A chronic systemic infectious disease transmitted by the bite of a sand fly.
Cause
- Flagellated protozoa Leishmania species
Clinical features
Visceral Leishmaniasis (Kala-azar)
- Chronic disease characterized by fever, hepatosplenomegaly, lymphadenopathy, anaemia, leucopenia, progressive emaciation and weakness
- Fever of gradual onset, irregular, with 2 daily peaks and alternating periods of apyrexia
- The disease progresses over several months and is fatal if not treated
- After recovery from Kala-azar, skin (cutaneous) leishmaniasis may develop
Cutaneous and Mucosal Leishmaniasis (Oriental sore)
- Starts as papule, enlarges to become an indolent ulcer
- Secondary bacterial infection is common
Differential diagnosis
- Other causes of chronic fever, e.g. brucellosis
- (For dermal leishmaniasis) Other causes of cutaneous lesions, e.g. leprosy
Investigations
- Stained smears from bone marrow, spleen, liver, lymph nodes, or blood to demonstrate Leishman Donovan bodies
- Culture of the above materials to isolate the parasites
- Serological tests, e.g. indirect fluorescent antibodies
- Leishmanin skin test (negative in Kala-azar)
Management
Cutaneous Leishmaniasis (all patients)
- Frequently heals spontaneously but if severe or persistent, treat as for Visceral Leishmaniasis below
Visceral Leishmaniasis (Kala-azar): All patients
- Combination: Sodium stibogluconate 20 mg /kg per day IM or IV for 17 days
- Plus paromomycin 15 mg/kg [11 mg base] per day IM for 17 days
Alternative first line treatment is:
- Sodium Stibogluconate 20 mg/kg per day for 30
days (in case paromomycin is contraindicated)
In relapse or pregnancy - Liposomal amphotericin B (e.g. AmBisome) 3
mg/kg per day for 10 days
In HIV+ patients
- Liposomal amphotericin B 5 mg/kg per day for
8 days
Post Kala-Azar Dermal Leishmaniasis (PKDL)
- Rare in Uganda
- Sodium Stibogluconate injection 20 mg/kg/day until clinical cure. Several weeks or even months of treatment are necessary
Note
- Continue treatment until no parasites detected in 2 consecutive splenic aspirates taken 14 days apart
- Patients who relapse after a 1st course of treatment with Sodium stibogluconate should immediately be retreated with Ambisome 3 mg/kg/day for 10 days
Prevention
- Case detection and prompt treatment
- Residual insecticide spraying
- Elimination of breeding places