Monday, 24 February 2014

Leishmanisis - Case Study of an Infectious/Communicable Disease


o More than 90% of global cases of visceral leishmaniasis occur in only 6 countries including India, Sudan and Brazil.

o Cutaneous leshmaniasis is more widely spread in 3 main epidemiological regions including South America and the Mediterranean basin with Sudan, Afghanistan and Brazil having some of the highest rates.


o Parasitic disease caused by the leishmania parasite and transmitted by the female phlebotomine sand fly; associated with malnutrition, famine and weak immune systems

o Cutaneous and mucocutaneous leishmaniasis affect the skin and mucous membranes of the mouth and nose leading to disfiguring scars and deformities

o Visceral leishmaniasis causes a swollen liver and spleen and can kill without treatment

o Health impact has been grossly underestimated until recently, now thought to be second to Malaria

o Could be due to a high morbidity and low mortality, although some epidemics of VL have high case-fatality rates e.g. 100 000 deaths caused in Sudan between 1984-94

o 70 000 deaths per year from VL

o HIV and Leishmaniasis are mutually reinforcing

o Leishmaniasis stimulates the HIV virus to replicate and people with HIV are up to 2000 times more likely to catch leishmaniasis because their immune system is supressed

o Affects the ‘poorest of the poor’ making it impossible to earn and thus affecting their whole family

o Cost of treatment in Bangladesh estimated to be 1.2x annual per capita income

o People have to sell or rent their assets or take loans to pay medical bills

o Delays socioeconomic development

o For example epidemics of the disease have delayed the implementation of development projects in the Amazon basin as money is needed for treatment instead

o Puts strain on the economic productivity of a country’s workforce as people are unable to work

o Social stigma due to disfiguring scars can cause anxiety, depression and quality of life

o Associated with illiteracy and low levels of education as people don’t know how to avoid it

o People don’t understand the disease so patients are victimised and isolated, especially those with active lesions, e.g. Afghan refugees have become known for their scars

o HIV-leishmaniasis sufferers can experience even more physical and psychological pain

o Particularly affects women and associated with gender discrimination

o Cultural expectations of women mean that any disability may cause abandonment by their husbands, in societies where women are very dependent.

o Most severely affected group children under 15, which could cause bullying and children to become a burden on the family

Discussion point: Which form of the disease do you think is the worst and why?

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