, the most virulent species of Leishmania, is found in the South Asian region that harbours the majority of visceral leishmaniasis (VL) cases in the world. The traditionally accepted relationships between the causative species of Leishmania and the resultant disease phenotype have been challenged during recent years and have underscored the importance of revisiting the previously established taxonomy with revisions to its classification. The weak voice of the afflicted with decades of neglect by scientists and policy makers have led to the miserably inadequate and slow advancements in product development in the fields of diagnostics, chemotherapeutics and vector control that continue to hinder the effective management and control of this infection. Limitations notwithstanding, the regional drive for the elimination of VL initiated over a decade ago that focused on India, Nepal and Bangladesh, the three main afflicted countries in the Indian subcontinent is ...
VISCERAL LEISHMANIASIS IN A NON-ENDEMIC REGION OF INDIA-INVESTIGATION OF AN OUTBREAK
Journal of Evolution of Medical and Dental Sciences, 2018
BACKGROUND Visceral Leishmaniasis (VL) is seen commonly in eastern parts of India, while occurrences of cutaneous forms of the disease have been reported recently from Western Ghats of southern India. The clinical manifestations of VL resembles many other chronic illnesses and its diagnosis and management requires added attention in southern parts of the country. The clinical, epidemiological and entomological investigations related to the occurrence of a case of VL in Kerala, south India are described in detail. MATERIALS AND METHODS This study is a descriptive study. The patient suffered from various clinical manifestations which were investigated repeatedly at various primary, secondary and tertiary care institutions. Several laboratory tests for multiple diseases turned out to be negative, even though the symptoms were persisting. Accurate diagnosis was made from the bone marrow cytological examination, which indicated the presence of Leishman-Donovan bodies. Further epidemiological and entomological investigations confirmed the presence of vector (Phlebotomus argentipes) from multiple locations around the residence of the patient. Evidence of Leishmaniasis or its source could not be diagnosed in contacts, vectors or suspected animal reservoirs in the area. RESULTS Accurate diagnosis was made from the bone marrow cytological examination, which indicated the presence of Leishman-Donovan bodies. Epidemiological and entomological investigations confirmed the presence of vector (Phlebotomus argentipes) from multiple locations around the residence of the patient. Evidence of Leishmaniasis or its source could not be diagnosed in contacts, vectors or suspected animal reservoirs in the area. CONCLUSION Early and accurate diagnosis of VL is difficult in south India due to unawareness about the manifestations of disease and also due to unavailability of reliable laboratory kits. The management of such cases is even more challenging due to the lack of availabi lity of proper drugs. The recent reports of emergence of resistant cases should be a pointer in creating improved awareness and facilities for the rapid identification and management of cases of visceral leishmaniasis. KEYWORDS Visceral Leishmaniasis, Leishmaniasis in Kerala, Kala-Azar in Kerala, Epidemiological Investigation of Leishmaniasis. HOW TO CITE THIS ARTICLE: Ravi K, Valamparampil MJ, Kumar PN, et al. Visceral leishmaniasis in a non-endemic region of India-investigation of an outbreak.
Asymptomatic Infection with Visceral Leishmaniasis in a Disease-Endemic Area in Bihar, India
American Journal of Tropical Medicine and Hygiene, 2010
A prospective study was carried out in a cohort of 355 persons in a leishmaniasis-endemic village of the Patna District in Bihar, India, to determine the prevalence of asymptomatic persons and rate of progression to symptomatic visceral leishmaniasis (VL) cases. At baseline screening, 50 persons were positive for leishmaniasis by any of the three tests (rK39 strip test, direct agglutination test, and polymerase chain reaction) used. Point prevalence of asymptomatic VL was 110 per 1,000 persons and the rate of progression to symptomatic cases was 17.85 per 1,000 person-months. The incidence rate ratio of progression to symptomatic case was 3.36 (95% confidence interval [CI] = 0.75-15.01, P = 0.09) among case-contacts of VL compared with neighbors. High prevalence of asymptomatic persons and clinical VL cases and high density of Phlebotomus argentipes sand flies can lead to transmission of VL in VL-endemic areas.
