NTDs 2 Flashcards

1
Q

Describe the coverage of schistosomiasis in Ethiopia

A

For schistosomiasis
Over 10 Million School-aged children requiring treatment - 2014
2.9 million school-aged children received treatment (29% coverage)-2014
6.4 million school-aged children targeted for treatment (64% coverage)-2015

Over 10 million school-aged children targeted for treatment (100% coverage)
-2016

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2
Q

Describe the coverage of STHs in Ethiopia

A
  1. 9 million school-aged children and pre-SAC require treatment- 2014
  2. 8 million school-aged children and pre-SAC received treatment (33%)- 2014
  3. 3 million school-aged children and pre-SAC targeted for treatment (83%)- 2015
  4. 9 million school-aged children and pre-SAC targeted for treatment (100%)- 2016
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3
Q

How many NTDs are there

A

Core Group of 13 – MDA for 7

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4
Q

Describe Leishmaniasis

A

Dermal – nasty superating wound at the site of the bite which self heals in 6 months – it can become “mucocutaneous” form causing gross mutilation by destroying soft tissues in nose mouth and throat
Visceral – leads to fever, weight loss, and an enlarged spleen and liver. P will have low red blood cell count (anemia), low white blood cell count, and low platelet count.
Transmitted by sandflies – small enough to go through a mosquito net – pin prick bite

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5
Q

Describe the prevalence of Leishmaniasis around the world

A

Over 90 percent of the cases of cutaneous leishmaniasis occur in parts of Afghanistan, Algeria, Iran, Iraq, Saudi Arabia, and Syria (in the Old World) and in Brazil and Peru (in the New World);
Over 90 percent of the cases of visceral leishmaniasis occur in parts of India, Bangladesh, Nepal, Sudan, and Brazil.
AmBisome as first line of treatment against VL

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6
Q

What is the vector for Trypanosomiasis (Sleeping sickness)

A

Transmitted by the Tsetse fly which has a sharp bite but fortunately a very limited distribution

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7
Q

Describe the two forms of Trypanosomiasis

A

Trypanosoma brucei gambiense (T.b.g.) is found in west and central Africa. This form represents more than 90% of reported cases of sleeping sickness and causes a chronic infection. A person can be infected for years without symptoms of the disease. When symptoms do emerge, the patient is often already in an advanced disease stage when the central nervous system is affected.

Trypanosoma brucei rhodesiense (T.b.r.) is found in eastern and southern Africa. This form represents less than 10% of reported cases but that is because it causes an acute infection.
First signs and symptoms are observed a few months or weeks after an infected Tsetse fly bite.
The disease develops rapidly and invades the central nervous system and kills !

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8
Q

Describe the status of sleeping sickness control

A
Control is dependent on early diagnosis (with only 2,500 new cases diagnosed in 2015)
Delivery of donated therapy to infected persons (Sanofi and Bayer donate the drugs)
Tsetse control (baited traps)
New tsetse control using systemic insecticides in cattle in Uganda to prevent the two forms mixing geographically
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9
Q

Describe the most recent data associated with sleeping sickness

A

An estimated 11,000 people are currently infected with 2,800 new infections in 2015.

In 2015 it caused around 3,500 deaths, down from 34,000 in 1990.

More than 80% of these cases are in the Democratic Republic of the Congo.[1

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10
Q

What is Chagas disease and what is it transmitted by

A

Chaga’s Disease – the South American form of Trypanosomiasis
Trypanosoma cruzi is found in parts of South America, with an estimated 10 million infected, and can cause major heart problems in up to 30% of these

It is transmitted by bed bugs and therefore is confined to people with poor quality housing

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11
Q

Describe the acute phase of Chagas

A

The acute phase of Chagas disease, which lasts for weeks or months, can be symptom-free. When signs and symptoms do occur, they are usually mild and may include:
Swelling at the infection site, Fever, Fatigue, Rash
Body aches, Headache, Nausea, diarrhea or vomiting, Swollen glands
Enlargement of your liver or spleen

If left untreated, the infection persists and advances to the chronic phase.

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12
Q

Describe the chronic phase of Chagas

A

Signs and symptoms of the chronic phase of Chagas disease may occur 10 to 20 years after initial infection, or they may never occur. In severe cases, however, Chagas disease signs and symptoms may include:
Irregular heartbeat
Congestive heart failure and sudden cardiac arrest
Difficulty swallowing due to enlarged esophagus
Abdominal pain or constipation due to enlarged colon

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13
Q

Describe Chagas disease (American Trypanosomiasis

A

Transmission documented in Louisiana and Texas
Treatment cost up to $1,000 per year
Diagnosis and access to care are major constraints
Vector control for breaking transmission.
Recently it has spread into Europe via immigrants who sell blood

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14
Q

Describe DNDi and new drugs

A

In the Business Plan for the period 2015-2023, DNDi maintains its commitment to develop treatments for African sleeping sickness, leishmaniasis, and Chagas disease as well as filarial diseases and paediatric HIV

