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Definition
An infectious disease.
Normally zoonotic Caused by the protozoa of the genus leishmania. Transmitted by the phlebotomine sandfly.
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Causative agent
Leishmania
L. Major L. Tropica L. Aethiopica L. Mexicana L. Amazonia
Donovani
Kala-azar
Cutaneous Leishmaniasis/oriental sore Cutaneous & mucosal Leishmaniasis/Espundia
L. Braziliensis
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Sandfly
Life cycle
Amastigote Promastigote Multiplication Inoculation MPS Amastigote Multiplication Rupture of MPS Release of Amastigote (in circulation)
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Host
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or canines as reservoirs.
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Pathogenesis
Parasitaemia
Strong immune response Eradication of parasite Asymptomatic infection Poor Immune response Unrestricted spread to R/E system Granuloma
Established infection
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Clinical features
Asymptomatic Symptomatic
Classical presentation
Fever-Usually insidious in 100% cases Weight loss Unexplained well-being Increased pigmentation
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...Clinical features
Features of complication
Bleeding manifestation Features of infection
Atypical presentation
Sub clinical-No fever
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...Clinical features
Signs: G/E
Increased temp. Skin changes Anaemia Lymphadenopathy Gum bleeding & epistaxis
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...Clinical features
Signs:
Abdominal
Splenomegaly in 100% cases Hepatomegaly Ascites
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...Clinical features
Cardinal Signs& symptoms:
H/O fever more than 2 wks Splenomegaly Loss of wt
Anaemia
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Differential diagnosis
Chronic malaria
CML Lymphoma Miliary TB CHA
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Complications
PKDL Secondary Infection (due to profound immunosuppresion)
Pul. tuberculosis
Pneumonia
Septicaemia Pneumococcal otitis media
Lab. diagnosis
A. Indirect evidence: a. Blood
Progressive leukopenia Relative lymphocytosis
...Lab. diagnosis
B. Serologic or Immunological test:
AT becomes positive after 3 months
CT DAT positive in titre 1:3200 ICT done with K- 39 antigen ELISA
CFT
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...Lab. diagnosis
a. Demonstration of LD body (Amastigote)
Spleen Bone marrow Liver Lymph node Buffy coat 98% sensitive 64-85% 75-85% 64% 67-99%
Treatment of Kala-azar
A. Symptomatic & supportive treatment
B. Specific treatment
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...Treatment of Kala-azar
A. Symptomatic & Supportive treatment Treatment of intercurrent infection Correction of Malnutrition
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Treatment of Kala-azar
B. Specific treatment Sodium stibogluconate-Drug of choice Pentamidine isothionate Liposomal amphotericin B Oral Miltefosine Others-Aminosidine (Paromomycin)
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Treatment of Kala-azar
Sodium stibogluconate -Drug of choice
Dose: 20mg/kg daily not exceeding 850mg Duration: 20 days
Contraindications:
Severe Kidney, Heart or Liver disorder
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Treatment of Kala-azar
Relapse case: Definition If infection occurs within 6 months after completion of Rx If Rx is interrupted before a 10 days course is
completed
If Rx interruption is more than 7 days Treatment:
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with Na-stibogluconate
If infection occurs Causes: Non-compliance Inadequate dose Drug resistance Interrupted Rx after a complete anti- Kala-azar Rx course With Na-stibogluconate in the last year
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Treatment Of KATF
Drug of choice: Pentamidine 50mg/ml
Dose:
4mg/kg b wt ,3 times/wk for 5 wks On 6th wk after completion of Pentamidine
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...Treatment of Kala-azar
Follow up of response
Clinical
General well being
Subsidence of fever
Lab
Hb% to be corrected S. Albumin S. Globulin Absence of LD body in bone marrow
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Prognosis
Mortality
Without treatment : 85-90%
Death usually occurs within a year
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...Prognosis
Causes of death
GI bleeding
Infection Renal failure
Severe malnutrition
Splenic infarction & shock Sudden, unwanted death related to treatment
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Nodular stage
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Syphilis
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Duration
Repeat the cycle 6 times allowing 10 days interval between each Rx cycle
Prognosis
Mortality rate -15-25% in advanced case.
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