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Visceral LeishmaniasisICD-10 B55.02.3.1 IdentificationDisease affects usually younger ages (below 5 years) in both sexes. The patients most commonly are from rural affected areas.Death rate usually is 10 – 30% and may be more in advanced cases and especially without or delay treatment.Clinical descriptionClinical: systemic disease characterizes by gradual or sudden onsite fever which is persistent and regular. Other associate features include: hepatosplenomegaly, lymphadenopathy, anemia, leucopenia, thrombocytopenia and progressive emaciation and general weakness, brownish coloration of skin with progressive enlargement of abdomen.Lab diagnosis: direct smear from the bone marrow (to find parasite amastigote), with bone marrow smear culture 3N media to find promastigote-with serological test (IFAT-ELISA-Rk39 dipstick).2.3.2 Infectious agentIntercellular protozoa of the genus Leishmania (L.donovani or L.infantum)Cases are reported in all provinces except Erbil, Dahuk, and SulaymaniyaThe cases registered mostly in Babil, Diyala, and Basrah.The disease increase usually in autumn and winter every year and prevalent in the middle and south provinces of Iraq2.3.4 ReservoirDogs, Rodents, Jackals, Foxes2.3.5 Modes of transmissionFrom the reservoir host by the bite of infected female sand fly.Female sandflies pick up parasite (amastigote or LD bodies) while feeding on an infected host. Parasite undergo morphological change to become flagellate, development and multiplication in the gut of sandflies and move to mouthparts.2.3.6 Incubation periodUsually from 1-3 months. (Range: 2 week-one year).2.3.7 Period of communicability Sand fly activity occurs in humid conditions when there is no rain or wind. They are usually most active at dawn, dusk and during the night, or if they are disturbed in their hiding places (animal burrows, holes in houses and other relatively cool, humid locations) in the daytime.2.3.8 Susceptibility and resistanceGeographical distribution of leishmaniasis is limited by the distribution of the sand fly, its susceptibility to cold climates, its tendency to take blood from humans or animals. Risk factor is the movement of susceptible populations into endemic areas, including large-scale migration of populations for economic reasons. Poverty and malnutrition play a major role in the increased susceptibility. 2.3.9 Methods of control 1.Case detection and rapid treatment from hospital and dem1atological department weekly and monthly.2.Two round spraying yearly by insecticide with residual action to control vector (sand fly) in the affected areas.3.Fogging by especially machine at evening in the affected areas.4.Rodent control measures.5.Stray dogs control measures.6.Specific treatment mainly by pentavellant antimony compounds (pentostam) by systemic route as follows ( 20 mg/ kg/ day ) for 28 days.2.3.10 Management of the disease ?Medicines called antimony-containing compounds are the main drugs used to treat leishmaniasis. These include:oMeglumine antimoniateoSodium stibogluconate?Other drugs that may be used include:oAmphotericin BoKetoconazoleoMiltefosineoParomomycinoPentamidineCure rates are high with the proper medicine. Patients should get treated before damage to the immune system occurs. ................
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