LEISHMANIASIS

In recent years the American Military have reported cases of Leishmanasis with Cutaneous Leishmaniasis observed in U.S. troops in Panama and Viscerl Leishmaniasis noted in U.S. troops returned from Saudia Arabia as well as Gulf War Veterans. (There are no reports of and Canadian veterns being infected). An epidemic of Leishmaniasis (kala-azar or black fever) is reported from the Northeast Indian state of Bihar with spread into neighbouring Nepal. In May 1993 WHO rpeorted an outbreak of Visceral Leishmaniasis in Southern Sudan and in the western Upper Nile Province.

The Ministry of Health in the State Capital Patna have reported 27,000 cases in 1992 and WHO estimates that there have been 10,000 deaths, with the possibility of dramatic increases in these figures.

The causative protozoan infection is transmitted by sandflies. Travellers to rural areas where this disease is being reported should take very strict precautions to avoid being bitten by sandflies because no vaccines or prophylactic drugs are available.

Preventive measures for the individual traveller are aimed at reducing man-fly contact. Outdoor activities should be avoided when sandflies are most active (dusk to dawn). Although sandflies are primarily nighttime biters, transmission of leishmaniasis may occur during the day if resting sandflies are disturbed. Sandfly activity in an area may easily be underestimated, because sandflies are noiseless fliers and occasional bites may not be noted.

Protective clothing and insect repellent should be used for supplementary protection. Clothing should cover as much of the body as possible and be tolerable in the climate. Wide-open collars and loose sleeves and pant legs should be avoided. Repellent with DEET (N,N-diethyl-m-toluamide) should be applied to exposed skin and under the edges of clothing, such as the ends of sleeves and pant legs. Repellent should be applied according to the manufacturer's instructions; repeated applications may be necessary under conditions of excessive perspiration, wiping and washing. Although impregnation of clothing with repellent may provide additional protection, it does not eliminate the need for repellent on exposed skin and should be repeated after every five washings.

Man-fly contact can be reduced by mechanical means, such as bed nets, and the screening of doors and windows. Fine mesh netting (at least 18 holes to the linear inch, some sources say even finer) is required for an effective barrier against sandflies, which are much smaller than mosquitoes (about one third the size). Such closely woven bed nets may be intolerable in hot climates. Impregnation of mosquito nets and window screens with permethrin aerosol may provide some protection, as well as spraying of quarters with residual-action insecticide.

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