Leishmaniasis kala-azar

The flagellate leishmania is transmitted to humans by the bite of the female sandfly of the genus Phlebotomus. Three principal diseases result from infection with Leishmania spp. L. donovani causes visceral leishmaniasis (kala-azar) L. tropica and L. major produce cutaneous leishmaniasis, and L. braziliensis causes South American mucocutaneous leishmaniasis. In visceral leishmaniasis, the protozoan parasitizes the reticuloendothelial cells, and this results in an enlargement of the lymph nodes, liver, and spleen the spleen can become massive. Cutaneous leishmaniasis remains localized to the site of inoculation, where it forms a raised disfiguring ulcerative lesion. South American leishmaniasis is variable in its presentation. It is characterized by ulceration of the mucous membranes of the nose, mouth, and pharynx some disfiguring skin involvement also is possible. 

Brazil is one of the few countries in the Americas that has applied insecticides for the control of visceral leishmaniasis (kala-azar). Since the areas of transmission often overlapped with those for Chagas disease, the insecticides used and areas sprayed were determined by the Chagas disease control programme. With the reduction in applications for Chagas disease control, the number of cases of kala-azar has... 

Murray HW. Treatment of visceral leishmaniasis (kala-azar) a decade of progress and future approaches. Int J imect Dis 2000 4(3) 158-77. 

Pentamidine has been used successfully in comses of 12 to 15 IM doses of 2 to 4 mg/kg either daily or every other day to treat visceral leishmaniasis (kala-azar caused by L. donovani). This compound provides an alternative to antimonials or lipid formulations of amphotericin B for patients who cannot tolerate the latter agents. Pentamidine isethionate given as fom IM doses of 3 mg/kg every other day has enjoyed some success in the treatment of cutaneous leishmaniasis (Oriental sore caused by L. tropica) but is not used routinely to treat this infection. 

After malaria, trypanosomiasis, leishmaniasis (kala-azar), and ameobiasis (amoebic dysentery) are the most serious of the diseases caused hy protozoa. 

A. Liposomal amphotericin B was approved by the US. Food and Drug Administration to treat visceral leishmaniasis. Pentavalent antimony compounds, pentamidine, amphotericin B, and aminosi-dine (paromomycin) have all been demonstrated efficacious here. The liposomal amphotericin appears to be better taken up by the reticuloendothelial system, where the parasite resides, and partitions less in the kidney, where amphotericin B traditionally manifests its toxicity. In addition to being better tolerated by patients, it has proved to be very effective in India, where resistance to antimony drugs is widespread. This patient appears to have acquired his infection there, where many infected patients develop darkening of the skin, hence the name kala-azar, or black sickness. Albendazole, an anthelmintic, has no role here. Atovaquone, a naphthoquinone, is used to treat malaria, babesiosis, and pneumocystosis. Pyrimethamine-sulfadoxine is used to treat malaria and toxoplasmosis. Proguanil inhibits the dihydrofolate reductase of malaria parasites and is used in combination with atovaquone. 

Antimony(III) sodium gluconate Sodium antimony(lll) dimercaptosuccmate (Stibocaptate) Ethylstibamme " Antimony(V) sodium gluconate Less toxic than tartrates 172 (mouse intravenous) Schistosomiasis Schistosomiasis Kala Azar Espudia Cutaneous leishmaniasis... 

Leishmaniasis. The causative agents are flagellated protozoa that are transmitted by sand flies to humans. The parasites are taken up into phagocytes, where they remain in phagolysosomes and multiply until the cell dies and the parasites can infect new cells. Symptoms A visceral form, known as kala-azar, and cutaneous or mucocutaneous forms exist (A). An estimated 12 million humans are affected. Therapy is dif cult pen-tavalent antimonial compounds, such as stibogluconate, must be given for extended periods. Adverse effects are pronounced. 

Flies also harbor diseases that can be transmitted to humans and other mammals when they bite to obtain a blood meal for themselves. For example, black flies can carry river blindness, sandflies can carry leishmaniasis and kala-azar, and tsetse flies (found mainly in Africa), carry the trypanosomes that cause sleeping sickness. Livestock, such as horses and cattle, can be infected with a variety of botflies and warbles that can infest and feed on the skin, throat, nasal passages and stomachs of their hosts. 

