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