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close this bookWHO Recommended Surveillance Standards (WHO; 1999; 157 pages)
View the documentAcknowledgements
View the documentAcronyms
View the documentIntroduction
View the documentNational Coordination of Communicable Disease Surveillance
View the documentExplanatory notes
View the documentSurveillance activities: criteria and WHO Department
View the documentCommunicable disease contacts in Regional Offices
close this folderDiseases
View the documentB20-B21-B22-B23-B24 AIDS
View the documentA22 Anthrax
View the documentA23 Brucellosis
View the documentA00 Cholera
View the documentA81.0 Creutzfeldt-Jakob disease
View the documentA90, A91 Dengue fever (A90) including Dengue haemorrhagic fever (DHF) & Dengue shock syndrome (DSS, A91)
View the documentA36 Diphtheria
View the documentB72 Dracunculiasis (Guinea worm disease)
View the documentA98.3, A98.4 Ebola-Marburg viral diseases
View the documentA83.0 Japanese encephalitis
View the documentB74 Lymphatic filariasis
View the documentB96.3 Haemophilus influenzae type b
View the documentB15-B17 Acute viral hepatitis
View the documentB20-B24 HIV infection
View the documentJ10, J11 Influenza
View the documentA96.2 Lassa fever
View the documentA48.1 Legionellosis
View the documentB55.1, B55.2 Cutaneous leishmaniasis
View the documentLeishmania / HIV co-infections
View the documentB55.0 Visceral leishmaniasis
View the documentA30 Leprosy
View the documentA27 Leptospirosis
View the documentB50-54 Malaria
View the documentB05 Measles
View the documentA39 Meningococcal disease
View the documentA87 Viral meningitis
View the documentB73 Onchocerciasis
View the documentA37.0 Pertussis
View the documentA20 Plague
View the documentA36 Poliomyelitis
View the documentA82 Rabies
View the documentA02.0 Salmonellosis
View the documentB65 Schistosomiasis
View the documentA50-52 Syphilis
View the documentA33 Tetanus, neonatal
View the documentB56-0, B56-1 African trypanosomiasis
View the documentB57 American trypanosomiasis
View the documentA15-A19 Tuberculosis
View the documentA75.3 Scrub typhus
View the documentA95.9 Yellow fever
open this folder and view contentsSyndromes
View the documentAnnex 1 Software free and in the public domain
View the documentAnnex 2 Proposed surveillance definitions
View the documentAnnex 3 Role and use of Geographic Information Systems (GIS) and mapping for epidemiological surveillance
 

B55.1, B55.2 Cutaneous leishmaniasis

RATIONALE FOR SURVEILLANCE

Cutaneous leishmaniasis is endemic in over 70 countries. The yearly incidence is estimated at 1 500 000 cases. The disease has several clinical forms: localized cutaneous leishmaniasis, diffuse cutaneous leishmaniasis, the most difficult to treat, and (in the western hemisphere mainly) mucocutaneous leishmaniasis, which is the most severe form as it produces disfiguring lesions and mutilations of the face. In foci where man is believed to be the sole reservoir (anthroponotic foci), epidemics are linked to human migrations from rural to poor suburban areas; in zoonotic foci, where mammals are the reservoirs, epidemics are related to environmental changes and movement of non-immune people to rural areas.

Surveillance is essential to establish disease impact and to monitor efforts towards the control of disease and the detection of epidemics.

RECOMMENDED CASE DEFINITION

Clinical description

Appearance of one or more lesions, typically on uncovered parts of the body. The face, neck, arms and legs are the most common sites. At the site of inoculation a nodule appears, and may enlarge to become an indolent ulcer. The sore remains in this stage for a variable time before healing, and typically leaves a depressed scar. Other atypical forms may occur. In some individuals, certain strains can disseminate and cause mucosal lesions. These sequelae involve nasopharyngeal tissues and can be very disfiguring.

Laboratory criteria for diagnosis

 

• positive parasitology (stained smear or culture from the lesion)
• mucocutaneous leishmaniasis only: positive serology (IFA, ELISA)

Case classification

WHO operational definition:

 

A case of cutaneous leishmaniasis is a person showing clinical signs (skin or mucosal lesions) with parasitological confirmation of the diagnosis (positive smear or culture) and/or, for mucocutaneous leishmaniasis only, serological diagnosis.

RECOMMENDED TYPES OF SURVEILLANCE

At peripheral level individual patient records must be retained for investigation and case management.

Routine monthly reporting of aggregated data of cases from periphery to intermediate and central level.

Active case finding through surveys of selected groups or mass surveys (standardized and periodical) is an alternative to estimate the prevalence of cutaneous leishmaniasis.

International: Annual reporting from central level to WHO (limited number of countries).

RECOMMENDED MINIMUM DATA ELEMENTS

Individual patient records at peripheral level

 

Leishmaniasis data: clinical features, date of diagnosis, parasitological (Mucocutaneous leishmaniasis only) and serological diagnosis, Leishmania species, treatment outcome.

Identification data: unique identifier, age, sex, geographical information, past travels, duration of stay at current residence.

Aggregated data for reporting

 

Number of cases by age, sex, type of diagnosis.

RECOMMENDED DATA ANALYSIS, PRESENTATION, REPORTS

Tables: Incidence by geographical area, by age, by sex, by type of diagnosis, by month/year. Point prevalence (if active case detection).

Maps: Incidence by village.

PRINCIPAL USES OF DATA FOR DECISION-MAKING

 

• Evaluate the real extent of the problem and the main populations at risk

• Improve and focus the control activities

• Improve management and follow-up of cutaneous leishmaniasis, disseminated cutaneous leishmaniasias and mucocutaneous leishmaniasis patients (WHO guidelines)

• Identify technical and operational difficulties

• Evaluate impact of control interventions

• Anticipate epidemics

SPECIAL ASPECTS

The prevalence of cutaneous leishmaniasis tends to be grossly underestimated because most of the official data are obtained through passive case detection only. Other factors that may lead to misdiagnosis or non-diagnosis are: wide scatter of foci, limited access to medical facilities, scarcity of diagnostic facilities and limited or irregular availability of first-line drugs.

CONTACT

Regional Offices:

See Regional Communicable Disease contacts on section "Communicable disease contacts in Regional Offices".

Headquarters: 20 Avenue Appia, CH-1211 Geneva 27, Switzerland

Department of Communicable Disease Surveillance and Response (CSR)

 

E-mail: desjeuxp@who.ch / Surveillancekitt@who.ch
Tel: (41 22) 791 38 70
Fax: (41 22) 791 4777 attn CSR
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