Kala-Azar epidemic in Paurai Nepal

[Snowy Owl]

French news from China

http://www.flutrackers.com/forum/showthread.php?t=24401

4 deaths and 25 in serious conditions

French cites sources of the report from the

http://www.thehimalayantimes.com/index.asp

There is a ongoing program between Nepal & Bangladesh to manage Kala Azar epidemics.

Snowy

[Gert van der Hoek]

Re: Kala-Azar epidemic in Paurai Nepal

Kala-azar kills 4 in central Nepal

May 21, 2007

At least four persons died of kala-azar in Paurai village of Rautahat district in central Nepal in recent days, The Himalayan Times reported on Monday.

According to the daily, the disease has been spreading in the village for three weeks. Kala-azar has rendered 25 persons critically ill.

The district health office has been informed about the spread of the disease, but no one has visited the village, local Ashok Pahadi was quoted by the daily as saying.

Some six kala-azar patients have been undergoing treatment at the district hospital, Pahadi said.

Source: Xinhua

http://english.people.com.cn/200705/21/eng20070521_376456.html

[Gert van der Hoek]

Re: Kala-Azar epidemic in Paurai Nepal

Kala-azar disease spread under control in eastern Nepal

April 26, 2007

Kala-azar disease spreading for the last two months in Saptari district in eastern Nepal is now under control, the Nepali National News Agency RSS reported on Wednesday.

Public Health Administrator Rakesh Thakur said that the disease has been controlled after sprinkling the medicine extensively in the disease-hit areas, distributing nets and launching several awareness programs.

The disease had claimed the lives of five people, including three from a family.

Kala-azar has taken the district in its stronghold for the last seven years, so that all efforts are made to eliminate the disease, Thakur added.

According to the Public Health Office, more than 95 villages in the district are affected by the disease.

The people suffered from the disease were treated freely in local hospitals and health centers, the RSS said.

A district level relief fund has been established because of impecunious condition, and an eight-member Epidemic Disease Control Committee has been formed under the convenorship of Dr Tek Narayan Mandal.

For the blood supply to the victims, various blood donation programs were held by the Nepal Army, non-governmental organizations and government offices.

It is said as many as 13 districts are under Kala-azar threat in Nepal.

Source: Xinhua

http://english.people.com.cn/200704/26/eng20070426_369962.html

[Commonground]

Re: Kala-Azar epidemic in Paurai Nepal

Dutchy, the above post has a date of April 26th.

[hawkeye]

Re: Kala-Azar epidemic in Paurai Nepal

Kala-azar kills four
Monday, May 21,2007

RAUTAHAT: Four persons died of kala-azar in Paurai of Rautahat on Friday and Saturday.
Jina Magar, 3, Somnath Majhi, 65, Shankar Yeslami,12 and Amrit Shani, 40 of Paurai-3 died of the disease, a local Laxman Neupane said, adding that they died for want of treatment.
The disease has been spreading in the village for three weeks. Kala-azar has rendered 25 persons, including Lok Bahadur Magar, Asman Gole, Tara Maya Lama, Sone Lal Sahani, Kumar Rai, Nirmala Magar and Man Bahadur Moktan, critically ill, Neupane said.
The district health office has been informed about the spread of the disease, but noone has visited the village, another local Ashok Pahadi said.
Six kala-azar patients have been undergoing treatment at the District hospital, Pahadi said. ?There is no doctor at the health post at Chandranigahapur so patients have to visit Gaur for treatment.
Effort to contact chief of the district hospital, Dr Brij Kishor Thakur, on the spread of kala-azar failed as he was not in the office.
Assistant vector controller at the hospital, Nandeshwor Chaudhari, said, he had no information about the outbreak of kala-azar.

[MHSC]

Re: Kala-Azar epidemic in Paurai Nepal

Many of these symptoms sound familiar, I have bolded a few.

Clinical manifestations:
The clinical features of visceral-leishmaniasis are remarkably similar in different areas of the world. The incubation period varies but it is usually in the range of 2 to 8 months. In one case the time that elapsed from arrival in an endemic area to the onset of fever was less than 10 days. Incubation periods as long as 34 months have also been reported. The onset of symptoms may be gradual or sudden. In subacute or chronic cases, there is an insidious onset of abdominal enlargement due to hepatosplenomegaly, fever, weakness, loss of appetite, pallor and weight loss. The symptoms can persist for weeks to several months before patients come to medical attention. Fever may be intermittent, remittent with twice daily temperature spikes; or less commonly, it may be continuous. It is relatively well tolerated. In acute cases there is an abrupt onset of high fever and chills, sometimes with a periodicity that mimics malaria. Chills but seldom rigors, accompany the temperature spikes. A patients subset has smoldering courses with mild symptoms or isolated splenomegaly. Some then evolve into frank visceral leishmaniasis, whereas other have self-resolving courses. As time passes, the spleen can become massively enlarged. It is usually soft and non-tender. The presence of a hard spleen suggests a hematologic disorder or another diagnosis such as schistosomiasis. The liver also enlarges; it usually has a sharp edge, soft consistency and a smooth surface. Lymphadenopathy is common in patients in Sudan but uncommon in other geographic areas. Elevated liver enzymes and bilirubin are observed occasionally. The skin in patients with visceral leishmaniasis often becomes dry, thin, and scaly, and hair may be lost. As the disease progresses, particularly in light-colored persons in India, the skin on the hands, fat, abdomen and face may become grayish. This discoloration gave rise to Indian name Kala Azar which means black sickness. Peripheral edema may be seen late in the disease, particularly in malnourished children. Hemorrhage can occur from one or more sites, epistaxis and gingival bleeding are most common. Petechiae (pinpoint hemorrhages in the skin - MHSC) and ecchymoses (blotchy hemorrhages larger than Petechiae - MHSC) may be observed on the extremities. Interstitial pneumonia and periodontitis have been observed in a few cases. Secondary bacterial infections of the skin, respiratory tract, and middle ear are common in persons with advance visceral leishmaniasis. Death may result from bacterial pneumonia, septicemia, tuberculosis, dysentery, or measles or may be the consequences of malnutrition, sever anemia, or hemorrhage. The laboratory findings include anemia, leukopenia and hypergammaglobulinemia. Anemia is almost always present and may be severe. It is usually normocytic and normochronic. It appears to be due to a combination of factors including hemolysis, marrow replacement with Leishmania infected macrophages, hemorrhage, splenic sequestration of erythrocytes, hemodilution, and effects of cytokines such as TNF-�. Leukopenia is also prominent, with blood cell counts occasionally as low as 1000/mm₃. It is not known whether the observed neutropenia is due to increased margination, splenic sequestration, or an autoimmune process, or a combination of those factors. Of note, anemia and neutropenia have not been prominent in patients with visceral leishmaniasis who have undergone splenctomy. Hyper gamma globulinemia circulating immune complexes and rheumatoid factors are present in the sera of most patients with visceral leishmaniasis. There is evidence of polyclonl �-cell activation. The globulin level may be as high as 9 g/dl, the ratio of globulin to albumin is typically high. The kidneys show evidence of immune complex deposition, and mild glomerulonephritis has been reported in humans as well as in naturally infected dogs. Renal failure is rarely a feature of visceral leishmaniasis^(1,4).


http://pearl.sums.ac.ir/semj/vol3/oct2002/kalazar.htm