Mountains in the Chaning World, Mountains in the Chaning World

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Emerging Cases of Kala-azar at High Altitude Regions of Nepal
Mitesh Shrestha, Jyoti Maharjan, Prakash Nidhi Tiwari, Basu Dev Pandey, Krishna Das Manandhar, Sher Bahadur Pun, Kishor Pandey

Last modified: 2017-08-26

Abstract


There is an observable effect of globalization, particularly climate change on geographical distribution of vector – borne diseases. Temperature recordings for Nepal from early 1970s till 2009 shows that the maximum and annual temperature has increased. Similarly, this rate is higher in mountain regions while low in Terai regions. With this rise in temperature, the incidence of vector borne diseases has shown increasing trends. Here, we report the first documented cases of visceral leishmaniasis (VL) from Dolpa and Humla districts of Nepal (above 3000 m asl). VL  also known as Kala –azar, is a vector borne disease caused by protozoan parasite Leishmania donovani (LD) and transmitted by bite of infected female sand fly. Patients were suspected based on the national guidelines of VL from Epidemiology and Disease Control Division. Blood samples were used for rK39 test and few drops were kept in filter paper for PCR analysis. Both cases were initially diagnosed as VL by positive result for the rK39 test. Furthermore, the sample obtained from Dolpa was confirmed to be Leishmania donovani by nested PCR. This study indicates that VL is spreading to high altitude regions of Nepal. The expansion of VL cases into new areas may be due to rising temperature which can pose challenges for its sustained elimination from Nepal. We, thus, recommend that surveillance system to be strengthened, early response of the cases and future research should extend in the areas currently been considered as non-endemic in the high altitude regions of Nepal.

 

Keywords: Dolpa, Leishmania donovani, Nepal, Nested PCR, rK39


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