Signs and Symptoms of Kala Azar

Signs and Symptoms of Kala Azar

Kala azar is a reticuloendotheliosis resulting from the invasion of the reticulo endothelial system by Leishmania donovani. This disease was first characterised in India, which is also known as Dum Dum fever, Burdwan fever or tropical splenomegaly or visceral leishmaniasis. It is reported that this disease affects largest population of 200,000 to 400,000 persons in the whole world each year which placed just after malaria. The infection is transmitted by the bite of the vector sandfly,Phlebotomus argentipes. This disease is not zoonotic in India, man being the only host and reservoir. The incubation period is usually 3 to 6 months, though occasionally it may be as short as 10 daysor as long as two years. Cutaneous lesion at the site of the bite of the sandfly is not seen in Indian patients in Sudan and Middle East. 

There are two hosts present in the life cycle of the parasite Leishmania donovanisuch as i) Definitive host- man and some other mammals ii) Intermediate host- Sandly (Phlebotomus argentipes). The parasite exists in two forms amastigote form which is also known as Leishman-Donovan bdies and promastigote form. The standard treatment is the pentavalent antimonial sodium stibogluconate given I.V. (intravenous), 600mg daily for 6 days. An alternative is pentamidine 4mg/kg/day given I.M. (intra muscular) for 10 days. In refractory cases, splenectomy followed by chemotherapy may succeed. Prophylactic measures consist of treating all cases, eradication of the vector sandfly and personal prophylaxis by using anti-sandfly measures.

                      

The response by the immune system of human body varies from person to person not only by the strength but also by the types too. Several types of symptoms appear in the body of the person who is affected by this disease as the parasite has enough capability to affect different organ at the same time. Splenomegaly starts early and is progressive as well as massive too. Some symptoms which are mostly noticed in the body of the patients are described in brief in the following:

 

• ·         Spleen is the organ which is mostly affected by this disease. It is grossly enlarged and capsule is frequently thickened due to perispleplenitis. As a result of it the patient becomes generally anaemic and emaciated.
• ·         Fever is the commonly reported symptom for this disease which persist from short to long span of time still the disease gets cured.
• ·         The liver is enlarged and the Kuffer cells and vascular endothelial cells are heavily parasitized resulting less affect in liver function though the production of prothrombin decreased significantly.
• ·         The bone marrow is heavily infiltrated with parasitized macrophages which may crowd out the haemopoietic tissues.
• ·         This disease progresses for several month with periods of apyrexia followed again by fever.
• ·         The skin of the affected patient becomes dry, rough and darkly pigmented.
• ·         The hair becomes thin and brittle.
• ·         Epistaxis and bleeding gums are the most common feature of this disease.
• ·         Post kala azar dermal leishmaniasis (PKDL) also develop in 10-20% of persons who just recovered from kala azar.