1 Dr. ENID ELIZABETH THOMAS COMMUNITY MEDICINE PARIYARAM MEDICAL COLLEGELeishmaniasis Japanese encephalitis Chikungunya Integrated vector control Dr. ENID ELIZABETH THOMAS COMMUNITY MEDICINE PARIYARAM MEDICAL COLLEGE
2 LEISHMANIASIS 3/28/2017
3 LEISHMANIASIS Leishmania donovaniLeishmaniasis are a group of protozoal diseases caused by parasites of genus “ Leishmania ”. 3/28/2017
4 Kala-azar/visceral leishmaniasis (V.L) Cutaneous leishmaniasis (C.L) Different types Kala-azar/visceral leishmaniasis (V.L) Cutaneous leishmaniasis (C.L) Muco-cutaneous leishmaniasis (M.C.L) Post-Kala-azar dermal leishmaniasis (P.K.D.L) Kala-azar=black sickness 3/28/2017
5 2 lakh- 4 lakh cases of KA annually PROBLEM STATEMENT 2 lakh- 4 lakh cases of KA annually India, Bangladesh, Brazil, Nepal, Ethiopia, Sudan INDIA: st reported 1950- decreased 1970- increased 3/28/2017
6 Endemic in 54 districts- Bihar, Jharkand, West Bengal, Uttar PradeshKA- most important in India 2015 Nov cases - 4 deaths 3/28/2017
7 2015- Malappuram- Pookottummala, Amarambalam Thrissur- Mulloorkkara KERALA 2015- Malappuram- Pookottummala, Amarambalam Thrissur- Mulloorkkara 2016- Chempanaruvi near Pathanapuram in Kollam dt Chittariparambu- Koothuparambu- Kannur 2017- near Cherupuzha 3/28/2017
8 SANDFLY mm 3/28/2017
9 Phlebotomus argentipes, P. papatasi3/28/2017
10 2 weeks 1-2 weeks 3-6 Days 2 weeks 3/28/2017
11 Hop from one place to another Incapable of flying over long distances Sandfly habits Nocturnal Holes, cracks, crevices Hop from one place to another Incapable of flying over long distances 50 yards of breeding places Only females bite Painful and irritating bites 3/28/2017
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17 LAB diagnosis Biopsy- spleen, bone marrow- LD bodies Antibody testRapid tests- rk39 Aldehyde test of Napier Serological tests ELISA Direct Agglutination test rk39 dipstick test Indirect fluorescent antibody test ICMR- new diagnostic kit- 2014 3/28/2017
18 Liposomal Amphotericin B (LAMB) - inj i/v - 10 mg/kg bw Treatment Liposomal Amphotericin B (LAMB) - inj i/v - 10 mg/kg bw Miltefosine capsules- oral Free through NVBDCP Paramomycin inj + Miltefosine 3/28/2017
19 DDT (1-2 g/m²), synthetic pyrethroids Sandfly control DDT (1-2 g/m²), synthetic pyrethroids Yearly twice in endemic areas –spraying- 6 feet high 3/28/2017
20 Small sized nets( 36-42 mesh size) Repellants Personal protection Small sized nets( mesh size) Repellants Avoid sleeping on floor, outdoors 3/28/2017
21 Environmental measuresImprove standard of living Plaster walls Close crevices, cracks Personal & environmental sanitation 3/28/2017
22 JAPANESE ENCEPHALITIS3/28/2017
23 JAPANESE ENCEPHALITISMosquito borne encephalitis Group B flavivirus – ssRNA virus Mainly zoonotic Incidently man 3/28/2017
24 1871 Japanese Encephalitis described in japan.1934 Japanese Encephalitis virus was isolated. 3/28/2017
25 Tamil Nadu, Karnataka, Haryana, Bihar, UP, Assam 2015- 8079 cases PROBLEM 68,000 Cases annually 20,400 deaths annually INDIA- Tamil Nadu, Karnataka, Haryana, Bihar, UP, Assam cases 1112 deaths 3/28/2017
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27 Culicine mosquitoes. (C.Tritaeniorhynchus,c.Vishnui, C.Gelidus) VECTOR OF JE Culicine mosquitoes. (C.Tritaeniorhynchus,c.Vishnui, C.Gelidus) Some anophelines. C.Tritaeniorhynchus – important vector In south india. 3/28/2017
28 Zoophilic, feeding primarily on animal hosts. Time of biting Breeding habits Breed in rice fields, Shallow ditches and pools. Choice of host Zoophilic, feeding primarily on animal hosts. Time of biting usually at nights. 3/28/2017
29 Disease is transmitted to man by bite of infected mosquitoes.No man to man transmission man is incidental “dead end” host. Incubation period Varies from 5-15 days 3/28/2017
30 CLINICAL FEATURES Divided into three stages: 1. Prodromal stage2. Encephalitic stage 3. Late stage 3/28/2017
31 Disease:asymptomatic infection=1:250 to 1:1000 C/F contd… Disease:asymptomatic infection=1:250 to 1:1000 Represents tip of iceberg It is characterized by CNS involvement Japanese encephalitis is also called BRAINFEVER 3/28/2017
32 PRODROMAL PHASE:- High grade fever, headache malaise Duration :6 daysC/F contd… PRODROMAL PHASE:- High grade fever, headache malaise Duration :6 days ENCEPHALITIC STAGE:- High fever, severe head ache, nuchal rigidity, focal CNS signs, seizures, altered sensorium, speech problem 3/28/2017
