visceral leishmaniasis (kala-azar)
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Etiology
Epidemiology
- Leishmania donovani predominates in Africa, India, Asia
- not common in West Africa[7]
- Leishmania infantum predominates in the Mediterranean & Middle East
- Leishmania chagasi occurs throughout Central & South America
- humans, dogs & cats may serve as host reservoirs
- opportunistic infection in AIDS patients
Clinical manifestations
- infection is generally benign & self-limited
- recurrent fever
- weakness
- sweating
- cough
- nausea/vomiting
- skin manifestations
- pale macules
- erythematous nodules
- verrucae
- hepatosplenomegaly
- lymphadenopathy
- disease may be fatal if not treated
Laboratory
- complete blood count (CBC) may show pancytopenia
- neutropenia is profound, eosinophils generally low
- hypergammaglobulinemia
- buffy coat
- lymph node aspirate or biopsy
- bone marrow aspirate*
- liver biopsy
- spleen biopsy
- serology available, but utility not known[5]
* histopathology image[8]
Radiology
* image[8]
Management
- classic kala-azar is generally fatal if not treated]
- sodium stibogluconate
- available from CDC (404 639-3670)
- 20 mg Sb[V]/kg IM/IV for 28 days
- patients become afebrile & feel better within 1 week
- aminosidine 12-15 mg/kg/day IM or IV as adjunctive therapy (not FDA approved)
- amphotericin B
- amphotericin B deoxycholate: 0.5-1.0 mg/kg QD or QOD for a total dose of 7-20 mg/kg (15 doses)
- liposomal amphotericin B: a single dose of 10 mg/kg as effect as 15 alternate day infusions of amphotericin B deoxycholate[6]
- pentamidine 2-4 mg/kg QD or QOD IV or IM for a total of 15 doses
- interferon-gamma & macrophage CSF have been proposed as adjunctive agents
- miltefosine (Impavido)
Also see Leishmaniasis
More general terms
Additional terms
References
- ↑ Clinical Diagnosis & Management by Laboratory Methods, 19th edition, J.B. Henry (ed), W.B. Saunders Co., Philadelphia, PA. 1996, pg 1266-68
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 1190-91
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 18. American College of Physicians, Philadelphia 1998, 2018.
- ↑ UpToDate 13.2
- ↑ 5.0 5.1 Veterans Administration
- ↑ 6.0 6.1 Sundar S et al Single-dose liposomal amphotericin B for visceral leishmaniasis in India. N Engl J Med 2010 Feb 11; 362:504 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/20147716 <Internet> http://content.nejm.org/cgi/content/full/362/6/504
- ↑ 7.0 7.1 Levine AC, Shetty PP, Henwood PC, Sabeti P, Katz JT, Vaidya A. Interactive medical case. A Liberian health care worker with fever. N Engl J Med. 2015 Jan 29;372(5):e7. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25629759 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMimc1414101
- ↑ 8.0 8.1 8.2 Loscocco GG, Piccini M Visceral Leishmaniasis. N Engl J Med 2019; 380:379 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30673546 https://www.nejm.org/doi/full/10.1056/NEJMicm1803648