Tropical diseases are the diseases that are most prevalent in tropical regions of the world. There are around 14 tropical diseases that causes great morbidity but still ranks low in the international health agendas and being "neglected" since it is confined to certain regions and does not spread across the globe. These diseases are eliminated in developed countries but are prevalent in developing countries because of improper sanitation.Here,I hope I have covered almost all the neglected tropical diseases.

1. Neglected Tropical
Diseases
Presented by
Dr.R.SINDHU
Postgraduate
Dept.Of Public Health Dentistry
SRM Dental College

2. CONTENTS
 Introduction
 Soil transmitted helminthiasis
 Schistosomiasis
 Oncocerciasis
 Dracunculiasis
 Lymphatic filiriasis
 Trachoma
 Leprosy
 Buruli ulcer
 Leishmaniasis
 Chagas disease
 Human African trypanomiosis
 Dengue fever
 Conclusion
 References

3.  The Society of Tropical Medicine of Philadelphia in 1903
 The Royal Society of Tropical Medicine and Hygiene in 1909[Patrick Manson-President and inventor of
”mosquito theory”]
These institutions officialized the designation “tropical diseases” in
medical terminology.
The designation “tropical diseases” was invented in19th
century.
It arose at no particular date and was gradually consolidated, as microorganisms came to be
acknowledged as the causal factors of diseases and transmission.
Since most of the new colonies were located in the tropics, these curious
and exotic diseases were said to be “tropical”.
Introduction
NTDs are a group of infectious diseases that cause substantial illness and impair physical
and cognitive development.
They generally are rare or absent in developed countries, but are often widespread in the
developing world.

4. Unsafe water, lack of access to health services, inadequate housing,
malnutrition and poor sanitation,filthy environments,abundant insects
and other vectors contribute to efficient transmission of infection
 Neglected tropical diseases have traditionally ranked low on national
and international health agendas.
 They do not spread to distant countries through travellers unless there
is an outbreak.

6. SOIL TRANSMITTED HELMINTHIASIS
Hookworm(Necator &
Ancylostoma spp)
Whipworm(Trichuris sp)
Roundworm(Ascaris
lumbricoides)
 They are transmitted by eggs present in
human faeces, which contaminate the soil in
areas where sanitation is poor.
 Approximately 1.5billion[24%]people are
infected with soil-transmitted helminths
worldwide.
 Over 267 million preschool-age children and
over 568 million school-age children live in
areas where these parasites are intensively
transmitted, and are in need of treatment and
preventive interventions.
 The worms feed on host tissues,
including blood, which leads to a loss of
iron and protein.
 chronic intestinal blood loss that can
result in anaemia.
 The worms increase malabsorption of
nutrients. Loss of appetite,a reduction of
nutritional intake and physical fitness.
 In particular, T. trichiura can cause
diarrhoea and dysentery.

7. CONTROLSTRATEGY
 Deworming:yearly(prevalence-20%),
Twice yearly(50%)
 Health and hygiene education
 Provision of adequate sanitation
 Medicines – albendazole (400 mg) and
mebendazole (500 mg)
Global target
The global target is to eliminate morbidity due to soil-transmitted helminthiases in children by 2020.
This will be obtained by regularly treating at least 75% of the children in endemic areas.
People at risk are:
•preschool children
•school-age children
•women of childbearing age
•adults in certain high-risk occupations such
as tea-pickers or miners.

8. Schistosomiasis (bilharzia)
3species
 China and far east
 Africa,South America
and Carribean
 Africa and Middle east
 Prevalent in tropical and subtropical areas, especially in poor communities
without access to safe drinking water and adequate sanitation.
 Infections are acquired with contact of fresh water where aquatic
snails(intermediate host) present.
 The worms of all species live in the blood vessels of the human host and the
major symptoms are caused by the eggs laid by the female worm.
 “African species” causes blood in the urine in children and severe damage to
the urinary tract, as well as bladder cancer in later life (urogenital
schistosomiasis).
 In Intestinal schistosomiasis,eggs get trapped in Liver and cause
chronic Liver damage and Liver fibrosis
 200 million people are infected globally,90% of those are in Africa
Blood flukes
(trematode worms)