33 Ocular palsies, hemiplegia, quadriplegia, tremorsC/F contd… Symptoms and signs of raised ICT- headache, vomiting,bradycardia,irregular breathing. Ocular palsies, hemiplegia, quadriplegia, tremors 3/28/2017
34 Active inflammation comes to an end Fever, ESR- normal LATE STAGE & SEQUALE: Active inflammation comes to an end Fever, ESR- normal Neurological signs improve Residual neurological deficits± Case fatality rate: 20-40% Average period b/w onset of illnes & death- 9 days 3/28/2017
35 Lab diagnosis Serology- IgM capture ELISA Antibody assaysDot blot assays Virus from encephalitic brain at autopsy 3/28/2017
36 Only symptomatic treatment maintenance of airway MANAGEMENT OF JE Only symptomatic treatment maintenance of airway fluid and electrolyte balance- BP control of convulsions, raised ICP, temperature 3/28/2017
38 UIP schedule: 1- 15 years. LA vaccine 9 months Booster at 16-24 months VACCINATION UIP schedule: years. LA vaccine 9 months Booster at months Travellers 3 primary 0,7,28 days or 2 primary doses 4 weeks apart Continued protection– 1 year & then every 3 years 3/28/2017
39 CHIKUNGUNYA FEVER 3/28/2017
40 WHAT IS CHIKUNGUNYA ? It is a debilitating, but non-fatal, viral infection that is spread by bite of the infected Aedes aegypti mosquito. 3/28/2017
41 Chikungunya was first described in Africa (Tanzania) in 1952. INDIA- Andhra Pradesh, Karnataka, Tamil Nadu, Kerala, Maharashtra, Gujarat etc ,000 cases reported 3/28/2017
42 Fever, chills, headache, lumbago, conjunctivitis Adenopathy CLINICAL FEATURES Fever, chills, headache, lumbago, conjunctivitis Adenopathy Morbilliform rash--- Purpura Coffee coloured vomiting. Epistaxis Arthropathy- pain , swelling, stiffness- mcp, wrist, elbow, knee, ankle, mtp joints (b/w 3rd & 5th day after onset of clinical symptom) 3/28/2017
43 Hemagglutination inhibition Complement fixation RT- PCR- rapid testDIAGNOSIS Serological tests ELISA Hemagglutination inhibition Complement fixation RT- PCR- rapid test 3/28/2017
45 CONTROL Vector control Vaccines 3/28/2017
46 INTEGRATED VECTOR CONTROL3/28/2017
47 Filaria, japanese encephalitis dengue, chikungunya, yellow feverMosquito Diseases Anopheles Culex Aedes Mansonoides Malaria Filaria, japanese encephalitis dengue, chikungunya, yellow fever Brugian filariasis 3/28/2017
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49 inclines at an angle to surface Tiger mosquito Day biters 100 m Anopheles Culex Aedes Mansonia ADULT Spotted wings inclines at an angle to surface Unspotted wings Hunch back Nuisance mosquitoes Night biters 11km Tiger mosquito Day biters 100 m Big, black/ brown BREEDING PLACES Fresh water Dirty water Artificial collections Under aquatic (pistia) plant 3/28/2017
50 Anopheles Culex Aedes Mansonia EGG Boat shaped Single OvalCluster/raft Cigar shaped Star shaped Cluster LARVAE No siphon tube siphon tube 3/28/2017
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52 EGGS 3/28/2017
53 LARVAE AND PUPA 3/28/2017
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56 IVC Anti larval measures Environmental , Chemical , BiologicalAnti adult measures Residual spray , Space spray, Genetic control Personal protection against bites Net, screening , repellents 3/28/2017
57 ANTILARVAL MEASURES Environmental control: source reduction, water mx, engineering methods Chemical control : Mineral oils: litres/ hectare , paris green- stomach poison - 1 kg/ hectare, synthetic insecticides – Fenthion, Chlorpyrifos, Abate - temifos Biological control : gambusia, lebister reticulatus, bacillus thuringensis 3/28/2017
58 ANTIADULT MEASURES Residual sprays (IRS)– DDT(50%), Synthetic Pyrethroids include deltamethrin 2.5% WP, Cyfluthrin 10% WP, lambdacyhalothrin 10% WP, Space sprays (ISS) – Pyrethrum extract- nerve poison; Residual insecticide – malathion, fenitothrion by ULV: Fogging- malathion Genetic control – sterile male technique, chromosomal translocation etc 3/28/2017
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62 PROTECTION AGAINST MOSQUITO BITESMosquito net- size should not exceed inch Screening – copper or bronze ( 16 meshes to the inch) Repellants – Diethyltouamide ( DEET) – culex hours 3/28/2017
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64 Thank you! 3/28/2017