Rare disease detected in tribal colonies

The Health Department authorities have stumbled upon a cluster of indigenous cases of Cutaneous Leishmaniasis, an infectious disease spread by sandflies and rarely seen in the State, in two tribal settlements of Aamala and Aayiramkallu in the forests near Kottoor in Kuttichal panchayat.The only previously known instance of Cutaneous Leishmaniasis in the State, which manifests on the skin, was in 1990 when two isolated cases were reported from Nilambur. This is the first time that a cluster of cases — about 11 cases have been detected so far — has been reported in the State, sending Health officials into a tizzy over the treatment and public health measures that need to be adopted to prevent spread of the disease."From the public health perspective, this is a very significant discovery. We do not know the extent of the problem now and detailed investigations are urgently required," said T. Dilip, assistant director, State Entomology Division.A disease usually seen in Bihar, West Bengal, leishmaniasis is spread by the female of the sandfly, which transmits the leishmania parasite from human to human through its blood-sucking bites. Dogs, rats also act as reservoirs of the parasite, which is then spread to humans by the sand fly. One strain — visceral leishmaniasis or 'kala azar' — can be fatal. Three cases of kala azar were reported in 2004 in Kerala, from Thenmala and Thrissur. Cutaneous Leishmaniasis is characterised by deep unhealing ulcers on the skin, resembling leprosy sores. "Some ulcers do heal but leave deep disfiguring scars on the skin. There is, indeed, an epidemic potential as the sandfly is found in cities also. We know so little about the disease and are still contemplating the treatment modalities. Treatment will have to be long-term, involving toxic drugs," said K. Vijayakumar, Professor of Community Medicine, Thiruvananthapuram Medical College, who led the first medical team to the tribal settlements last week. It was one of the cases which came to the Dermatology department at the Medical College Hospital that led the Health Department to the tribal colonies where more cases were detected. Microbiology and histo-pathological investigations at the MCH confirmed the disease. Several persons with healed ulcers were also found in the settlement, which indicates that the disease must have been doing the rounds for some time, Dr. Vijayakumar said. The Health Department has initiated insecticide spraying to control the sandfly population. However, entomologists admit that this is easier said than done as the sandflies are found inside houses as well as in the natural surroundings. It breeds in organic wastes, manure and leaf litter and in the forest area, control measures are especially difficult.One problem that public health experts point out is that it would be useless to treat the patients and send them back to the same environs where the animal hosts as well as the vectors continue to co-exist. Officials will also have to investigate if any unreported cases of the visceral strain (Kala azar) is there in the locality .The Health Department has sought detailed entomology studies by the regional team from National Institute for Communicable Diseases, Kozhikode.

 

The Hindu, 8th March 2009