all about Leishmaniasis or Kala-azar Diagnosis signs and symptoms

• with treatment and classification of Leishmaniasis or Kala-azar

Leishmaniasis or Kala-azar Diagnosis signs and symptoms with treatment

• Leishmaniasis or Kala-azar is a disease caused by protozoa called Leish­mania.
• Leishmaniasis or Kala-azar is a vector-borne disease.
• Rodents are reservoir hosts and humans are inciden­tal hosts for Leishmaniasis or Kala-azar .

Types Classification of Leishmaniasis or Kala-azar —

1. Visceral Leishmaniasis –

• due to infection of macrophages in reticuloendothelial system by Leishmania donovani.

2. Cutaneous Leishmaniasis –

• due to infection of macrophages in skin by Leishmania mexicana.

3. Mucosal Leishmaniasis

• due to infection of nasopharyngeal mucosa by Leishmania amazonensis.

Etiology of Leishmaniasis or Kala-azar —

• Leishmaniasis is caused by Leishmania or Viannia.

• The female sand fly (Phlebotomus) bites the host and injects promastigotes which enter the macrophages.

• They multiply, and when the macrophages rupture, amastigotes are liberated into the blood which are again ingested by sandflies.
• and the life cycle of Leishmaniasis or Kala-azar will continue to next to next.

Diagnosis of Leishmaniasis —

• The amastigotes can be seen under the microscope in a thin smear or histology section.
• Skin testing for delayed type hypersensitivity reac­tions are also useful.

Visceral Leishmaniasis —

• Visceral Leishmaniasis  Occurs through bite of sandfly, by blood transfusion, or needle sharing. The disease may be acute, sub­acute or chronic.
• Incubation period of Visceral Leishmaniasis  may be weeks, months or years. This disease is also called Kala-azar or Black fever as the patients appear grey.
• There is fever, splenomegaly, hepatomegaly, periph­eral lymphadenopathy. Spleen may be very big, soft and non-tender.
• There is pancytopenia – anaemia, leukopenia, lym­phocytosis, monocytosis, thrombocytopenia, hypergammaglobulinaemia, hypoalbuminemia.
• Some patients may have dermal leishmaniasis in Kala­azar.

Diagnosis of Visceral Leishmaniasis —

• Parasites may be seen in peripheral smear, tissue aspirates, biopsy specimen of spleen, liver, bone­marrow or lymph node.
• Presence of Visceral Leishmaniasis is seen as a nucleus and a kinetoplast (extra nuclear DNA) called LD bodies, which is very typical of kala-azar.
• Patients of florid kala-azar have high titers of LD an­tibodies (Leishmanin or Montenegro test). ,

Leishmaniasis or Kala-azar Treatment —

• Pentavalent antimonial compound – 20 mgjkg daily for 28 days.
• Amphotericin B – 15 to 20 mgjkg daily.
• r;.-/ Paromom cin (amino I coside – 15 to 20 mgj kg daily for 21 days.
• Miltefosine – Dose 50-100 mg daily for 28 days. Visceral leishmaniasis is common in persons with HIV and need HAART (highly active antiretroviral therapy).

Cutaneous Leishmaniasis –

• incubation period is from weeks to months.
• There is a papule at the site of bite, and lymphaden­opathy.
• There may be change of papule to nodule and ulcer­ative lesion with central depression and raised bor­der several cms. in size.
• in Cutaneous Leishmaniasis Satellite lesions and secondary bacterial infection may occur.

Treatment  Cutaneous Leishmaniasis  —

• Amphotericin B
• Miltefosine

Mucosal Leishmaniasis —

• Mucosal Leishmaniasis Nasopharyngeal mucosa is infected and is quite dis­figuring.
• Mucosal Leishmaniasis is caused by Viannia. There are persistent nasal symptoms, and epistaxis.

Treatment of Mucosal Leishmaniasis —

• Amphotericin,
• Antimonial compounds
• and glucocorticoids.