Prevention of Mucocutaneous leishmaniasis

• arly case-detection, treatment and reporting of the case. Control of leishmaniasis is sometimes restricted to these "minimal control initiatives" owing to, for example, financial reasons.

• Vector control with insecticides in and around dwellings. This can be coordinated with malaria and/or Chagas’ disease control.

• Use of a fine gauze mosquito net impregnated with permetrine if transmission is taking place via a nocturnal biting vector

• Biotope modification: environmental sanitation in order to destroy the sandflies’ breeding sites. An area of 300 metre radius is sometimes cleared of vegetation around villages (Amazonia, French Guyana).

• Reservoir control: Sick dogs are treated or killed (L. infantum). Pets can wear a dog-collar impregnated with deltametrine, permetrine of phenthione or be treated with a lotion containing these active compounds. May be combined with rabies and echinococcosis control. Rodents (L. major) are suitably controlled by various methods: poison such as anticoagulants, deep ploughing to destroy their holes and passageways, elimination of their breeding sites (rubbish dumps) and of food plants (such as goosefoot [Chenopodium] for Psammomys obesus ("fat sand rat").

• Vaccination with L. major on aesthetically unimportant body sites. This causes a lesion for a varying number of months which sometimes has to be treated. New developments are vaccines based on killed Leishmania organisms mixed with BCG and vaccines based on genetically modified Leishmania parasites and variants of these. The value of vaccination remains disputed and vaccination is not practised routinely.

Category: Medicine Notes