New appearances of old neglected tropical diseases and its control

1. Dr. Esteban A Morales m.d; mph; msc

2. GROWING PUBLIC HEALTH PROBLEM

3. 

climate change - such as global
warming, phenomena of the child/of the
Southern Oscillation (ENSO) and the girl
(AENOS),
population growth unprecedented in the
region and not always with an appropriate
health infrastructure (not controlled or
planned urbanization)),

4. 


VECTOR
HABITS
HUMAN
BEING

5. 

Last year, in Panama, the largest number of
deaths from dengue hemorrhagic fever since
the last reinfestation by Aedes mosquito
aegypti in 1985.
Around 2000 cases of classic dengue

6. BACK AT THE
MACROFACTORES

7. 



Two megaprojects of the time
1850 The Panamá railroad
discovery of gold in California in the latter
part of 1848
1914. the Panama Canal.

8. What happened two
centuries ago
FERDINAND DE LESSEPS


The French started to build the
canal in 1850 until they fell into
the historical financial disaster
that led into bankruptcy in 1885;
after a second attempt with
another French company started
in 1989, they decided to sell the
rights for the building of the
canal to the United States, for
40 million dollars in 1902.

9. but the health aspects were
especially important. Death
and suffering and disease
were the principal
characteristics in this period
of time

10. 
The workers were
constantly attacked with
fever and
malaria, and, though the
whole working party was
changed every week, it
was necessary to keep
constantly importing
others to take the places
of those who fell sick or
died.

12. It was the prospective home
of M. Jules Dingler directorgeneral of the first French
company
he never occupied it.
cost including the grounds
is said to have been about
$50,000.
one of the saddest incidents
in French canal history.
he is credited with having
said, "I am going to show
them, that only drunkards
and the dissipated contract
yellow fever and die."
Afterwards his son, daughter
and wife died of yellow
fever. Then he relinquished
his post and went back to
France

13. It was the era of the
megaconstruction of
the Panama canal
The great
transformation
faced deteriorated
due to rapid
immigration, the
But the process
concentration of
itself, also produced
this population in risk situations, such as
the cities. The
the proliferation of
excavations and large
response of the
ditches, which were
institutions of the
important under the
State were not at
epidemiological point
the same speed.
of view

14. HOSPITAL ANCÓN. PANAMÁ. 1900
NICE
HOSPITALS
ARE NOT
ALWAYS
THE
ANSWER

15. But... the French
failed in its mission.
What happened
then?
 But... the
hospitals are also
needed

17. 
When the United
States started into
build the Panama
Canal, the first duty
was the sanitation of
the area. Col.
William Gorgas was
in charge of it

18. 
He was fresh from his successes in
Cuba, where he had, applied the lessons of
sanitation that had been learned by Dr.
Carlos Finlay in their remarkable series of
experiments with yellow fever, who found
out that a mosquito was the transmitter of
this disease.

19. 


he was assisted by a number of
experienced surgeons, as well as by Major
Roland Ross, the man who had proven the
mosquito theory of the causation of
malaria
Gorgas bases his strategy on a mass
sanitation.
He proposes the construction of 10 clinics
(outpatient) along all the waterway, between
Panama and Colon

22. Distribution of the workers for 1913 :
Antillanos
29667
Chinos
15000
Españoles
8722
Italianos
1941
Colombianos
1403
Panameños
357
Ticos
244
Franceses
19
Armenios
14
No
Clasificados
69

23. WHEN IT MOVED FROM THIS…
AND GRADUALLY CAME TO
THIS…

24. THE RAPID POPULATION
GROWTH WAS FACED
WITH REORGANISATION
MEASURES, WHICH WAS INNOVATIVE

25. 
they are repeated, but magnified
tremendously, events of that first Republic.
We are living in an era with similar
characteristics

27. The extension works, initiated since
September 2007, with a value of
5,250 million dollars of which 3.2
billion are aimed at the design and
construction of a third set of locks,
work that has advanced 22%