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15
Q

Describe Buruli Ulcer

A

A chronic skin disease caused by Mycobacterium ulcerans endemic in 33 countries but highest in Ghana, Gabon and Australia
About 5,000 cases per year are reported from half of the 33 countries
Poor knowledge and reporting may hide the true prevalence

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16
Q

Describe Buruli control strategy

A

Training of health workers
early case detection
treatment with antibiotics
Case management – surgery if necessary

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17
Q

What is Leprosy also known as

A

Hansen Disease

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18
Q

Describe Leprosy

A

Leprosy is a chronic disease caused by a bacillus, Mycobacterium leprae

M. leprae multiplies very slowly and the incubation period of the disease is considered to be about five years.

Can you believe that over 95% of the population have natural immunity

Since 1981, WHO Study Group recommended multi-drug therapy (MDT), a combination of three drugs which effectively kills the pathogen and cures the patient. This is donated by Novartis

19
Q

Describe the elimination goals associated with leprosy

A

In 1991 World Health Assembly passed a resolution to eliminate leprosy as a public health problem by the year 2000 - defined as a prevalence rate of less than one case per 10,000 population.
The global disease burden was reduced from 5.2 million in 1985 to 805,000 in 1995 to 753,000 by 1999 to 220,000 cases by 2005.

Now about 150 to 250 people in the United States and 250,000 around the world are estimated to get new infections

The South-East Asia Region, including India, achieved the elimination goal in December 2005.
The last six major countries to achieve the target were:
DR Congo, Madagascar, Mozambique, Nepal, Tanzania and the last to do so was BRAZIL

20
Q

Describe the Leprosy new cases trends

A

The most recent World Health Organisation figures state that in 2014 there were 213,899 new cases of leprosy diagnosed. More than half of these were found in India.

21
Q

Describe the leprosy strategy for prevention and control

A

Target 1 Implementation of early detection and MDT
Target 2 Reduce new cases by 50% by 2020
Target 3 Capacity building to sustain control
Target 4 Reduce stigma and discrimination
Target 5 Intensify research

22
Q

Describe Podoconiosis (non LF elephantiasis)

A

Podoconiosis (‘‘dust in the feet’) presents as a horrible swelling of the feet and lower legs. It is seen in susceptible families of bare-footed farmers in well-defined fertile volcanic highland zones of Africa, Central and South America, and Indonesia, and also in the lowlands irrigated by rivers from these highlands.
It is due to the absorption of silica particles from the soil, through the feet of someone from a susceptible family.
This causes the the legs and feet swell, and progress
through stages which are described as
‘‘water bag’, ‘‘rubbery’, and ‘‘wooden’.

Treatment – choose another occupation !!!

23
Q

Describe viral and helminth NTDs

A
Viral
Dengue
Rabies
Helminths
Echinococcus
Taeniasis – cysticercosis
Loa loa
24
Q

Describe Dengue

A

A mosquito borne (Aedes aegypti) viral disease with a global tropical distribution.
It is spreading – in 1955 there were 3 and in 1959 there were 9 countries reported having Dengue
Today over 100 countries have Dengue
There are 4 known viral serotypes
And dengue hemorraghic fever (DHF) is the serious consequence

25
Q

Describe the current statistics associated with Dengue

A

About 2.5 billion people, or 40% of the world’s population, live in areas where there is a risk of dengue transmission.
Dengue is endemic in at least 100 countries in Asia, the Pacific, the Americas, Africa, and the Caribbean.
The World Health Organization (WHO) estimates that 50 to 100 million infections occur yearly, including 500,000 DHF cases and 22,000 deaths, mostly among children

26
Q

Describe the control strategy for Dengue

A

There is no specific treatment and no vaccine
Diagnosis and case management
Integrated surveillance and outbreak response
Sustainable vector control
Possible vaccine in the future
Operational research

27
Q

Describe Hepatitis

A

An estimated 71 million people worldwide are chronically infected with hepatitis C and 257 million with hepatitis B. In 2016,

WHO set a target of a 90% reduction in new chronic infections and a 65% reduction in mortality by 2030 from 2015 levels.

For this to happen, it is crucial to increase the number of people being tested for viral hepatitis.

28
Q

Describe Hepatitis C

A

Schistosomiasis treatment programmes in the 1960’s are blamed for Egypt having more Hepatitis C cases than any other country

(repeated sharing of needles during treatment with Astiban)

If untreated can lead to cancer of the liver in some cases

The first treatment was with interferon, but more modern treatments are now available

Harvoni and related chemicals Olysio (simeprevir) and Sovaldi.