9. CONTROL STRATEGY
 Large-scale treatment of at-risk population
groups, access to safe water, improved sanitation,
hygiene education, and snail control.
 Periodic, targeted treatment with
praziquantel(preventive chemotherapy )
Groups targeted for treatment are:
•School-aged children in endemic areas.
•Adults considered to be at risk in endemic areas,
and people with occupations involving contact with
infested water, such as fishermen, farmers,
irrigation workers.
•Entire communities living in highly endemic areas

10. Onchocerciasis (river blindness)
o River blindness was the first disease to be
tackled on a large scale in Africa in the last 4
decades.
o In 1970, up to 50% of African populations living
on the banks of fast moving rivers suffered
impaired vision.
o It is transmitted to humans through exposure to
repeated bites of infected blackflies of the
genus Simulium.
o Larvae produced by the adult worms in the human
body migrate across the eye.
Severe itching
Skin irritation
Irreversible
blindness
Onchocerca volvulus

11.  In 1974 the Onchocerciasis Control Programme (OCP) controlled river
blindness by spraying insecticides using planes and helicopters into
West Africa’s major rivers where the Black Flies breed.
 The OCP relieved 40 million people from infection, prevented
blindness in 600 000 people, and ensured that 18 million children
were born free from the threat of the disease and blindness.
 African Programme for Onchocerciasis Control (APOC) was launched
in 1995  Ivermectin
TREATMENT
Ivermectin at least
once yearly for
between 10 to 15
years

12. Dracunculiasis
 Also known as “Guinea worm disease”
 Infection is acquired from swallowing infected water fleas infected with guinea worm larvae
 Affects subcutaneous tissues[leg and foot]
 The adult female worm lay eggs, emerges through the skin forming blisters usually around the ankle
Dracunculus
medinensis
• Blisters cause
burning
sensation
• Allergic reactions
• Arthritis
The worm then emerges from the skin over the course of
a few weeks
One end is tied and removed slowly.

13. In 1984, the WHO asked the United States Centers for Disease Control and
Prevention (CDC) to spearhead the effort to eradicate dracunculiasis in
endemic areas-Pakistan, Yemen and 17 countries in Africa; an effort that was
further supported by the CARTER CENTER.
In 1986, Jimmy Carter and the Carter Center began leading the global
campaign, in conjunction with CDC, UNICEF and WHO.
Close to
Eradication

14. Lymphatic filariasis (LF – elephantiasis) Wuchereria
bancrofti(90%)
Brugia malayi
Brugia timori
 Infection occurs when filarial parasites are transmitted
to humans through mosquitoes.
 It is usually acquired in childhood causing hidden
damage to the lymphatic system.
Culex (urban and semi-
urban)
Anopheles(rural areas)
Aedes(endemic islands in
the Pacific)
ASYMPTOMATIC
No external signs of infection but still cause damage
to the lymphatic system and the kidneys, and alter
the body's immune system.
ACUTE
local inflammation involving skin, lymph nodes and
lymphatic vessels
CHRONIC
lymphoedema (tissue swelling) or elephantiasis
(skin/tissue thickening) of limbs and hydrocele
(scrotal swelling)

15. Filaria Endemic Districts
Endemicdistrict 250
(in 20States/UTs)
Population:600Million

16. WHO’s strategy is based on 2 key
components:
 Large-scale treatment
Interruption of transmission of filariasis by
Annual MDA for 5 years or more to the
population except:
- children below 2 years
- pregnant women
- seriously ill persons
 Morbidity management and disability
prevention
- Home based management of lymphoedema
cases and up-scaling of hydrocele operations
in the identified CHCs / District hospitals/
medical colleges.
Success in 2020 will be achieved if patients have access to
the following minimum package of care:
 Treatment for episodes of adenolymphangitis (ADL);
 Surgery for hydrocele;
 Treatment of infected persons with antifilarial medicines.
Albendazole/Diethyl
carbamazine citrate

