Kala-Azar is a slow progressing indigenous disease caused by a protozoan parasite of the genus Leishmania. In India Leishmania donovani is the only parasite that causes this disease. The parasite primarily infects the reticulo-endothelial system and may be found in abundance in bone marrow, spleen and liver.
Post Kala-Azar Dermal Leishmaniasis (PKDL)
Post Kala-Azar Dermal Leishmaniasis is a condition in which Leishmania donovani parasites invades in skin cells. The parasite resides and develops there and manifests as dermal lesions. PKDL develops in some of the Indian Kala-Azar patients usually 1-2 years or more following recovery of Kala-Azar; less commonly without suffering from Kala-Azar. Recently it is believed that PKDL may appear without passing through visceral stage. However, adequate data is yet to be generated on course of PKDL manifestation.
The content of this module has been validated by Dr. Indu Grewal, Central health Education Bureau New Delhi , on 3rd November 2014.
Recurrent fever intermittent or remittent with often double rise of temperature.
There is only one sand fly vector of Kala-Azar in India i.e. Phlebotomus argentipes. Sand flies are small insects, about one fourth of the size of a mosquito. The length of a sand fly body ranges from 1.5 to 3.5 mm.
Sand flies breed in high relative humidity, warm temperature, high subsoil water and abundance of vegetation. Sandflies breed in favourable micro-climatic conditions in places with high organic matter that serve as food for larvae.
These are ecologically sensitive insects, fragile and cannot withstand desiccation.
A case of fever of more than two weeks duration not responding to anti-malarials and antibiotics. Clinical laboratory findings may include anemia, progressive leucopenia thrombocytopenia and hypergammaglobulinemia.
This is just an indicative information. For diagnosis and treatment you should consult your doctor.
Diagnosis and treatment of Kala-Azar are problematic because of a variety of reasons. While treatment is lengthy and relatively costly, definitive diagnosis of Kala-Azar requires tissue specimens, which are conventionally obtained by organ needle aspiration for microscopic demonstration of amastigote forms in stained smears. Bone marrow the spleen, and lymph-node (in some regions) are the tissues most often sampled in patients with suspected infection. The diagnostic sensitivity of splenic aspiration is high (95% - 98%), but the procedure carries a risk of bleeding; the sensitivity of examination of bone marrow specimens is considered to be lower (53% - 95%). Organ aspiration and accurate examination of smears also require technical skills that are not uniformly available in rural areas. Culture or PCR testing of aspirate material improves parasitologic yield, but these methods are seldom undertaken outside of research laboratories.
Some of the drugs available for treatment of Kala-Azar in India:
This is just indicative information. For diagnosis and treatment you should consult your doctor.
There are no vaccines or preventive drugs for visceral leishmaniasis. The most effective method to prevent infection is to protect from sand fly bites. To decrease the risk of being bitten Following precautions are suggested:
-Avoid outdoor activities, especially from dusk to dawn, when sand flies generally are the most active. When outdoors (or in unprotected quarters): Minimize the amount of exposed (uncovered) skin. To the extent that is tolerable in the climate, wear long-sleeved shirts, long pants, and socks; and tuck your shirt into your pants.
-Apply insect repellent to exposed skin and under the ends of sleeves and pant legs. Follow the instructions on the label of the repellent. The most effective repellents generally are those that contain the chemical DEET (N,N–diethylmetatoluamide)
-Stay in well-screened or air-conditioned areas.
-Keep in mind that sand flies are much smaller than mosquitoes and therefore can get through smaller holes.
-Spray living/sleeping areas with an insecticide to kill insects. If you are not sleeping in a well-screened or air-conditioned area, use a bed net and tuck it under your mattress.
-If possible, use a bed net that has been soaked in or sprayed with a pyrethroid-containing insecticide. The same treatment can be applied to screens, curtains, sheets, and clothing (clothing should be retreated after five washings)."