Leishmaniasis 2
Leishmaniasis 2
Leishmaniasis 2
Life cycle
Clinical features
The disease usually infect children, infant and less commonly adults where common
infection of adult in HIV patients. The incubation period from weeks to months and
less commonly for days. The patient complains of fever and chills which decrease
over weeks or months relapse of fever may occur but with less intensity, the patient
will has splenomegally as the disease progress to be massive, moderate
hepatomegally, lymphadenopathy, black discoloration of the skin for which it has its
name Kala- Azar (in India mean black fever ). In advance disease pancytopenia,
moderate to severe anemia develop rapidly and progress to congestive cardiac
failure, the patient will develop thrombocytopenia associated with hepatic
dysfunction may result in bleeding in retina, GIT and nose, hypoalbuminemia may
1
occur lead to pedal edema, as cites and anasarca. Immune-suppression may lead to
secondary infection like tuberculosis, pneumonia, sever amebic dysentery, herpes
zoster …etc . If patient not properly treated may die.
Investigations
1- Haematological test shows pancytopenia, agranulocytopenia and
monocytosis. Hypergammaglobulinemia IgG then IgM . Hypoalbuminaemia at
late stage .
2- Tissue biopsy, aspiration or scraping with Giemsa stain or Leishmania stain
for Demonstration of amastigoate bodies i.e. Leishmania Donovani bodies
(LD. Bodies) ) like bone marrow or lymph node aspirate, splenic aspirate can
give diagnosis of 98% after staining but it carry risk of hemorrhage from
spleen so it need fully experience hand. Demonstration of amastigote can be
by Buffy coat smear which has high sensitivity especially in
immunocompromised patient.
Diagnosis can be made in reverse way through culture of the aspirated
material.
PCR for detecting the DNA of parasite and its species.
3- Immunological test serology: ELISA . Direct agglutination test (Anti –
Leishmania Ab test).
immunochromatography k39 strip test in urine can diagnose infection but it
remain positive months after cure the patients so it not differentiate
between new and past infection .
Immunoflourscent study ( IFAT for Kala –azar)
Management
1- Pentavalent antimony : Sodium stibogluonate drug is the mainstay treatment
of leishmaniasis it given in dose of 20 mg|kg for 28 -30 days its side effects
are arthralagia, myalgia, raised hepatic transaminase, pancreatitis,
cardiotoxicity like t-wave inversion and cardiac arrhythmias.
2- Amphotericine B: It given as infusion once daily in dose of 0.75 -1 mg |kg for
15 -20 days it given when there is resistance to sodium stibogluconate it give
cure rate nearly 100 % . Its side effects are fever, rigor, thrombophlebitis,
diarrhea, vomiting, hepatic and renal toxicity, hypokalemia and
thrombocytopenia. Liposomal Amphotericine B is new generation and less
toxic drug.
3- Oral miltefosine : It is given in dose of 2.5 mg |kg for 28 days. Its side effects
include vomiting, diarrhea, skin allergy and it is teratogenic
2
4- Paromomycin: It is given in dose of 11 mg |kg for 3 weeks although it is
aminoglycoside but it has no nephrotoxicity or audio toxicity.
The treatment of leishmaniasis either by single drug or multi-drug regimen like one
dose of Amphotericine B then 7 days of miltefosine and there are another regimen.
The response to treatment will be by the patient feel of well being, fever subside,
increase body weight, the spleen regress and blood study improved .
HIV- visceral leishmaniasis : Patients with HIV has 100-1000 chance of getting visceral
leishmaniasis. Abnormal sites of infection may occur like tonsillitis, pericardial and
pleural effusion. Amastigote may found in pleural, pericardial or brochoalveolar
lavage. Best treatment is by Amphotericine B. Prevention after treatment by
monthly liposomal Amphotericine B infusion.
Post Kala – azar dermal leishmaniasis may occur in 6 months – 3 years after
treatmen,t where micronodular rash, or papular rash treatment is the same for few
months and has high cure rate .