Asymptomatic leishmaniasis in kala-azar endemic areas of Malda district, West Bengal, India (original) (raw)
Related papers
Transactions of the Royal Society of Tropical Medicine and Hygiene, 2011
A cohort of 91 asymptomatic individuals with visceral leishmaniasis (VL) were identified during base line screening using recombinant 39-aminoacid antigen (rk-39) and polymerase chain reaction (PCR) conducted from December 2005 to June 2006 involving 997 individuals of two highly endemic villages of Vaishali district, Bihar. The point prevalence of asymptomatic infection was 98 per 1000 persons at baseline. There was no statistically significant difference between rk-39 and PCR positivity rate (P > 0.05), even though PCR positivity alone was found significantly higher (4.2%) than rk-39 positivity alone (2.6%). The monthly follow-up of the asymptomatic cohort revealed a disease conversion rate of 23.1 per 100 persons within a year. There was a statistically significant difference in conversion of disease when individuals were positive by both tests as compared to single tests by rk-39 and PCR (P < 0.01). Disease conversion rate in the subjects residing in households with a history of VL (62%, 13/21) was higher than those residing in the households without a history of VL (38%, 8/21). Most of the identified asymptomatic individuals were from low socioeconomic strata similar to that of VL cases in general. Apart from rk-39, PCR may be considered for screening of asymptomatic Leishmania donovani infection in large-scale epidemiological studies. Screening of asymptomatic cases and their close follow-up to ascertain early detection and treatment of VL may be considered in addition to the existing VL control strategies.
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.
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.
PLoS neglected tropical diseases, 2017
The South-East Asia Region Kala-azar Elimination Programme (KAEP) is expected to enter the consolidation phase in 2017, which focuses on case detection, vector control, and identifying potential sources of infection. Post-kala-azar dermal leishmaniasis (PKDL) is thought to play a role in the recurrence of visceral leishmaniasis (VL)/kala-azar outbreaks, and control of PKDL is among the priorities of the KAEP. We reviewed the literature with regard to PKDL in Asia and interpreted the findings in relation to current intervention methods in the KAEP in order to make recommendations. There is a considerable knowledge gap regarding the pathophysiology of VL and PKDL, especially the underlying immune responses. Risk factors (of which previous VL treatments may be most important) are poorly understood and need to be better defined. The role of PKDL patients in transmission is largely unknown, and there is insufficient information about the importance of duration, distribution and severity ...
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.
American Journal of Tropical Medicine and Hygiene, 2012
Post-kala-azar dermal leishmaniasis (PKDL) has important public health implications for transmission of visceral leishmaniasis (VL). Clinical and epidemiologic profiles of 102 PKDL patients showed that median age of males and females at the time of diagnosis was significantly different (P = 0.013). A significant association was observed between family history of VL and sex of PKDL patients (χ 2 = 5.72, P 0.01). Nearly 33% of the patients showed development of PKDL within one year of VL treatment. The observed time (median = 12 months) between appearance of lesions and diagnosis is an important factor in VL transmission. A significant association was observed between type of lesions and duration of appearance after VL treatment (χ 2 = 6.59, P = 0.001). Because PKDL was observed during treatment with all currently used anti-leishmanial drugs, new drug regimens having high cure rates and potential to lower the PKDL incidence need to be investigated.
Atypical leishmaniasis: A global perspective with emphasis on the Indian subcontinent
PLoS neglected tropical diseases, 2018
Among the neglected tropical diseases, leishmaniasis continues to be prevalent in many tropical and subtropical countries despite international, national, and local efforts towards its control and elimination over the last decade. This warrants a critical evaluation of such factors as under-reporting, asymptomatic infections, post kala azar dermal leishmaniasis (PKDL) cases, and drug resistance. In this review, we highlight lesser-understood atypical presentations of the disease involving atypical parasite strains against a background of classical leishmaniasis with a focus on the Indian subcontinent. A literature review based on endemic areas, the nature of disease manifestation, and underlying causative parasite was performed with data collected from WHO reports for each country. Searches on PubMed included the term ''leishmaniasis" and "leishmaniasis epidemiology" alone and in combination with each of the endemic countries, Leishmania species, cutaneous, vi...
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.
Parasites & Vectors, 2013
Post kala-azar dermal leishmaniasis (PKDL) is a neglected complication of visceral leishmaniasis (VL)―a deadly, infectious disease that claims approximately 20,000 to 40,000 lives every year. PKDL is thought to be a reservoir for transmission of VL, thus, adequate control of PKDL plays a key role in the ongoing effort to eliminate VL. Over the past few years, several expert meetings have recommended that a greater focus on PKDL was needed, especially in South Asia. This report summarizes the Post Kala-Azar Dermal Leishmaniasis Consortium Meeting held in New Delhi, India, 27–29 June 2012. The PKDL Consortium is committed to promote and facilitate activities that lead to better understanding of all aspects of PKDL that are needed for improved clinical management and to achieve control of PKDL and VL. Fifty clinicians, scientists, policy makers, and advocates came together to discuss issues relating to PKDL epidemiology, diagnosis, pathogenesis, clinical presentation, treatment, and co...