Date: 21st June 2018
Clinical site: Busia Alupe Leprosy Hospital
Facilitators: Francis Amakoye (occupation therapist)
Mr. Mbaya (Clinical officer)
Mr. Siachi
OBJECTIVES
1. Identified how infectious diseases at Alupe Leprosy Hospital, KEMRI and KETRI centers are
managed.
2. Learn leprosy management and control
3. Identify leprosy patients at various stages of te disease and discuss its placemnet in the current
control method
4. Observe Trypanosomiasis patients at KETRI centre and describe the current management and
control methods.
Alupe hospital started as a leprosorium in 1952 and people with leprosy hosted and given food and
medication.
Overview of Leprosy
· Oldest disease
· known host is man
· Can't be cultured
· Long incubation/multiplication period - minimum 14 days and can take upto 5-20 years before
signs and symptoms appear.
· Affinity to peripheral nerves
· Most distabilizing
· Most stigmatizing
Common clinical features
Early signs: Tingling sensastion
Numbness
Burning sensation
Joint pain
Late signs: Hypopigmented patches with loss of sensation
Nodules
Nerve enlargement with neurities
paralysis
Loss of hair
Dryness
Un noticed injuries
Diagnosis
· Sensory loss in hypopigmented patches- use cotton wool with light touch, pt may not be able to
feel.
· Enlargement of peripheral nerves
· Presence of Mycrobacterium Leprae in slit Skin Smears from ear lobes, elbows, knees, where
there is a patch.
· They rely on the 1st and 2nd because in the 3rd, only one person is able to read skin smears in
the whole country and is based at port victoria.
Management of leprosy
· It is managed not treated.
· Health education- patient, family, community.
· Chemotherapy - currently they are being managed on Multi drug therapy: Clofazimine,
Dapsone, Rifampicin for 6-12 months
· Pre and post operative exercises
· Reconstructive surgery
· Vocational rehabilitation: doing something different from their initial occupation
· Special foot wear
· Social aspects.
Incidence of Leprosy in Kenya
1/1000 population.
Endemic regions:
· Coast; kwale, kilifi
· Eastern; kitui, maua in meru
· Nairobi; slums, streets
· North Rift; Nandi, west pokot
· Nyanza; all counties except kuria and greater kisii
· Western; Bumala in Bungoma, Butere in Kakamega, Nambale in Busia(the triangle).
TOPIC: TRYPANOSOMIASIS
-Human African trypanosomiasis is also known as Sleeping sickness.
-Zoonotic vector-borne parasitic disease caused by protozoa of genus trypanosoma
-Transmitted by Tsetse fly.
-Humans are the main reservoir host for trypanosoma brusei gambiense while domestic cattle and wild
animals are main reservoir of the trypanosoma brucei rhodesiense.
-An estimate of 30,000 are currently infected with over 7000 new cases reported in 2012. 80% of these
cases are in the DRC..
-3 Major epidemics recorded historically so far: 1896-1906 in uganda and congo basin , 1920 and 1970.
-In kenya 36 counties have tsetse flies and therefore are at risk of an endemic.
- There are 3 main groups:
5. Sananah grassland
6. Riversine group
7. Forest group
Transmission
· Tsetse fly bite
· Mother to child transmission
· Blood transfusion
· Laboratories contamination and mis handling of specimens in lab
· Sexual contact
Incubation period
Determined by: type of parasite
Host immunity
parasite: T.b gambiense- cause chronic form
-can extend in passive phase for months or years before symptoms emerge
T.b rhodensiense- cause acute form
-symptoms emerge in 1-3 weeks and is more virulent and fast developing
-Host immunity determines how fast the symptoms will appear.
Clinical features
1. Early stage or hemolytic stage
· history of bite
· formation of achancre
· fever, headache
· winterbottoms sign
-if untreated : Anemia, edocrine,cardiac and kidney disorders.
2. Neurological phase
· pass the blood brain barrier
· confusion
· reduced coordination
· insomnia
· fatique
-Without treatment lead to mental deterioration-coma-death
-Damage caused by neurological phase can be irreversible.
Diagnosis
8. Based on high index of suspicion
9. History
10. Laboratory
· Thin and thick blood smears
· Mice inoculation
· Dry blood spot
· PCR
· Lymph node aspirate
· BMA
· CSF
Treatment
- The current standard treatment for 1st stage
iv pentamidine 4mg/kg daily for 7-10days (TbG)
Iv Suramin 20mg/kg weekly for 5-6 weeks (TbR)
-Later stage (2nd stage)
Iv Melarsoprol 2.2mg/kg daily for 10days
or
Iv melarsprol 0.6mg/kg on day 1
Iv melarsoprol 1.2mg/kg on day 2
Iv melarsoprol 1.2mg/kg plus oral 7.5 mg/kg nifurtimox twice a day on day 3 to 10 or Iv eflornithine
50mg/kg every 6hours for 14 days
Combined therapy: Nifurtimox/ eflornithine combination( NECT) better than monotherapy
Prevention
11. Medical or veterinary
-Targets the disease directly
-surveillance to reduce the number of organisms which carry the disease
-prophylaxis
-Treatment
2. Entomological: intend to disrupt the cycle of transmission by reducing the number of flies by use
of the sterile insect technique
3. Regular active surveillance: detection and prompt treatment of new infection
4. Systematic screening of communities at risk.
-At KEMRI Alupe they carry out
12. EID- early infant diagnosis
13. Viral load
-They use:a) whole blood for Adults
b) DVS filter paper for infant
-They have machines like :
14. Abbott M2000-PCR Technology
15. Panther(Roche)-TMA Technology.
16. CAP CTM-PCR Technology
-They cover Bungoma, Busia, Nyamira, Vihiga and Kakamega