Diagnosis:
Visceral leishmaniasis
Visceral leishmaniasis
Leishmaniasis is a disease caused by protozoan parasites of the genus Leishmania. Visceral leishmaniasis is the most severe form of leishmaniasis, and also called kala-azar, black fever, and Dumdum fever. The parasite migrates to the internal organs such as the liver, spleen and bone marrow, and, if left untreated, will almost always result in the death. Signs and symptoms include fever, weight loss, fatigue, anemia, and hepatosplenomegaly.
Two species of Leishmania are known to give rise to the visceral form of the disease. The species commonly found in East Africa and the India is L. donovani and the species found in Europe, North Africa, and Latin America is L. infantum, also known as L. chagasi. The insect vectors are species of sandfly.
The gold standard for diagnosis is visualization of the amastigotes in splenic aspirate or bone marrow aspirate. This is a technically challenging procedure. Serological testing is much more frequently used in endemic area. There are no vaccines or preventive drugs for visceral leishmaniasis. The most effective method to prevent infection is to protect from sand fly bites.
The traditional treatment is with pentavalent antimonials such as sodium stibogluconate and meglumine antimoniate. Resistance is now common in India. The treatment of choice for visceral leishmaniasis in India is now amphotericin B. In East Africa, the WHO recommended treatment is SSG&PM (sodium stibogluconate and paromomycin). Miltefosine is the first oral treatment for this disease. The cure rate of miltefosine in Phase III clinical trials is 95%; Studies in Ethiopia show that is also effective in Africa.
Two species of Leishmania are known to give rise to the visceral form of the disease. The species commonly found in East Africa and the India is L. donovani and the species found in Europe, North Africa, and Latin America is L. infantum, also known as L. chagasi. The insect vectors are species of sandfly.
The gold standard for diagnosis is visualization of the amastigotes in splenic aspirate or bone marrow aspirate. This is a technically challenging procedure. Serological testing is much more frequently used in endemic area. There are no vaccines or preventive drugs for visceral leishmaniasis. The most effective method to prevent infection is to protect from sand fly bites.
The traditional treatment is with pentavalent antimonials such as sodium stibogluconate and meglumine antimoniate. Resistance is now common in India. The treatment of choice for visceral leishmaniasis in India is now amphotericin B. In East Africa, the WHO recommended treatment is SSG&PM (sodium stibogluconate and paromomycin). Miltefosine is the first oral treatment for this disease. The cure rate of miltefosine in Phase III clinical trials is 95%; Studies in Ethiopia show that is also effective in Africa.