VECTOR-BORNE

DISEASES------
SANDFLY
DR ALMAS FARHAN
SANDFLY EXTERNAL
APPEARANCE
Sand fly adults are small flies – only about 3
mm long
Golden, brownish or gray colored
They have long, piercing mouthparts
Sand flies hold their hairy-looking wings in a
vertical V-shape when at rest, a characteristic
that distinguishes them from some other small
flies
Six legs on the adults are extremely long,
being longer than the insect’s body
BEHAVIOR
Female sand flies are blood feeders ,

Females must consume a blood meal before they are

able to develop eggs
Both males and females also consume sugar-related
nutrients that come from plant nectar or honeydew
Sand fly bites are very painful
Most flies that bite humans feed during the evening and throughout
the night.
Daytime resting sites include cavities close to the ground such as dry
tree holes, hollow logs, palm tree crowns and the canopy of tropical
and sub-tropical rain forest jungles
Another commonly found place for daytime resting is inside the
home.
Sand flies develop by complete metamorphosis
Sand flies complete their life cycle within 1-3
months,
Sand fly adult females lay from about 30-70 eggs that
are laid singularly in small batches on moist surfaces
like soil in protected areas with high humidity and
high organic matter
DISEASES CAUSED BY SANDFLY
•Leishmaniasis
•Sandfly fever
PAPPATACI FEVER (Sandfly
Fever)
Pappataci fever, also called phlebotomus
fever, three-day fever, or sandfly fever
Caused by a PHELEBOVIRUS (family Bunyaviridae)
It is transmitted to humans by the bloodsucking
female SAND FLY
PREVALANCE
Prevalent in the moist subtropical
countries of the Eastern Hemisphere
 lying between latitude 20° and 45° N,
particularly around the 
Mediterranean Sea, in the Middle East,
and in parts of India
The sand fly can become infected as a result of
biting an infected person any time from 48
hours before until 24 hours after the onset of 
fever. Once it has been transmitted, the virus
requires 7 to 10 days to incubate, after which
the sand fly remains infected for life.
SIGN AND SYMPTOMS
• lassitude, abdominal distress, and dizziness
• followed within one day by a chilly sensation and a
rapid rise in temperature during the next day or two
to 102°–104.5°F
(38.8–40.3° C).
• As in dengue, symptoms include severe frontal
headache and postorbital pain, intense muscular and
joint pains, and a flushed appearance of the face
•During the first day of fever the pulse is accelerated
•Usually after two days the temperature slowly returns to normal; only
rarely is there a second episode of fever.
•Following the febrile period, there is great fatigue and weakness,
accompanied by slow pulse and frequently subnormal blood pressure.
•Convalescence may require a few days or several weeks, but the
prognosis is always favourable.
•Treatment is entirely symptomatic.
LEISHMANIASIS
TYPES OF PROTOZOA (LEISHMANIA)

Leishmania classified into

•L. Donovani
•L. Tropica.
•L. Mexicana.
EPIDEMIOLOGY
LIFE CYCLE OF THE PARASITE
LEISHMANIA present in 3 main forms
Visceral leishmaniasis (VL), also known as kala-azar is fatal if left
untreated in over 95% of cases.

Most cases occur in Brazil, East Africa and in South-East Asia.

It is characterized by irregular bouts of fever, weight loss,
enlargement of the spleen and liver, and anaemia.
Bone marrow when involved, give rise to: 
Pancytopenia i.e., anemia, leukopenia, and thrombocytopenia.
TLC is usually below 4000/cmm and is between 2000 to 3000/cmm.
There is monocytosis.
High total protein level and a low albumin level, with hyper gamma globulinemia.
Lymphadenopathy may be noted, particularly in some geographic regions, such as Sudan.
HIV-coinfected patients may have atypical manifestations, such as involvement of the
gastrointestinal tract and other organ systems.
Cutaneous leishmaniasis
Leishmania tropica
Incubation time is 2 months to 3 years.
In general, cutaneous leishmaniasis causes skin lesions, which can persist for months,
sometimes years.
The skin lesions usually develop within several weeks or months after the exposure.
These lesions are usually on the face.
The lesions typically evolve from dry papules to nodular plaques to ulcerative lesions.
These ulcers are usually 2 cm in Diameter or more with typical itching.
These lesion has raised border and central depression, which can be covered by scab
or crust.
Rarely some lesions persist as nodules.
These lesions are painless but some time
may give rise to pain when these are
infected.
The healing process typically results in
atrophic scarring.
Leishmania Major:

◦ It produces an acute infection with a duration of 3 to 6

months.
◦ The lesion primarily occurs on the lower limbs.
◦ These lesions are moist and tend to ulcerate very early.
◦ There may secondary and lesions on other sites.
Leishmania Mexicana:
This causes new world cutaneous leishmaniasis
◦ It is endemic in these areas.
◦ The amastigotes are found in the skin lesion of the
humans, wood rats, and cats.
◦ Lesions are usually single and 40% involve ears.
This may give rise to the diffuse cutaneous lesion
Mucocutaneous Lesimaniasis
L. braziliensis causes mucocutaneous leishmaniasis,
also called espundia and uta.
• There is the formation of the ulcer on the oral nasal mucosa. 
• This is common in the Brazil.
• The cutaneous lesions are multiple and large in size.
• Secondary infection plays role in their persistence of the large size lesion.
• Sometimes it spreads to the mucous membranes.
• The entire nasal mucosa and the hard and soft mucosa are involved.
• The nasal septum will be destroyed. 
• But unlike syphilis, the bone is not involved.
• The ulceration leads to loss of all soft parts of the nose, the lips, and soft palate.
• Death may occur in these patients due to secondary infection.
DIAGNOSIS
TREATMENT
•The best drug is Sodium stibogluconate
•Meglumine antimonate
•Pentamidine.
•Oral Ketoconazole
•Steroids
MAJOR RISK FACTORS
Socioeconomic conditions
Poverty increases the risk for leishmaniasis. Poor housing and
domestic sanitary conditions (such as a lack of waste
management or open sewerage) may increase sandfly breeding
and resting sites, as well as their access to humans. Sandflies are
attracted to crowded housing as these provide a good source of
blood-meals. Human behaviour, such as sleeping outside or on
the ground, may increase risk.
Population mobility
Epidemics of both cutaneous and visceral leishmaniasis are often
associated with migration and the movement of non-immune people
into areas with existing transmission cycles. Occupational exposure
as well as widespread deforestation remain important factors.
Malnutrition
Diets lacking protein-energy, iron, vitamin A and zinc increase the
risk that an infection will progress to kala-azar.
Environmental changes
The incidence of leishmaniasis can be
affected by changes in urbanization, and
the human incursion into forested
areas.
Climate change
Leishmaniasis is climate-sensitive and affect the
epidemiology of leishmaniasis in a number of ways:
changes in temperature, rainfall and humidity can
have strong effects on vectors and reservoir hosts by
altering their distribution and influencing their
survival and population sizes;
small fluctuations in temperature can have a profound
effect on the developmental cycle
of Leishmania promastigotes in sandflies, allowing
transmission of the parasite in areas not previously endemic
for the disease;
drought, famine and flood can lead to massive displacement
and migration of people to areas with transmission
of Leishmania, and poor nutrition could compromise their
immunity.