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Study of Leishmaniasis in Tajikistan

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Epidemiological Characteristic of Leishmaniasis in Tajikistan, as the Basis for Rationalization of Preventive Measures

Tech Area / Field

  • MED-DIS/Disease Surveillance/Medicine

Status
3 Approved without Funding

Registration date
24.02.2011

Leading Institute
Republican Center of Tropical Diseases (RCTD), Tajikistan, Dushanbe

Supporting institutes

  • Institute of Zoology and Parasitology named after E.N.Pavlovsky, Tajikistan, Dushanbe

Collaborators

  • SWORDE Teppa / Representative Office, Tajikistan, Khatlon\nYale University / Yale School of Public Health, USA, CT, New Haven\nUniversity of Notre Dame / Department of Biological Sciences, USA, IN, Notre Dame

Project summary

According to the World Health Organization the cases of human leishmaniasis are registered in 88 countries in Asia, Africa, southern Europe, Central and South America, where annually more than 2 million cases are reported, of which 59 000 cases lethal, 12-14 million of population infected by the disease in the world (Jorge Alvar, Dmitriy Kovalenko: WHO consultants, 2008).

Leishmaniasis, a group of protozoan vector-borne diseases in humans and animals, characterized by a primary lesion of the internal organs (visceral leishmaniasis) or the skin and mucous membranes (cutaneous leishmaniasis) and transferred to their owners, human and animal by mosquitoes’ bite of the Phlebotomus.

Visceral leishmaniasis (VL)-transmissible protozoan disease characterized by chronic, systemic disease with a wave-like fever, splenomegaly, hepatomegaly, progressive anemia, leukopenia, thrombocytopenia, cachexia, lymphadenopathy (pancytopenia), progressive malnutrition, weakness, hemorrhagic syndrome. Commonly Complications arise as a result of the accession of associated infection. VL Patients without specific treatment in 98-99% of cases die from severe complications and associated infections. If treated early, usually in all cases, patients recovered.

Mainly preschool age children are infected by VL (99% of registered patients in 1994-2009), and rarely adults. The infection is seasonal in the whole period of activity of mosquitoes: in Penjikent, Aini, Istaravshan district of Sughd region from May to August, in Vanzh, Darvoz districts and Horug of GBAO from June to August. The incubation period is from 2 weeks to 1 year or more (on average 3-5 months), so the incidence of disease reported all year-round, with some peaks in winter and spring months.

Visceral leishmaniasis has never been the subject of special study in Tajikistan. Therefore, for visceral leishmaniasis, except for descriptions of inpidual cases (E. A. Nemirovsky, 1962; A. Tarpey, 1938; NI Latyshev, MA Shoshina, AP Kryukov, VA Chernyshov, 1946; M. Artemyev, and VM Neronova, 1984;) so far, in fact, nothing is known.

Cutaneous leishmaniasis (CL) is transmissible protozoan disease, clinically characterized by skin lesions with ulceration and scarring.

Unfavorable sanitary conditions, failure to comply with basic hygiene standards, lack of timely removal of household garbage and a mosquito treatments lead to increase the incidence of leishmaniasis. Lack of preventive veterinary work among potential reservoirs (rodents, jackals, dogs) in particular, the lack of data on faunistic survey centers in rural areas, aimed to identify animals which are actually a reservoir of leishmaniasis. Currently, control of leishmaniasis in Tajikistan is limited only by the late treatment of patients with complications. Integrated control measures, ie active detection and timely adequate diagnosis, radical treatment by specific drugs because of insufficient material and technical equipment of the laboratory service is not performed at all. The main difficulty in control of the disease are late diagnosis, poor people's knowledge about the prevention of the disease, lack of trained personnel (surgeons to collect material for parasitological research, laboratory, medical parasitologists and infectionists), lack of specific drugs and prevention (bed nets, insecticides, etc.).

The existing parasitological laboratories in the country are using outdated research methods, facing lack of using more modern and efficient methods for diagnostic such as serological methods, immunologic tests Montenegro, cultivation, xenodiagnosis (infection of experimental animals). Current parasitological methods contribute to more effective early diagnosis of diseases. In all areas of the country there are no specialists on identification and diagnosis of leishmaniasis, and there is limited access to health services in rural areas. Thereby, the real figures of leishmaniasis incidence much higher than official statistics shows.

Thus, many questions of epidemiology, the natural foci and the epidemiological stratification of the diseases remain uninvestigated.


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