29
Q

Describe Rabies

A

A viral disease with most cases now in Asia and Africa
Once symptoms develop death rate is 100% - but there is an effective vaccine which must be given shortly after any infected contact
There are several animal reservoirs (eg bats) but dog bites are by far the most common way humans get infected

30
Q

Describe the statistics associated with rabies

A

Rabies caused about 17,400 deaths worldwide in 2015. More than 95% of human deaths caused by rabies occur in Africa and Asia. About 40% of deaths occur in children under the age of 15

31
Q

Describe the control successes with rabies

A

Canine vaccination
Humane management of dogs
Vaccination of people immediately after exposure
Elimination target is this year in Latin America and 2020 in China, Japan and Korea

32
Q

What is Treponematoses

A

Treponema (a spirochete bacterium) infection causes Pinta, yaws, and syphilis

33
Q

What is Pinta

A

Pinta (also known as Azul, Carate, Empeines, Lota, Mal del Pinto and Tina) is a human skin disease endemic to Mexico, Central America, and South America caused by infection with the spirochete, Treponema carateum,

34
Q

Describe Yaws

A

Yaws affects children 2-14 years old (in fact mostly boys)
The Yaws target is eradication by 2020
Using azithromycin treatment (Mass Drug Administration or targetted treatment

35
Q

Describe Yaws cases

A

From 1952 – 1964 a campaign reduced infections from 50 million to less than 2.5 million, but it was not followed through to elimination
Currently Ghana has the most cases in Africa (over 20,000), but Cote D’Ivoire also has cases.
PNG (34,000) and Solomon Islands (over 20,000) are the other high prevalence countries

36
Q

Describe new developments associated with yaws

A

1.Effectivetreatment – azithromycin
1.1. Effective for active and latent yaws, and H. ducreyi ulcers
20 mg vs 30 mg/kg trial completed

  1. Comprehensive diagnostic framework - Trep-RDT, DPP and PCR
  2. 1.Strategy to reduce costs through sequential testing with RDT and confirmed by DPP
    1. PCR -new insights on best primers to identify T. pertenue

3.Knowledge management:
3.1. Completion of 1 a programme managers guide,
2 an eradication verification guide,
3 supportive IEC materials and
4 an integrated skin NTDs guide

37
Q

Describe the next steps for Yaws

A
  1. Scale up mapping
  2. 1.Operational research on optimal mapping strategies for a disease targeted for eradication
  3. Scaling up MDA with donation
    1. Determine the optimal number of rounds of MDA to achieve interruption of transmission

5.2 Social and health system research to achieve high coverage and integrate surveillance with other skin diseases

38
Q

Describe SYPHILLIS

A

Syphilis is a sexually transmitted disease (STD) caused by the bacterium Treponema pallidum, and is passed from person to person through direct contact with a syphilitic chancre.
Chancres occur mainly on the external genitals, vagina, anus, or in the rectum but can also occur on the lips and in the mouth.
Transmission of the organism occurs during vaginal, anal, or oral sex.
Pregnant women with the disease can transmit it through the placenta to the fetus or at birth to the neonate.
Many people infected with syphilis do not have any symptoms for years, yet remain at risk for late complications if they are not treated.
The estimate by WHO in 2015 is 18 million infected adults

39
Q

Describe Loa Loa

A

Distributed around west and central Africa not important as far as pathology in itself
A filarial worm transmitted by Tabanids – horseflies

Important because mass treatment of LF and onchocerciasis with albendazole and ivermectin can cause serious side effects in people infected with Loa Loa in certain areas of west and central Africa, especially in patients who have high Loa loa microfilarial densities.
This necessitates the development of more specific diagnostics tests for Loa loa to identify high risk areas prior to treatment.

40
Q

Describe Cysticercosis (Taenia solium)

A

Leading cause of epilepsy among Hispanic Americans

41,400-169,000 cases

10% of seizures presenting to ED in Los Angeles

41
Q

Describe the characteristics of Taenia solium the pork tapeworm

A

The adult worm lives in the human gut and infects between 4 and 8 million people
The eggs of the worm are excreted in the stool
If consumed by a pig, cysts are formed in the pig meat which if eaten undercooked develop into a new tapeworm

The problem is that poor hygiene can lead to humans consuming eggs and then cysts develop in the brain causing epilepsy

42
Q

Describe the treatment of Taenia solium the pork tapeworm

A

The adult worm in man is susceptible to treatment with praziquantel
This also kills the cyst in the brain which might change the cyst from asymptomatic to symptomatic (hence vigilance when treating for schistosomiasis

Treating pigs is also possible but better hygiene is the ultimate answer

43
Q

Describe Echinococcus granulosis - the dog tapeworm

A

The adult worm lives in the dog and eggs are passed out in the faeces

The eggs are consumed by sheep and develop into cysts in the sheep brain and liver and body cavities. When sheep are slaughtered, the offal is often thrown to the dogs which of course leads to new worm infections.

Humans are involved when they have intimate closeness with dogs and somehow the eggs get into humans mouth – then cysts can develop in human livers (Turkana in Kenya)