17. MDA has been stopped in:
Goa,Daman &
Diu,Pondicherry(2013)
Tamilnadu,Assam &
Lakshadweep(2015)

18. Trachoma Chlamydia
trachomatis
• Eye discharge
• Swollen eyelids
• Trichiasis (turned-in
eyelashes)
• Swelling of lymph
nodes in front of the
ears
• Sensitivity to bright
lights.
International Trachoma
Initiative (ITI) promotes
an integrated approach
named the SAFE strategy
S-surgery
A-Antibiotics
F-face-washing and
E-environmental
improvements to reduce
the infestation of flies.
Azithromycin (single oral dose of
20 mg/kg) or topical tetracycline
(one percent eye ointment twice a
day for six weeks).
In 1996,WHO launched “GET 2020” and eliminated
Trachoma in Morocco
 It is known to be a public health problem in 41 countries, and is responsible for the blindness or
visual impairment of about 1.9 million people. In 2016, 190.2 million people lived in trachoma
endemic areas and were at risk of trachoma blindness
 It spreads by both direct and indirect contact with an affected person's eyes or nose.
 Children spread the disease more often than adults.
 Poor sanitation, crowded living conditions, and not enough clean water and toilets also increase
spread.
Leading infectious
cause of blindness
worldwide

19. Leprosy Mycobacterium
leprae
It mainly affects the skin and nerves

21. MULTIDRUGTHERAPY
MB leprosy
Rifampicin,clofazimine,dapsone
PB leprosy
Rifampicin,dapsone

22. NATIONAL LEPROSY ERADICATION PROGRAMME(2015-16)
1.DPMR Services
 Total 115 (Govt.- 61 and NGO- 54) Institutions have been recognized for conducting Reconstructive Surgery to correct the disability in LeprosyAffected
Persons.
 During the year 2015-16 a total of 3107 RCS (Govt. – 934 and NGO – 2173) were conducted.
 A total of 276 Relapse cases were confirmed and treated at District Hospitals.
 MCR foot-wears were provided to 52227 LeprosyAffected Persons with Grade I disability.
2.ASHA Involvement
 ASHAs under the NRHM were involved in Leprosy programme for last 8 years.
 However during 2015-16, their participation has substantially improved.
 Out of the total 127334 new cases detected cases brought byASHA were 29379(23.07%).
 ASHAs also helped in completion of treatment in 22753 cases. Incentives were paid during the year to 20944 ASHAs.
3.Child cases with Grade II disability
 To give focus on the policy of No. child cases with disability, information on the cases of Gr. II disability in children was collected and compiled at the
central level.
 Out of the total 11230 new child cases detected during 2015-16, the number of child cases with Gr. II disability was 162.
4.Training
 Medical officer –9189, Health supervisor 4665, Health Workers 16436, LabTechnician- 305, NMS 399, Para MedicalWorkers 366 andASHA/ AWWs-167649
 Central LeprosyTraining & Research Institute,Chengalpattu ,Tamilnadu conducted 16 courses for 150 participates. Regional LeprosyTraining &
Research Institute, Gouripur, West Bengal has conducted 1 course for 9 participants.Chhattisgarh has conducted 46 courses for 646 participants.
5.IEC/BCC Activities
State level
 IEC activities were carried out in a campaign mode during theAnti Leprosy Fortnight starting from 30th January 2016 and ending on 13th February
2016(Newspaper ads,posters,press conference,tv/radio,wall painting,..)
Central level
 Newspapers in Hindi, English and Regional languages which were released through DAVP on 30th January 2016. Leprosy awareness drive was conducted
by IRCTC where message were displayed on flask, menu card , napkins cups etc.

23. Buruli ulcer Mycobacterium
Ulcerans
o Originated from Buruli,Uganda,Africa where the large number of
cases were reported late in 1960s and 1970s.
o Mode of spread is not known.
o Few cases of death from sepsis,tetanus and haemorrhage have
been reported
o Increasing number of bone infections which could complicate are
also being reported
Starts as a painless itchy nodule,which
left untreated leads to massive skin
ulceration,debilitating complications
including contracture deformities and
amputation of the limb
Reported in 33 countries in Africa, the Americas, Asia
and the Western Pacific. Some countries in West and
Central Africa – Benin, Cameroon, Côte d’Ivoire,
Democratic Republic of the Congo and Ghana – report the
majority of cases. Australia and Japan are major
endemic countries outside Africa.

