KALA AZAR | LEISHMANIASIS | BLACK FEVER | DUMDUM FEVER | MEDICINES | DRUG OF CHOICE FOR KALA AZAR
Channel: PHARMAROCKS THE WAY OF SUCCESS
Date: 2020-11-17

Kala azar (leishmaniasis)

WHAT IS KALA AZAR

WHAT IS LEISHMANIASIS

Kala azar, also called visceral leishmaniasis, is a disease in which a parasite migrates to the internal organs such as the liver, spleen (hence "visceral"), and bone marrow. 
If left untreated, will almost always result in the death of the host.

Word kala-azar consists of “Kala” (in Hindi means “Black”) & “azar” (in Hindi means “Fever)”
Fever associated with dark complexion

Indian name Kala-Azar meaning “Black fever”.
A disease caused by infection with leishmania parasites. (Leishmania donovani )
Kala-azar first came to the attention of Western doctors in 1824 in Jessore, India (now Bangladesh), where it was initially thought to be a form of malaria. 
Assam gave kala-azar one of its common names, Assam fever.

KALA AZAR HISTORY

Kala azar Causes
Visceral leishmaniasis (VL; kala-azar) caused by 
Leishmania donovani (and other Leishmania species) occurs in several tropical and subtropical regions of the world.


Kala azar sign & symptoms
Loss of appetite
Weight loss
Fever 
Weakness (fatigue)
Skin – Dry, thin and scaly and hair may be lost. 
Enlarge liver, spleen
Light colored person show grayish discoloration of the skin of hands, feet, abdomen

Kala azar patients
Kala azar transmission by sand fly

Drugs for Leishmaniasis (KALA-AZAR)
1. Antimonials:  
Sodium stibogluconate (SSG) (Antimonate)
t has been the standard first line drug for VL in most parts of the world achieving more than 90% cure rate, and is still used in East Africa, Central Asia, Mediterranean basin and South America, 
But is no longer effective in India and Nepal because of extensive resistance

1. Antimonials:  Meglumine (Antimonate)
Meglumine is an amino sugar derived from glucose. 
It is often used as an excipient in pharmaceuticals and in conjunction with iodinated compounds in contrast media 
such as diatrizoate meglumine, iothalamate meglumine and iodipamide meglumine.

2. Diamidine:  Pentamidine
Pentamidine is an antimicrobial medication used to treat African trypanosomiasis, leishmaniasis, Balamuthia infections, babesiosis, and to prevent and treat pneumocystis pneumonia (PCP) in people with poor immune function.


3. Antifungal drugs:  
Amphotericin B
Ketoconazole

4. Others: 
Miltefosine
Paromomycin
Allopurinol

Kala azar drug of choice
drug of choice for visceral leishmaniasis

Amphotericin-B is more effective and may prove to be the drug of first choice

Liposomal amphotericin B is drug of choice for visceral leishmaniasis
3–5 mg/kg i.v. infusion daily for 3–5 days
total dose 15 mg/kg

Amphotericin B deoxycholate 
0.75-1.0 mg/kg i.v. infusion over 4hr daily 
On alternate days 15 mg/kg total dose

Amphotericin B is the drug with highest cure rate in kala-azar: up to 99% clinical and parasitological cure has been reported from India in SSG  resistant cases
it is treated as the ‘reference drug’ while comparing the efficacy of other drugs.

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