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Visceral Leishmaniasis { (Kala- azar ) (Dum-Dum fever, Black fever)}

Visceral Leishmaniasis { (Kala- azar ) (Dum-Dum fever, Black fever)}. Clinical and epidemiological types. 1-Mediterranean (Infantile) type Sporadic cases.

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Visceral Leishmaniasis { (Kala- azar ) (Dum-Dum fever, Black fever)}

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  1. Visceral Leishmaniasis {(Kala-azar) (Dum-Dum fever, Black fever)}

  2. Clinical and epidemiological types 1-Mediterranean (Infantile) type • Sporadic cases. • Distributed in the Mediterranean basin, middle east, former southern USSR and northern China (this type is found in middle and south of Iraq). • Affects chiefly infants and young children (especially under 5 years). • Reservoir hosts are domestics and wild dogs (fox and Jackal), so it is a zoonotic disease. • Caused by L. infantum.

  3. 2-Indian (Classical) type • Epidemic disease. • Distributed in India subcontinent. • Man is the reservoir host, lack of an animal reservoir host (not a zoonotic disease). • Seen in young adults and adolescents. • Frequent presence of amastigote in peripheral blood (circulating macrophages). • Caused by L. donovani.

  4. 3-African type (Sudanese) type • Seen in adult men. • Rodents and dogs are the reservoir hosts (zoonotic disease). • Distributed in Sudan and East Africa. • Presence of the parasites in peripheral blood is less common. • Caused by L. donovani(as Indian type).

  5. South America type • Distributed in central and south America. • Affects mainly children. • Reservoir host are foxes , domestic dogs and cats (zoonotic disease). • Caused by L. chagasi.

  6. Mode of transmission • Vector born transmission (by insect bite). • Blood transfusion. • Needle sharing. • Congenital transmission. • Sexual transmission. • Laboratory acquired transmission. • Person to person transmission.

  7. Clinical presentation -Incubation period: 2 weeks to 18 months. -VL characterized by pentad of: 1-irregular fever, 2-hepatosplenomegaly, 3-weight loss, 3-pancytopenia (leucopenia, anaemia and thrombocytopenia), 5- hypergammaglobulinemia. -VL may be fetal (95%) if left untreated.

  8. Pathogenesis -Infection of R.E. cells. -Hepatosplenomegaly. -LAP. -Anaemia and leucopenia. -epistaxis and ecchymosis. -skin hyperpigmentation. -recovery from leishmaniasis. -death.

  9. Diagnosis • Microscopic detection of amastigotes (LD bodies):(bone marrow , spleen and s.t lymph node aspirates). • Cultivation of aspirates: (promastigotes seen). • Serological method (detection of specific anti-leishmanial antibodies) • Molecular method (PCR polymerase chain reaction): • Leishmanin skin test (Montenegro test): in kalaazar this test is negative. • Aldehydetest.

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