| ID | 200 |
|---|---|
| Name | KALA-AZAR (Visceral Leishmaniasis) |
| Cause | |
| Signs Symptoms | |
| Diagnosis | |
| Investigations | Investigations: Indirect- 1. Leucopenia with relative lymphocytosis 2. Serum glob in is high 3. C.F.T for Kala-azar is positive 4. Aldehyde test is positive- (a bedside test). 5. DAT- direct agglutination test for Kala-azar is positive (liters of 1:256 or higher). Direct- 6. Bone marrow examination shows LD bodies. |
| Management | |
| Introduction | Kala-azar or visceral leishmaniasis is a protozoal disease caused by leishmania donovani. It is transmitted by a certain species of female phlebotomine sandfly. In Indian subcontinent, where the disease is epidemic, man appears to be the chief host. The incubation period is usually about 1-2 months (but range: 10 days to 10 years) |
| History | |
| Etiology | |
| Clinical Features | Clinical features:1-2 Symptoms: 1. Fever: onset may be acute or insidious with a low grade fever, patient remains ambulent or it may be abrupt with sweating and high intermittent fever, sometimes it shows a double rise of temperature in 24 hours. 2. Patient has a good appetite. Singns: 1. Anemia. 2. Pigmentation of skin, specially on the hands, feet, abdomen & face or forehead. 3. Splenomegaly, hepatomegaly. 4. Generalized lymphadenopathy. 5. Westing or emaciation occurs in extreme progress of disease. |
| Preventions | |
| Treatment | Treatment: 1. Bed rest 2. Diet- normal 3. If fever- paracetamol 500mg 2 or 3 times daily. 4. Inj. Sodium stibogluconate 20mg/kg/day for 20-30 days. With incomplete response or relapse, the treatment should be repeated upto 60 days. Before giving sodium stibogluconate, see the reaction with 100mg i.v stat. In resistant cases pentamidine 3-4mg/kg 1 or 2 times per week. Or, amphotericin B can be given in required dose. 5. Antibiotic- to prevent secondary infection. |
| Complications | Complications: A. Blood- anemia, thrombocytopenia, agranulocy-tosis, hypersplenism, bone marrow depression. B. Alimentary system- cancerum oris, amoebic or bacillary dysentery, diarrhoea. C. Respiratory system- bronchopneumonia, pulmonary TB. D. Skin- P.K.D.L (post Kala-azar dermal leishmaniasis). |
| Prognosis | Prognosis: Early diagnosis and treatment reduces the mortality rate. Without treatment the case fatality rate may be as high as 90%. Death usually occurs due to intercurrent infection, within months to 1-2 years |
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| Observation | |
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