Published Date: 1997-09-27 23:50:00
Subject: PRO> Leishmaniasis - Nepal (02)
Archive Number: 19970927.2042
LEISHMANIASIS - NEPAL (02)
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A ProMED-mail post
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Leishmaniasis - Nepal 970408132948Leishmania/HIV co-infections 970222143043
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Leishmaniasis, canine - Italy: advice needed -Reply 970411151032
Leishmaniasis, control strategies - RFI 970125124453
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Leishmaniasis diagnosis by PCR: RFI 970327170444
Date: Fri, 26 Sep 1997 22:37:58 -0200
From: Luiz Jacintho da Silva <luisjs@guttenberg.correionet.com.br>
Source: Kathmandu Post E-mail edition <tkpfeed@mos.com.np>, 26th September,
1997
<http://www.south-asia.com/news-ktmpost.html>
KATHMANDU, Sept 25 - Sanchita Regmi reports that the debilitating Kala-azar
[visceral leishmaniasis which killed thousands in the 1950s and through
the 1960s in the Terai is making a comeback.
Health workers say the parasitic disease carried by the sandfly has already
claimed tens of lives in recent years, but the toll is likely to go up in
coming years as thousands of others succumb to the slow-developing disease.
Though sandflies are not generally found at an altitude higher than 2000
ft, and therefore not in Kathmandu, the increasing trend of migration from
the Terai to Kathmandu means that infected people are moving into the
capital and will fall ill there.
According to the Ministry of Health, the number of infections reported was
70 in 1995 and 72 in 1996. But the actual incidence is believed to be much
higher as many cases never get reported. "This is because the people are
not aware of the symptoms of the disease," says Dr Ananda Ballav Joshi,
principal investigator of Kala-azar at TU Teaching Hospital. The classical
features of the disease are fever, weight loss and anaemia. The skin of
face, hands and feet darkens and the liver and spleen become enlarged.
Kala-azar has its source in the plains. It has been known to occur in
epidemic proportions in well-defined areas, especially in the eastern
region of the country.
Says Dr Joshi: "As a result of the massive malaria eradication campaign,
helped by spraying of insecticides, between 1958 and 1964, Kala-azar
declined to a point where the degree of epidemicity was extremely low.
But even during this period some had Kala-azar and they acted as a
reservoir of infection. This is proved by the fact that the disease has
periodically [resurfaced." [The only known reservoir of the disease in the
Indian subcontinent is man - Mod.JW
The incidence of this disease, however, started gradually rising during
the late 1960s and early 1970s. By 1977, the epidemic reached its peak
with an estimated 10,000 cases and 4,500 deaths in the borders of Nepal
and India. This outbreak declined in the 1980s, thanks to various control
measures.
Kala-azar was earlier affecting the eastern regions--as Jhapa and
Morang--but more currently it is endemic in districts of Saptari,
Dhanusa, Sarlahi, Bara, and even Banke in the west. The prevalence
rate of the disease is higher in rural areas, especially during and
after rains. People who work in farms, forestry, mining and fishing are
at a greater risk--simply because they are exposed to bites from
sandflies.
It is seen that deforestation and urbanization are leading factors of
Kala-azar. "Hill migrants to Terai living near forests are most prone as
their sanitation level is very poor." The same applies to urban slums,
occupied by the poor and the illiterate.
Kala-azar can occur among all age groups including infants below the age
of one. It usually strikes the poorest of the poor. As a disease, it
more often debilitates than kills and makes people weak by loss of
weight.
The risk of infection can be reduced through awareness and by such
protective measures as avoiding sleeping on floors and keeping the
environment clean. [Sandflies bite very close to ground level - Mod.JW
[Is there a role for Aids in the current outbreak of Kala-azar? - see:
"Leishmania/HIV co-infections" referenced above
--
Luiz Jacintho da Silva. M.D.
Professor adjunto, Disciplina de Doencas Transmissiveis
Depto. Clinica Medica, FCM, Unicamp
E-mail: luisjs@correionet.com.br
Fone/Phone: +55 (019) 287 4910
Fax: +55 (019) 251 92 56
Cx. Postal 6019 - Unicamp
13081-970 - Campinas, SP - Brasil/Brazil
................................................jw
--
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