Kalazar

Kalazar

Leishmania donovani, a parasitic protozoa that causes the fatal disease kalazar, bites infected female sand flies (PHLEBOTOMUS ARGENTIOES) and passes on to people. Kalazar is a severe form of leishmaniasis characterized by anemia, splenomegaly, fever, and liver and spleen enlargement.

There are different forms of leishmaniasis.

• Cutaneous leishmaniasis
  • Affects the skin and mucous membranes. Skin sores usually start at the site of the sand fly bite.
• Systemic or visceral leishmaniasis
  • It affects the entire body. This form occurs 2-8 months after a person is bitten by the sandfly.

Transmission

• The female phlebotomine sand fly bite is how it spreads from one person to another.
• It can also spread through infected syringes and needles and blood transfusions.
• Additionally, contamination of the bite wound or contact when the bug is crushed while feeding can result in transmission.
• The sand fly becomes infectious 6–9 days after ingesting a blood meal that is infectious.

Clinical feature

• Systemic or visceral, leishmaniasis:
  • Fever
  • Spleenomegaly
  • Hepatomegaly
  • Anemia
  • Weight loss
  • Darkening of the skin of the face, hands feet, and abdomen is common.
• Cutaneous leishmaniasis
  • The disease may be mistaken for leprosy.
  • Characterized by painful ulcers in the body exposed to sand fly bite.

Signs and tests

• A physical exam may show signs of an enlarged spleen, liver and lymph nodes.
• Tests that may be done to diagnose the condition include:
  • Biopsy of the spleen and culture.
  • Bone marrow biopsy and culture
  • Direct agglutination assay
  • Indirect immunofluorescent antibody test.
  • Leishmania-specific PCR test
  • Liver biopsy and culture
  • Lymph node biopsy and culture
  • Montenegro skin test
  • Skin biopsy and culture
• Other tests that may be done include.
  • Complete blood count
  • Serologic testing
  • Serum albumin
  • Serum immunoglobulin levels
  • Serum protein

Treatment

• First line drugs- short term
  • Sodium stibogluconate:
    • 20 mg/kg body weight/day (maximum 85mg/day) IM/IV for 20.
  • Amphotericin B:
    • 1mg/kg body weight IV infusion daily or alternate day for 15-20 infusions.
• First line drugs- long term
  • In areas with high level of SSG resistance(>20%) : Miltefosine : 100mg daily in two divided doses for 4 weeks.
  • In areas with SSG sensitivity (>80%): SSG IM or IV 20mg/kg/day for 30days.
• Seconds line drugs
  • SSG failure :
    • Amphotericin B1 mg/kg body at IV infusion daily or alternate day for 15-20 days.
  • SSG and miltefosine failure:
    • Liposomal amphotericin B is used.

Nursing management

• Admit patients for laboratory and cardiac monitoring at the start of treatment.
• administer antibiotic treatment.
• Wear clothes that completely encloses your body. Long slacks and shirts with long sleeves tucked into them.
• Apply insect repellent to any exposed skin as well as the cuffs and ends of sleeves and slacks.
• Use pesticide to treat sleeping spaces indoors.
• A building's higher floors are best for sleeping.
• In the hours between dusk and dawn, stay indoors.
• Use a mattress-tucked bed net.