The protozoan parasites that are known to be of the Leishmania genus are the cause of various diseases such as Leishmaniasis. One of the most severe forms of this disease is the Visceral Leishmaniasis or Kala Azar or Black Fever. After malaria, it is the second most common and largest parasitic killer in the world.

Definition of Visceral Leishmaniasis or Kala Azar:

Caused by Leishmania Donovani, Visceral Leishmaniasis or Kala Azar is an intracellular protozoan infection that is usually transmitted by phlebotomine sandflies.

Signs and Symptoms of Visceral Leishmaniasis or Kala Azar

Signs and Symptoms of Visceral Leishmaniasis or Kala Azar:

As the name suggests, Visceral Leishmaniasis or Kala Azar is a disease in which the parasite migrates to the internal organs. The most common types of symptoms that are seen to be occurring in the patients suffering from Visceral Leishmaniasis or Kala Azar are –

  • Enlargement of the spleen
  • Enlargement of the liver
  • Night sweats
  • Severe temperature or irregular bouts of fever that can last for weeks
  • Bleeding
  • Blackening of the skin is one of the symptoms of Visceral Leishmaniasis or Kala Azar
  • Scaly skin
  • Dark and ashen skin
  • Cough
  • Weakness
  • Substantial weight loss
  • Thinning of hair
  • Anemia or decreased production of red blood cells of a serious sort is also a symptom of Visceral Leishmaniasis or Kala Azar
  • Destructive ulcerations of the mucosa, in muco-cutaneous leishmaniasis

Although L. donovani is not the cause of direct death in case of patients suffering from Visceral Leishmaniasis or Kala Azar, it can however, lead to other complications that can be life threatening. Often pneumonia, AIDS, dysentery as well as tuberculosis are seen to be present in the regions in which Visceral Leishmaniasis or Kala Azar is seen to occur. In such cases, it becomes quite difficult to treat the other complications along with Visceral Leishmaniasis or Kala Azar and it adds to the morbidity rate.

Epidemiology and Prognosis of Visceral Leishmaniasis or Kala Azar:

Visceral Leishmaniasis or Kala Azar is a disease that is found to be distributed all around the globe and is registered in the five continents and with registered cases in 88 countries, which is mostly in the tropical and subtropical regions. An estimated 12 million cases of Visceral Leishmaniasis or Kala Azar are found and registered worldwide, with an average of 1.5 to 2 million new cases in every passing year.

Visceral Leishmaniasis or Kala Azar is one of the most neglected tropical diseases and is found to occur mostly in the poor and neglected populations of the Indian sub-continent, including Bangladesh, Afghanistan and the Syrian Arab Republic, Nepal as well as East Africa, specially Brazil, Ethiopia, Kenya and Sudan. Although there are different kinds of leishmaniasis, Visceral Leishmaniasis or Kala Azar affects some of the internal organs of the body. Amongst all the registered cases, 90% of the Visceral Leishmaniasis or Kala Azar cases are found to occur in the six countries of India, Bangladesh, Nepal, Sudan, Ethiopia and Brazil.

If Visceral Leishmaniasis or Kala Azar is diagnosed on time, it can be treated with the latest medical advancements. However, with wrong diagnosis and delay in treatment, Visceral Leishmaniasis or Kala Azar can lead to 100% deaths. Usually the cause of death in Visceral Leishmaniasis or Kala Azar is the consequential hemorrhagic or infectious complications and hence, Visceral Leishmaniasis or Kala Azar has a high mortality and morbidity rate with 50,000 registered cases of death every year, 90% of these patients suffering from Visceral Leishmaniasis or Kala Azar have died due to absence of treatment.

Cause of Visceral Leishmaniasis or Kala Azar:

Phlebotomine sandflies, belonging to the Phlebotomus genus are the insect vectors that carry the protozoa of Leishmania donovani. As the sand fly sucks blood of the prey, the protozoa Leishmania donovani is injected into the prey's body and there it completes its life cycle.

Diagnosis of Visceral Leishmaniasis or Kala Azar:

Diagnosis of Visceral Leishmaniasis or Kala Azar is very important. This is because delay in this or even a wrong diagnosis may lead to a fatal consequence. Since, Visceral Leishmaniasis or Kala Azar occurs after months of the actual sand-fly bite or in cases, after years, it is hard for a person to remember whether a sand-fly has bit him or not. This is the reason, why it becomes even more difficult to understand whether it is Visceral Leishmaniasis or Kala Azar or some other disease. The doctor usually considers the enlargement of the spleen and liver as the most significant symptoms of this disease.

Sample of the bone marrow biopsy and sample of the blood is collected to check for the presence of the parasite in blood as well as pancytopenia and hypergammaglobulinemia. This is called the gold standard for diagnosis of Visceral Leishmaniasis or Kala Azar, which is done to check the amastigotes. At times, splenic puncture is also recommended; however, it can cause severe bleeding. Recently the K39 Strip Test or a recombinant protein test is also found to be very useful in diagnosing Visceral Leishmaniasis or Kala Azar, if Serologic Antibody Test for immunoblot, immunoassay or indirect fluorescent does not help.

Treatments for Visceral Leishmaniasis or Kala Azar:

The only way to treat Visceral Leishmaniasis or Kala Azar is the use of some medicines. The common drugs are Sodium Stibogluconate (Pentostam), Pentamidine, Allopurinol, Amphotericin B (Fungizone) and Miltefosine (Impavido). These drugs have their side effects in many cases and hence, they should be used only under the surveillance of the doctor, who will also manage the consequential complications.

Visceral Leishmaniasis or Kala Azar is a highly fatal disease that can be mortal if not treated on time or properly. Hence, diagnosis is must. However, its extent has been reduced to a great extent in the past few years and vaccine preparation is a process that is continuing to bring positive results. Yet, it is always better to stay away from the vectors of this parasite, as much as possible.

Prevention of Visceral Leishmaniasis or Kala Azar:

The only way to prevent Visceral Leishmaniasis or Kala Azar is by staying away from these flies as much as possible. To avoid a possible bite, make sure –

  • You should wear clothing that covers your skin as much as possible.
  • Spray insecticides inside the house, especially in the sleeping areas.
  • Use insect repellent, especially those which contain DEET.
  • As these flies are active mostly during twilight, avoid staying out in this time.
  • Sleep on higher floors as the sand-flies are poor fliers.
  • Use mosquito nets and tuck it under the mattress and bed as tightly as possible. Sandflies are much smaller than usual mosquitoes and hence, they might be able to enter through the net, if loosened at places. Spraying the net with insecticides is better.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: July 7, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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