Thrombocytopenia has been reported in a patient with Leishmania donovani infection and AIDS after stibogluconate therapy for 7 days (SEDA-13, 838). There have been two further reports, one involving a patient with cutaneous leishmaniasis (occurring after 19 days of treatment), the second a man with kala-azar (who became thombocytopenic 11 days after starting therapy) in kala-azar a low platelet count is common and the count normally rises with treatment (SEDA-18, 294). 

Thakur CP, Kumar K. Efficacy of prolonged therapy with stibogluconate in post kala-azar dermal leishmaniasis. Indian J Med Res 1990 91 144-8. 

Sitamaquine (1) is an 8-aminoquinoline that has been used to treat kala-azar (visceral leishmaniasis) (2) and is being tested for activity against Pneumocystis proved (1). 

Sangraula H, Sharma KK, Rijal S, Dwivedi S, Koirala S. Orally effective drugs for kala-azar (visceral leishmaniasis) focus on miltefosine and sitamaquine. J Assoc Physicians India 2003 51 686-90. 

The introduction of tartar emetic (1) in 1912 for the treatment of mucocutaneous leishmaniasis heralded a new era in the treatment of the disease, which was followed by the investigation of a number of other antimonials for clinical efficacy in leishmaniasis. This led to the discovery of a number of fivevalent antimony compounds, that have laboratory and clinical efficacy and are better tolerated than tartar emetic. These included sodium stibogluconate (2), meglumine antimoniate (3), derivatives of stibanilic acid (stibamine, 4), stibacetin (5), ethyl stibamine (a mixture of 4, 5, antimonic acid and Et2NH in a molar ratio of 1 2 1 3 with 41-44% of fivevalent antimony content) and urea stibamine (6) have been used to treat kala-azar, cutaneous and mucocutaneous leishmaniasis in man. 

Pearson RD, De Queiroz Souza A, Jeronimo SMB. Leishmania species Visceral (kala-azar), cutaneous, and mucosal leishmaniasis. In Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases, 5th ed. New York, Churchill-Livingstone, 2000 2831-2845. 

In 1912, however, (201) it was discovered that espundia (American mucocutaneous leishmaniasis) can be cured by tartar emetic. It was soon learned that kala-azar (visceral leishmaniasis) and oriental sore (a cutaneous form of the disease occurring in the Middle East) also respond to antimonial therapy, especially when compounds of pentavalent antimony are employed. Treatment of leishmaniasis with the latter type of antimonials is safe and effective in over 90% of the cases (202). In 1918, it was demonstrated that tartar emetic is of value in the treatment of schistosomiasis (203). Pentavalent antimonials proved to be less effective. The introduction of antimony compounds for the treatment of parasitic diseases is undoubtedly one of the important milestones in the history of therapeutics (see Antiparasitic agents). 

Leishmaniasis (parasite) Kala - Azar Insects (Phlebotomus) + + + + ... 

A. Pentamidine Pentamidine is commonly used in the hemolymphatic stages of disease caused by Ttypanosoma gambiense and T rhodesiense. Because it does not cross the blood-brain barrier, pentamidine is not used in later stages of trypanosomiasis. Other clinical uses include pneumocystosis and treatment of the kala azar form of leishmaniasis (Table 53-3). 

The visceral leishmaniasis, also known as kala azar (black fever), is caused by Leishmania donovani. This form of the disease is systemic and is characterized in patients by fever, typically nocturnal, diarrhea, cough, and enlarged liver and spleen. The skin of the patient may become darkened. Without treatment, death may occur in 20 months and is commonly associated with diarrhea, superinfections, or Gl hemorrhage. Visceral leishmaniasis is most commonly found in India and Sudan. 

L. donovani Visceral leishmaniasis with rare cases of post kala azar dermal leishmanoid East Africa, sub Saharan Africa, Southern Asia including India... 

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