Page 178 - Learnwell EVS
P. 178
6. Parasitic diseases
Visceral leishmaniasis
– P arasitolog ical d iag nosis: id entification of G iem sa- stained parasites in sm ears of
splenic, bone m arrow , or lym ph nod e aspiration- biopsy. Splenic aspiration is th e
m ost sensitiv e tech nique but carries a th eoretical risk of potentially fatal
h aem orrh ag e.
– Serolog ical d iag nosis: rK 3 9 d ipstick test and d irect ag g lutination test (D A T ) can be
used for d iag nosis of prim ary v isceral leish m aniasis in clinically suspect cases.
D iag nosis of relapse is only by parasitolog ical confirm ation.
Treatment
T h e v arious species of Leishmania respond d ifferently to d rug s. F ollow national
recom m end ations. F or inform ation:
Cutaneous and mucocutaneous leishmaniasis
– C utaneous lesions g enerally h eal spontaneously in 3 to 6 m onth s. T reatm ent is only
ind icated if lesions are persistent ( > 6 m onth s) , d isfig uring , ulcerating , or
d issem inated .
– F orm s w ith a sing le lesion or few lesions: start w ith local treatm ent w ith a 6
pentav alent antim onial: sodium stibogluconate or meglumine antimoniate, 1 to 2 m l
infiltrated into th e lesion if it is a nod ule and into th e ed g es and base around th e crust
if it is an ulcer.
I t sh ould be repeated ev ery 3 to 7 d ays for 2 to 4 w eeks. O nce h ealing beg ins, th e
treatm ent can be stopped and h ealing w ill continue.
– I M treatm ent w ith a pentav alant antim onial ( 2 0 m g / kg / d ay for 1 0 to 2 0 d ays) is
restricted to sev ere cases and m ust be ad m inistered und er close m ed ical superv ision.
– M iltefosine P O (as for v isceral leish m aniasis) for 2 8 d ays is effectiv e in m any form s of
cutaneous leish m aniasis.
– U lcers are often second arily infected w ith streptococci and staph ylococci: ad m inister
suitable antibiotics.
– M ucocutaneous form s: as for v isceral leish m aniasis.
Visceral leishmaniasis
– Visceral leishmaniasis in East Africa
• F irst-line treatm ent:
a pentavalent antimonial IM or slow IV : 2 0 m g / kg / d ay for 1 7 d ays
+ paromomycin IM : 1 5 m g (1 1 m g base)/ kg / d ay for 1 7 d ays
• Second - line treatm ent for relapse and for specific v ulnerable g roups: sev ere
d isease, preg nant w om en, patients ov er 4 5 years:
liposomal amphotericin B I V infusion: 3 to 5 m g / kg / d ay for 6 to 1 0 d ays up to a total
d ose of 3 0 m g / kg
• T reatm ent in H IV co-infected patients:
liposomal amphotericin B I V infusion: 3 to 5 m g / kg / d ay for 6 to 1 0 d ays up to a total
d ose of 3 0 m g / kg
145
Visceral leishmaniasis
– P arasitolog ical d iag nosis: id entification of G iem sa- stained parasites in sm ears of
splenic, bone m arrow , or lym ph nod e aspiration- biopsy. Splenic aspiration is th e
m ost sensitiv e tech nique but carries a th eoretical risk of potentially fatal
h aem orrh ag e.
– Serolog ical d iag nosis: rK 3 9 d ipstick test and d irect ag g lutination test (D A T ) can be
used for d iag nosis of prim ary v isceral leish m aniasis in clinically suspect cases.
D iag nosis of relapse is only by parasitolog ical confirm ation.
Treatment
T h e v arious species of Leishmania respond d ifferently to d rug s. F ollow national
recom m end ations. F or inform ation:
Cutaneous and mucocutaneous leishmaniasis
– C utaneous lesions g enerally h eal spontaneously in 3 to 6 m onth s. T reatm ent is only
ind icated if lesions are persistent ( > 6 m onth s) , d isfig uring , ulcerating , or
d issem inated .
– F orm s w ith a sing le lesion or few lesions: start w ith local treatm ent w ith a 6
pentav alent antim onial: sodium stibogluconate or meglumine antimoniate, 1 to 2 m l
infiltrated into th e lesion if it is a nod ule and into th e ed g es and base around th e crust
if it is an ulcer.
I t sh ould be repeated ev ery 3 to 7 d ays for 2 to 4 w eeks. O nce h ealing beg ins, th e
treatm ent can be stopped and h ealing w ill continue.
– I M treatm ent w ith a pentav alant antim onial ( 2 0 m g / kg / d ay for 1 0 to 2 0 d ays) is
restricted to sev ere cases and m ust be ad m inistered und er close m ed ical superv ision.
– M iltefosine P O (as for v isceral leish m aniasis) for 2 8 d ays is effectiv e in m any form s of
cutaneous leish m aniasis.
– U lcers are often second arily infected w ith streptococci and staph ylococci: ad m inister
suitable antibiotics.
– M ucocutaneous form s: as for v isceral leish m aniasis.
Visceral leishmaniasis
– Visceral leishmaniasis in East Africa
• F irst-line treatm ent:
a pentavalent antimonial IM or slow IV : 2 0 m g / kg / d ay for 1 7 d ays
+ paromomycin IM : 1 5 m g (1 1 m g base)/ kg / d ay for 1 7 d ays
• Second - line treatm ent for relapse and for specific v ulnerable g roups: sev ere
d isease, preg nant w om en, patients ov er 4 5 years:
liposomal amphotericin B I V infusion: 3 to 5 m g / kg / d ay for 6 to 1 0 d ays up to a total
d ose of 3 0 m g / kg
• T reatm ent in H IV co-infected patients:
liposomal amphotericin B I V infusion: 3 to 5 m g / kg / d ay for 6 to 1 0 d ays up to a total
d ose of 3 0 m g / kg
145
