Kala-azar (visceral leishmaniasis)

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Organism: leishmania donovani Vector: Phlebotomine sandfly Clinical presentation:- 1) Fever of insidious onset, later on intermittent high fever and sometimes showing double rise in 24 hours. 2) Weight loss with normal appetite. 3) Increased pigmentation especially over the face. 4) On examination- Hepatosplenomegaly &Anaemia and less commonly jaundice may be present. Investigations:- a) Peripheral blood film shows- Progressive anaemia Progressive leukopeina Progressive thrombocytopenia With relative monocytosis b) Bone marrow- Hypercellular marrow with increased myeloid/erythroid ratio. There is marked increase in plasma cells and histiocytes, which depress the development of other elements of the bone marrow. Macrophages in the bone marrow contain LD (Leishmania donovani) bodies. c) CFT(Compliment fixation test) for kala-azar is positive. d) Serum protein- increased gamma globulin. e) ELISA test for detection of antibody against LD is positive. f) Aldehyde & Chopra test- positive. Treatment:- 1) Sodium stibogluconate- The daily dose is 20mg/kg body weight (maximum 800mg), is given either intravenously or intramuscularly for 28-30 days. OR 2) Amphotericin B- The antifungal drug, amphotericin B deoxycholate given once daily or on alternative days at a dose of 0.75-1mg/kg body weight for 15-20 doses, is used in patients with sodium stibogluconate failure. OR 3)Miltefosine- A daily dose of 50mg (patient's body weight or equal to 25 kg body weight) or 2.5mg/kg body weight for children, for 28 days. Complications:- 1) Pancytopenia 2) Recurrent infections 3) Rupture speen 4) Post kala-azar dermal leishmaniasis (PKDL) 5) Weight loss and wasting 6) Hepatocellular damage and bleeding are late complications.