Kala Azar (Leishmaniasis) - Symptoms, Diagnosis, Treatment, Prevention

Kala Azar (Leishmaniasis) - Symptoms, Diagnosis, Treatment, Prevention

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Leishmaniasis refers to a collection of clinical diseases resulting from an infection by the Leishmania parasite. Kala-azar is a disease caused by a parasite called Leishmania donovani, and other members of the species.

The disease has a worldwide prevalence. The Ganges and Brahmaputra are the home of kala-azar in India. It is endemic in Assam, West Bengal, Bihar, eastern Uttar Pradesh, the foothills of Sikkim, Tamil Nadu and Orissa. It is also prevalent in Northwest India, West Pakistan, the Middle East, Southern Russia, the region of the Mediterranean, in Mexico and parts of South America. It is generally more common in rural than urban areas.

In India the type of kala-azar prevalent has man as the reservoir but in other parts of the world rodents and dogs are also reservoirs and propagate its transmission.

The female sandfly, phlebotomus is the vector for the parasite. It ingests blood from an infected person, and after a part of the life cycle of the parasites is completed in its gut it transmits it, deposits fresh parasites on abraded skin or lesions of another host. Rarely can transmission occur through blood transfusions, contact innoculation and coitus.

The incubation period for this disease ranges from a few days to many weeks.

A person is infective as long as the parasites remain in the lesions. In untreated cases it may be a year or more. How long the sandfly is infective is not known.

In India the disease is seen in two presentations

• Visceral presentation—attacks the organs or viscera.

• Cutaneous presentation—when it attacks the skin.

The incubation period for the visceral lesions is 1-4 months but may range from ten days to two weeks. The case presents with the following:

• Irregular episodes of fever occurring suddenly or insidiously leading on to a chronic febrile state.

• The liver and spleen are enlarged and the abdomen looks bloated. The rest of the body appears wasted.

• The organisms affect the red blood cells which break up easily and a persistent state of anaemia results.

• Hyperpigmented patches appear on the forehead and hands.

• In later stages of skin manifestation, hypopigmentation occurs in the form of macules and papules interspersed with reddish patches.

The skin lesions appear akin to those seen in leprosy. The leprosy lesions are insensitive and do not ulcerate. The kala-azar lesions are self-healing and are called Oriental sores. If they get super-infected with bacteria, pus is emitted and the lesion is extremely painful, limiting the patients capacity to work. When these lesions are present around the mouth and nose they have a mutilating effect and the victim becomes a social outcast.

• Jaundice is a later appearance heralding liver failure.

• The scalp hair becomes brittle and falls off.

• The lungs are affected in chronic cases which have been harbouring the parasite for over two years. Secondary infection supervenes, which may invariably lead to a fatal end.

All lesions show the presence of the parasite. Diagnosis is by direct smear examination, culture of the parasite and serological tests specific for the condition.

Parental pentavalent antimony compounds and amphotericin B are being used. This treatment is to be taken under medical supervision as the adequate dose is often bordering on toxic limits which have to be monitored.

Without treatment kala-azar is fatal. Timely therapy is curative and if observation is maintained for a follow up period of at least a year, all parameters return to normal.

General measures include bed rest, good oral hygiene, proper and adequate nutrition, treatment of anaemia with hematinics and of secondary infection with antibiotics.

Lies in control of the vector and the reservoir. If all individuals suffering from kala-azar are detected, fully treated in time and vigilance maintained towards any relapses, the reservoir will cease to exist.

Sandfly control is the same as for malaria. Insecticides sprayed on breeding areas, use of mosquito nets at night and insect repellant oil/creams to be used when working outdoors in endemic areas.

General improvement of living and housing conditions, and sanitation should be implemented and maintained.

Health education in endemic areas regarding the cause, mode of transmission, course of the disease, its control and treatment is important.

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