24. Ten years ago, treatment relied almost exclusively on surgery that
involved extensive excision, skin grafting and, in some patients,
amputation of limbs.
30 September 2015 | WHO in collaboration with the Foundation for
Innovative New Diagnostics,innovative diagnostic test developed by
researchers at Harvard University that can lead to rapid confirmation
of Buruli ulcer in a patient.
Boronate-assisted fluorescent thin-layer chromatography
to selectively detect mycolactone when visualized with
ultraviolet light.
Results are ready in an hour
Rapid diagnosis of Buruli ulcer now possible at
district-level health facilities
Clinical diagnosis of Buruli ulcer currently relies on well-
trained, experienced health workers. Polymerase chain
reaction – the most widely used diagnostic test because
of its high sensitivity – can be done only in reference
laboratories, remote from affected communities;
results will be available after few weeks

25. LEISHMANIASIS
Leishmania
 The parasite is transmitted to humans and animals(dogs)
through the bite of an infected sandfly(mosquito Phlebotomus)
 second-largest parasitic killer in the world (after malaria),
responsible for an estimated 200,000 to 400,000 infections each
year worldwide
1. Visceral leishmaniasis
2. Mucocutaneous leishmaniasis
3. Post- kala azar dermal
leishmaniasis (PKDL)
Visceral leishmaniasis
 kala-azar,black fever, and Dumdum fever
 East Africa and the Indian subcontinent -L. donovani
 Europe, North Africa, and Latin America-L. infantum
 Parasite migrates to the internal organs such as
the liver,spleen and bone marrow

26.  HIV infection increases the risk of developing active VL by between 100 and 2320 times, while VL
accelerates HIV replication and progression to AIDS.
 The risk of treatment failure for VL is high.
 35 countries throughout the world have reported cases of
VL/HIV co-infection
 In southern Europe, up to 70% of cases of
visceral leishmaniasis in adults are associated
with HIV infection and particularly in
men (94.8%).
 Co-infection cases have also been reported
recently from Ethiopia (569 cases), Brazil (91),
Sudan (8) and India (7).
VL/HIV co-infection
http://www.who.int

27. South-East Asia, Middle East, Southern Europe, Eastern
Africa and Latin America but majority of the cases are
from the Indian subcontinent, Sudan and Brazil

28. National Kala-azar Elimination Programme
The Elimination strategy
1.Early diagnosis & complete case management
Single Dose 10mg/kgbw Liposomal Amphotericin B (LAMB)
Combination regimens (e.g. Miltefosine & Paromomycin)
Amphotericin B emulsion
Miltefosine
Amphotericin B deoxycholate in multiple doses
2.Integrated Vector Management and Vector Surveillance
Indoor residual spraying twice a year in all houses (upto six feet height) and complete coverage of cattle
sheds in villages which had a Kala-azar case reported in the last 3 years
3.Supervision, monitoring, surveillance and evaluation
15-20% of KA patients seek treatment in the private sector. Information from private sector is essential to
have better picture of burden of disease and sustain the gains achieved towards elimination.
4.Strengthening capacity of human resource in health
Engaging ASHA at community level, ANM at sub-health centre level,
laboratory technicians at PHCs.
5.Programme management
Coordination between centre and state level offices(drug requests, procurement and transportation of drugs,
diagnostics and commodities)

29. Chagas disease
Trypanosome
 Chagas disease in South America is a disease of poor quality housing because it is transmitted by Triatomine bugs
 When a person is infected from a bed bug bite, the organism invades and damages the heart and other organs, although the pathology takes many
years to develop.
Amphotericin B 109 million people at risk
7.7 million infected
21000 deaths/year
Currently,a vaccine is
being tested
COMPLICATION
Spread through blood transfusion and because of increased migration from
endemic areas to USA and Europe and the donation of blood by migrants, the
disease is being found in non-South Americans through transfusion.
Acute toxicity-nausea, vomiting, rigors,
fever, hypertension or hypotension, and
hypoxia.
Chronic- nephrotoxicity

30.  Domestictransmissionofthedisease
hasbeencontrolledin5countries(thesouthern
coneinSouth America)byindoorhousespraying
withinsecticide.
 TheremainingcountriesinSouth Americahave
similarcontrol plan.