30. EL CONTEXTO GEOGRÁFICO
cuentan con la mayoría de los recursos naturales y
ambientales disponibles en el territorio nacional.
Climate Intertropical
Region
high rainy season
precipitation temperatures
Tropical diseases:
Malaria.
Dengue.
Leishmaniasis.
Enf. de Chagas

31. PANAMA ESTE, PARTE DE
LA CUENCA DEL CANAL

35. AEDES AEGYPTI Y
DENGUE

37. Is the main vector - trypanosoma cruzi
in Panama and the single triatomineo
transimisor Trypanosoma rangeli here
in Panama
 It is a hematophagous insect of the
order diptera, family Reduviidae,
subfamily Triatominae

great ability to invade and
colonize human
habitation.

38. Main reservoirs are the
mammals (90%), mainly
zariguellas.
 47% Collected triatomine
were positive by
trypanosomes of which
85% corresponded to T.
cruzi and the rest to T.
rangeli.

Héctor Paz

39. Captación activa

40. Leishmaniasis
The regions most
affected are
Colon, Bocas del
Toro, Coclé, Darie
n, Panama. East
and Western
Panama recorded
incidence
rates, during all
the period, rates
higher than the
national rate.

41. The presence of livestock in the
basin has left deep marks on its
natural resources. Firstly, it has
caused the Elimination of important
forest areas. The loss of plant cover,
in turn, increases levels of sediment
entering the Lakes of the channel,
influencing the quality of its waters.
Studies on water quality in different
points of the basin indicate that
direct animal contact with bodies of
water affects the concentration of
micro-organisms harmful to human
health.

42. PEOPLE MOVEMENT
DEFORESTATION

43. Concept and importance

44. Probably the first formal
discussion about ND was
held in 1977, with the
Rockefeller Foundation,
establishing the “Great
Neglected Diseases of
Man Kind Program”,
focusing in collaborative
researches on malaria in
poor countries.
One of the first
authors that
defined the criteria
for NTD was
Ehrenberg
(Ehrenberg & Ault
2005).
They pose a major challenge to the
fulfillment of the Millennium Development
Goals; hence, there is involved an ethical and
strategic component in the control of these
diseases.
In general
terms the so
called ND are
those related to
the also
called, neglecte
d population.
are
communicable
diseases from
the tropical
areas of the
world.

45. 






a changing world where borders between countries
are disappearing
Global communication and technology make global
communities
migratory movements have increased
Typology of population movement according to the
characteristics of onset, cause, direction and
motivation. Lechat (1976); Shears (1991); and others
mega projects need the contribution of human
resources from many different part of the globe
new transport infrastructure allows parasites and
vectors to travel greater distances
population resettlement may introduce parasite
carriers to receptive areas or to those who are not
immune to pathogens transmitted by vectors.

46. There is a great variety of diseases
considered as NTD´s depending of the
region of the world, history and resources
(Weekly epidemiological record, No. 13, 25
march 2011)

47. 






Dengue. A mosquito-borne viral
disease.
Rabies. A viral zoonotic disease.
Trachoma. A bacterial infection
of the eye caused by Chlamydia
trachomatis.
Buruli ulcer. A severe sken
disorder caused by the
bacterium Mycobacterium.
Endemic treponematoses.
(yaws, endemic syphilis and
pinta.
Leprosy. A chronic bacterial
infection caused by the bacillus
Mycobacterium.
Chagas disease (American
trypanosomiasis) .









Human African trypanosomiasis
(sleeping sickness).
Leismaniasis
Cysticercosis. A severe helmint
infection.
Dracunculiasis. (guinea-worm
disease) A helminth infection.
Food borne trematode
infections. A group of parasitic
worm infection.
Lymfatic filariasis.
Onchocerciasis. (river blindness)
Shistosomiasis (bilharziasis)
Soil transmited helminthiases.

49. other author (N. Akritidis )
Although prions cannot strictly
considers Parasitic, fungal be considered to be infectious
and prion zoonoses as other agents, as they are not
less classic ND. a list that is pathogens as such, BSE
likely to expand in the future possesses all the typical
characteristics of a zoonotic
as novel human immune
infection. the disease induced in
compromised
humans, variant Creutzfeldt–
Jakob disease behave as a typical
zoonosis.

