KAMRC MUZAFFARPUR BIHAR FREQUENTLY ASKED QUESTIONS

Kala-Azar (Visceral Leishmaniasis)

Kala-Azar is one of the most dangerous neglected tropical diseases (NTDs), fatal in 95% of cases if left untreated. Also known as visceral leishmaniasis, kala azar is the most serious form of leishmaniasis and as of 2020 is endemic in 90 countries. The parasite is spread to humans by bites from infected female sandflies. It attacks the immune system and is almost always fatal if not treated. It's estimated that there are between 50,000 and 90,000 new cases a year, about 90 percent of which occur in Brazil, Ethiopia, India, Kenya, Somalia, South Sudan and Sudan.

Frequently Asked Question

1. What causes kala azar ?

Kala azar is caused by bites from female phlebotomine sandflies – the vector (or transmitter) of the leishmania parasite. The sandflies feed on animals and humans for blood, which they need for developing their eggs. If blood containing leishmania parasites is drawn from an animal or human, the next person to receive a bite will then become infected and develop leishmaniasis. Months after this initial infection, the disease can progress into a more severe form, called visceral leishmaniasis or kala azar.

2. What are the symptoms of kala azar ?

Initially, Leishmania parasites cause skin sores or ulcers at the site of sandfly bites. If the disease progresses, it attacks the immune system. Kala azar presents after two to eight months, with more generalised symptoms, including prolonged fever and weakness. Co-infection of kala azar and HIV is a major challenge, as the diseases influence each other in a vicious spiral as they attack and weaken the immune system.

3. What are the symptoms of PKDL ?

Types of morphological lesions :

Early hypopigmented macules similar to macular lesions of Lepromatous Leprosy but normally less than 1 cm. Usually occur on face but can affect any part of the body.

Later (after a variable period of months or years) diffuse nodular lesions on those macules

Erythematous butterfly rash which may be aggravated by exposure to Sunlight; an early sign of PKDL

Erythematous papules and nodules which usually occur on face, especially the chin.

Lesions progressive over many years , seldom heal spontaneously

Rare manifestations of PKDL include:

Multiple lesions coalesce to form larger plaque type lesions

Verrucous lesions (hands and feet)

Papillomatous lesions (on muzzle area of face, nose, chin, and lips)

Hypertrophic lesions (eyelids, nose and lips)

Xanthematous rash (orange plaque on axillary fold, cubital fossae, inner thighs, outer canthus of the eye and perioral)

Pityriasis rosea like lesions

HIV and Kala-azar co-infection

Visceral leishmaniasis (VL) has emerged as an opportunistic infection in HIV and other immunosuppressed patients

More than 1000 cases of HIV and VL are reported from 25 countries. However, in India yet not a serious problem

VL may be first Opportunistic Infection in asymptomatic HIV-I infected person

Also occurs in advanced stage of AIDS

All co-infected patients are not symptomatic

Diagnosis may be altered because symptoms may be of short duration; fever and spleen may not be marked; Leishmania antibodies may be undetectable.

However peripheral blood smears of buffycoat and blood culture may yield good results

Response to treatment is poor; drug side effects may be more and relapses may be common

4. How kala azar transmitted ?

Kala-azar is a vector borne disease

Sandfly of genus Phlebotomus argentipes are the only known vectors of kala-azar in India

Indian Kala-azar has a unique epidemiological feature of being Anthroponotic; human is the only known reservoir of infection

Female sandflies pick up parasite (Amastigote or LD bodies)while feeding on an infected human host.

Parasite undergo morphological change to become flagellate (Promastigote or Leptomonad), development and multiplication in the gut of sandflies and move to mouthparts.

Healthy human hosts get infection when an infective sandfly vector bites them.

5. How is kala azar diagnosed ?

The most effective diagnostic tests for leishmaniasis are invasive and potentially dangerous, where tissue samples are required from the spleen, lymph nodes or bone marrow. These tests require lab facilities and specialists not readily available in resource-poor, endemic areas.The most common method of diagnosing kala azar is by dipstick testing. However, this method is highly problematic. In endemic areas, people can become infected with kala azar, but it may not develop into the disease. Therefore, no treatment will be required. Unfortunately, dipstick testing only establishes whether a patient is immune to kala azar – so if the parasite is present, it would appear that the patient has the disease. Because of this, dipstick testing can’t be used to see if the patient is cured, is re-infected or has relapsed.

6. How is kala azar treated ?

Today, liposomal amphotericin B is becoming the primary treatment drug in Asia, either alone or as part of a combination therapy. While safer and shorter than previously used medication, it requires intravenous administration, which remains an obstacle to its use in local clinics. An oral drug, miltefosine, is often added to optimise treatment regimens in patients. In Africa, the best available treatment is still a combination of pentavalent antimonials and paromomycin, which is toxic and requires a number of painful injections. Research into other treatment combinations is underway. In 2022, research conducted by MSF and partners in India contributed towards the WHO releasing updated treatment recommendations for people with both HIV and kala azar.

7. What is the extent of problem of Kala Azar in India ?