31. Human African Trypanosomiasis (HAT)
 African Sleeping Sickness
 Transmitted by the tsetse fly that breeds in savanna and riverine woodland in
a belt across Africa.
 When humans become infected from the bite of the fly, the parasites first
invade the blood and later invade the CNS with fatal consequences if
untreated.
Fever
Rashes
Headache
Severe fatigue
Muscle & joint pain
Edema around
eyes and hands
Weightloss

33. DENGUEFEVER
Aedes aegypti
Ae. albopictus. Severe dengue (Dengue Haemorrhagic Fever) was first recognized in the 1950s
during dengue epidemics in the Philippines andThailand.
 Today, severe dengue affects most Asian and Latin American countries and has
become a leading cause of hospitalization and death among children and adults in these
regions.
Infected person with
Dengue becomes infective
to mosquitoes 6 to 12 hours
before the onset of the
disease and remains upto 3
to 5 days.
4 SEROTYPES of
the virus DENV:
• DENV1
• DENV2
• DENV3
• DENV4

34. • Abrupt onset of high
fever
• Severe frontal
headache
• Pain behind the eyes
which worsens with
eye movement
• Muscle and joint
pains
• Loss of sense of taste
and appetite
• Measles-like rash
over chest and upper
limbs
• Nausea and vomiting
• Symptoms similar to
dengue fever
• Severe continuous stomach
pains
• Skin becomes pale, cold or
clammy
• Bleeding from nose, mouth
& gums and skin rashes
• Frequent vomiting with or
without blood
• Sleepiness and restlessness
• Patient feels thirsty and
mouth becomes dry
• Rapid weak pulse
• Difficulty in breathing
Dengue Haemorrhagic feverDengue fever
• Dengue should be suspected when a
high fever (40°C/104°F) is accompanied
by any of these 2 symptoms
• Symptoms usually last for 2–7 days,
after an incubation period of 4–10 days
after the bite from an infected
mosquito.

38. TREATMENT
 Prevention is better than cure
 No drug or vaccine is available for the treatment of
Dengue/DHF
 The control of Aedes Aegypti mosquito is the only
method of choice
Dengue shock syndrome:
• Replacement of plasma losses
• Correction of electrolyte and metabolic disturbances
• Blood transfusion
Immunization
In late 2015 and early 2016, the first dengue vaccine,
Dengvaxia (CYD-TDV) by Sanofi Pasteur, was registered
in several countries for use in individuals 9-45 years of age
living in endemic areas.
VECTOR CONTROL MEASURES
 PERSONAL PROPHYLACTIC MEASURES
• Use of mosquito repellent creams, liquids, coils,
mats etc.
• Wearing of full sleeve shirts and full pants with
socks
• Use of bednets for sleeping infants and young
children during day time to prevent mosquito bite
 BIOLOGICAL CONTROL
• Use of larvivorous fishes in ornamental tanks,
fountains, etc.
• Use of biocides
 CHEMICAL CONTROL
• Use of chemical larvicides like abate in big breeding
containers
• Aerosol space spray during day time
 ENVIRONMENTAL MANAGEMENT & SOURCE
REDUCTION METHODS
• Detection & elimination of mosquito breeding
sources
• Management of roof tops, porticos and sunshades
• Proper covering of stored water
• Reliable water supply
 HEALTH EDUCATION
 COMMUNITY PARTICIPATION

39. CONCLUSION
WHO goal is to reduce the health and socioeconomic impact due to NTDs, especially among vulnerable groups, and to eliminate specific
NTDs where feasible, thus contributing to the achievement of the Millennium Development Goals.
This will be accomplished through the achievement of the following five objectives:
1. To strengthen political commitment, advocacy and resource mobilization for NTDs.
2. To enhance NTD programme management and intersectoral collaboration in order to sustain and scale up NTD programmes.
3. To scale up access to quality NTD prevention and case management interventions.
4. To strengthen integrated NTD surveillance, monitoring and evaluation.
5. To strengthen research capacity on NTDs and implement research to fill programmatic knowledge gaps.