51. 


high financial burden to the individual, the
family, the community, the country and even
the region – impairing its development.
Since most are zoonosis, they represent a
serious menace to food security, and
adversely affect opportunities for income
generation.
long-lasting sequels' and cause persisting
symptoms if the infestation remains
untreated.

52. 
causes significantly more accumulated
morbidity (anemia, chronic diarrhea and
pain, undernutrition from protein
loss, exercise intolerance, infertility, poor
school performance) than previously
thought (King CH, Dickman K, Tisch DJ

53. 

affect the most vulnerable people (women,
children, eldest, migrant, inmuno supressed,
indigenous population, minority ethnic
groups, refugees. This confers the attention
of NTD an ethical component
When all the NTD are put together in a single
rate, these represent the second cause of
death after HIV.

54. 
Are responsible of 27% of lost disabilityadjusted life years. According to WHO
(2006) ranked sixth among the ten leading
causes of Disability Adjusted Life Years
(DALYS) is the aggregated measure of 11 of
the NTDs

56. 
Hotez et.al(2010) consider that such diseases
are not confined to developing nations. He
estimates that millions of Americans living in
poverty also suffer from NTD-like infections.
Parasitic diseases such as
cysticercosis, Chagas
disease, trichomoniasis and toxocariasis
occur with high frequency in our inner
cities, post-Katrina Louisiana, other parts of
the Mississippi Delta, the border region with
Mexico, and Appalachia

57. 
CHAGAS DISEASE afflicts an estimated
300,000 people in the U.S. Screening of
donated blood, started in 2007, finds that
cases are concentrated in areas with large
numbers of immigrants from Latin America
living in substandard housing.(Hotez et.al
2010)

59. 



It consists of a group of parasitic
diseases, caused by different species of
Leishmania
It is a zoonosis
Discovered by Brazilian scientists in 1909
In Panama the first indigenous case was
reported by Dr. S. T. Darling in 1910.

60. VISION TO SMEAR MICROSCOPY
In the host
vertebrate
intracellular
amastigotes
(aflagelado))

61. promastigota
(flagellate)) found
in digestive tract
of thr flies

64. 



Leishmaniasis Visceral
Leishmaniasis Cutánea del Viejo Mundo
Leishmaniasis Cutánea del Nuevo Mundo
(América)
Leishmaniasis mucocutánea.

67. Delicate and
tiny flies only
about 2-4 mm
long, these flies
belong to the
subfamily
phlebotominae,
family
Psychodidae

69. 





Luztomia panamensis.
Luztomia trapidoi.
Luztomia Gomezi
Luztomia ylephileptor.
Luztomia sanguinarialis
Luztomia olmeca.

70. “perezoso
colorado”
of two nails
(choloepus
hoffmanni)

71.  pentavalent antimony
compounds have remained the
principal solution for nearly 75
years

73. Globalization, Population movements, as
crucial factors related to neglected
tropical diseases

74. 

Globalization has led to massive migratory
movements; unplanned urbanization and the fast
conexion between massive transport media have
made more dangerous these diseases since many of
them are zoonosis and vector transmitted diseases.
According to the International Organization for
Migration (IOM) (2009), more than 200 million people
are estimated to be international migrants; another 26
million are internally displaced in at least 52 countries
as a result of conflict. Overall migrants comprise 3% of
the world’s population (IOM 2009).

75. 

Migration, poverty and disease is many times
a funest triangle that leads to more disease,
more poverty and more under develope.
For example, some authors found that
leismaniasis is four times more frequent
among people with protein-energy
malnutrition (Machado-Coelho et al. 2005)

76. 


Since the focus is given to the international heath, then
the strategies derived from it suggest a strong
international cooperation.
Following the initative proposed in the first Universities
allied for esential medicines neglected diseases and
innovation symposium.
Finally, I consider that one of the main issues related to
the problem of NTDs in general and to leishmaniasis in
particular is the one related to vaccination and
medication.