Visceral Leishmaniasis (Kala-azar)

Visceral leishmaniasis, also known as kala-azar, is a serious parasitic infection transmitted by the bite of infected sandflies, affecting internal organs such as the spleen, liver, and bone marrow. It is fatal in most cases without treatment.

• Prolonged fever, often with a pattern of peaks
• Weight loss
• Marked enlargement of the spleen and liver, causing abdominal swelling and discomfort
• Anaemia, and other signs of reduced blood cell counts, such as easy bruising or recurrent infections
• Progressive weakness and fatigue

• Caused by Leishmania parasites, transmitted through the bite of infected female sandflies.
• Sandflies breed in specific environmental conditions, and risk is highest for people living in or near known endemic areas.
• Malnutrition and weakened immunity, including HIV infection, increase the risk of progression to severe disease.

• Suspected based on prolonged fever with an enlarged spleen in someone from or living in an endemic area.
• Diagnosis is confirmed through specific blood tests, or through microscopic examination of a sample from the spleen, bone marrow, or lymph node, performed at a facility with the necessary expertise given the small procedural risks involved.

Treatment requires specific antileishmanial medicines, given at a specialised treatment centre, with the regimen depending on local parasite resistance patterns and available medicines.

Supportive care addresses complications such as severe anaemia and secondary infections, which are common in advanced disease.

Nutritional support is an important part of recovery, given the significant weight loss and malnutrition often present.

Close follow-up after treatment is needed, as relapse can occur, particularly in people with HIV co-infection.

• Use insect repellent and sleep under an insecticide-treated bed net in endemic areas.
• Support sandfly vector-control measures where implemented by local health authorities.
• Seek prompt medical assessment for prolonged fever with abdominal swelling, particularly in a known endemic area.
• Address malnutrition, which increases vulnerability to severe disease.