Tropical Medicine & International Health, 2012
We assessed the prevalence of post-kala-azar dermal leishmaniasis (PKDL), a late cutaneous manifestation of visceral leishmaniasis (VL), in 16 VL-endemic communities in Bihar, India. The prevalence of confirmed PKDL cases was 4.4 per 10 000 individuals and 7.8 if probable cases were also considered. The clinical history and treatment of the post-kala-azar dermal leishmaniasis cases are discussed.
Post-kala-azar dermal leishmaniasis in visceral leishmaniasis-endemic communities in Bihar, India
Tropical Medicine & International Health, 2012
We assessed the prevalence of post-kala-azar dermal leishmaniasis (PKDL), a late cutaneous manifestation of visceral leishmaniasis (VL), in 16 VL-endemic communities in Bihar, India. The prevalence of confirmed PKDL cases was 4.4 per 10 000 individuals and 7.8 if probable cases were also considered. The clinical history and treatment of the post-kala-azar dermal leishmaniasis cases are discussed.
VISCERAL LEISHMANIASIS IN KERALA: AN EMERGING DISEASE
National Journal of Community Medicine, 2016
Leishmaniasis though endemic to certain parts of India is rare in the state of Kerala. Though cutaneous forms of the disease have been reported from a few pockets in Kerala the Visceral form is rare. We report the clinico-epidemiological profile of two cases of visceral leishmaniasis reported from Malappuram district in Kerala. The public health interventions instituted following the confirmation of diagnosis has also been mentioned.
Asymptomatic Leishmania infections in northern India: a threat for the elimination programme?
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2014
Visceral leishmaniasis (VL) continues to embody as a mammoth public health problem and hurdle to the socioeconomic development of Bihar, India. Interestingly, all leishmanial infections do not lead to overt clinical disease and may stay asymptomatic for a period of time. Asymptomatic cases of VL are considered as probable potential reservoirs of VL, and thus can play a major role in transmission of the disease in highly endemic areas of Bihar, India. They outnumber the exact disease burden in endemic areas of this region, thus jeopardizing the goal of the elimination program that is due by 2015. This article discusses the potential risk factors, epidemiological markers of transmission and requirement of highly sensitive diagnostic tools for efficient recognition of the high risk groups of conversion to symptomatic for proper designing of strategies for implementation of the control programs.
Cutaneous leishmaniasis: An emerging infection in a non-endemic area and a brief update
Indian Journal of Medical Microbiology, 2007
We report here the emergence of a new focus of cutaneous leishmaniasis (CL) due to Leishmania tropica (L. tropica) in the Ajmer city of Rajasthan, India, a previously non-endemic area. Between January-February 2006, 13 new indigenously acquired cases of CL were diagnosed among the patients attending the Skin and STD department, JLN Hospital, Ajmer. The diagnosis was based on clinical presentation, demonstration of amastigotes (LT bodies) in Giemsa stained smear of the lesion and response to intralesional / local anti-leishmanial drug therapy. In addition, culture of the promastigote forms of L. tropica from the lesion was successfully attempted in four of the smear negatives cases. By retrospective analysis, 23 new indigenous cases of CL have been diagnosed in the same setting during the period January 2004-December 2005, based on clinical and therapeutic response alone. There was no clear-cut history of sandß y bite and travel outside the district or state to endemic area in any of the cases. However, all of them came from a common residential area (famous dargah of Ajmer) and the peak incidence was seen in January, four months after the famous Urs fair of Ajmer, the location was urban and the lesions were characteristic of L. tropica. Therefore, the disease is suspected to be anthroponotic. These features are suggestive of a common mode of transmission, source and/or vector signalling introduction of this infection into a non-endemic area.