LEISHMANIASIS - KALA AZAR IN ENGLISH

                                                      

                             LEISHMANIASIS - KALA  AZAR IN ENGLISH

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KALA AZAR

          Leishmaniasis is a protozoal infection caused by several species of the genus Leishmania. It is mainly of two types-

          1. Cutaneous or mucosal leishmaniasis

          2.  Visceral leishmaniasis (KALA AZAR)

CAUSATIVE AGENT-

          Leishmaniasis is mainly caused by

           Leishmania tropica,

          L. major, L. aethiopica,

          L. braziliensis and 

          L. mexicana

MODE OF TRANSMISSION-

          Leishmanisis spreads from the animal reservoir through the bite of infective female phlebotomines (sandflies).

          Motile promastigotes develop and multiply in the gut of the sandfly after it has fed on an infected mammalian host

          In humans and other mammals, the organisms are taken up by macrophages and transform into amastigote forms, which multiply within the macrophages until the cells rupture,

CLINICAL MANIFESTATIONS-

Ø  Cutaneous leishmaniasis starts with a macule then a papule that enlarges and typically becomes an ulcer . Mucosal leasions may apper in oro-pharyngeal mucosa.

Ø  Lesions may be single or multiple

Ø  Lesions may heal spontaneously within weeks to months, or last for a year or more.

Ø  Visceral leishmaniasis occurs due to pathogenic effects of intracellular leishmania

Ø  Clinical manifestations of visceral leismaniasis includes-

Ø   Fever

Ø  Hepato-splenomegaly,

Ø   Lymphadenopathy,

Ø  Anemia,

Ø  Leukopenia,

Ø  Thrombocytopenia and

Ø  Progressive emaciation and weakness.

Ø  Grayish discoloration of the skin of hands, feet, abdomen and face.

Ø  Due to this discoloration visceral leishmaniasis is also known as KALA AZAR (black fever)

 

DIAGNOSTIC INVESTIGATIONS-

Ø  Parasitological diagnosis is based preferably on culture of the organism from a biopsy specimen or aspirated material.

Ø  Demonstration of intracellular amastigotes in stained smears from bone marrow, spleen, liver, lymph nodes or blood.

Ø  Recently, inexpensive, easy to use and reliable field tests such as freeze-dried antigen (DAT) and dipsticks (k39/k26) have become available.

TREATMENT-

Ø  The skin sores of cutaneous leishmaniasis usually heal on their own, even without treatment.

Ø  Medications used for the treatment of visceral leishmaniasis are intravenous liposomal amphotericin B (L-AmB)  and oral miltefosine

 

PREVENTION

Ø  Early diagnosis and prompt treatment of patients is a very good method for prevention of spread of leishmaniasis.

Ø   Phlebotomine sandflies have a relatively short flight range and are highly susceptible to control by systematic spraying with residual insecticides.

Ø  Possible breeding places of sandflies, such as stone walls, animal houses and rubbish heaps, must be sprayed by residual insecticides.

Ø  Use of Insecticide-treated bed-nets are a good vector control alternative

Ø  Eliminate rubbish heaps and other breeding places of sand flies.

Ø  General cleanliness of neighborhood help in preventing breeding of sand flies and ultimately it help in controlling spread of leishmaniasis.