Kala Azar

Overview

Kala azar or also known as visceral leishmaniasis is caused by the protozoan genus Leishmania (more than 20 species). These parasites are transmitted to humans by the bites of the infected female sandfly of subfamily Phlebotomine. In addition to that, it has also occur through blood transfusion and can present unexpectedly in immunosuppressed patients. Most people infected by the parasite do not develop any symptoms at all in their life. Therefore, the term Leishmaniasis refers to the fact of becoming sick due to Leishmania infection and not the mere fact of being infected with the parasite.

Signs and Symptoms

High fever, Rigor and chills, Splenomegally, Hepatomegally, Lymphadenopathy, Blackish discoloration of the skin, Pancytopenia, Thrombocytopenia, Advance illness: pedal edema, ascites, anasarca

Common Causes

Parasites (commonly L. donovani and L. chagasi) are transmitted to humans through the bite of the infected female sandfly of the Phlebotomine subfamily

Risk Factors

Immunocompromised: renal transplantation, HIV infection Poverty and malnutrition Endemic areas: India, Sudan, Bangladesh, Brazil, Nepal

Investigation Techniques

Full blood count, Splenic/ bone marrow/ lymph node smear, PCR, ELISA, Rapid immunochromatographic k39 strip test, Formal gel (aldehyde) test

Treatment and Prevention

Pentavalent antimonials: first drug to be used and remains the mainstay, Amphotericin B: if antimony is not responsive, Oral miltefosine: alkyl phospholipid, phosphocholine analogue that was originally developed as an antineoplastic agent; it interacts with membrane synthesis and signal production., Paromomycin: aminoglycoside, given intramuscularly, Pentamidine: preferred in areas where antimonial resistance is prevalent, given intramuscularly, Antifungal therapy: ketoconazole, flucanazole, Surgical intervention may be necessary for adjunctive splenectomy in patients with treatment-resistant disease, Carefully monitor patients with leishmaniasis for relapse or recrudescence for up to 6 months after successful treatment