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Visceral Leishmaniasis (Kala-Azar)

Systemic protozoal infection caused by Leishmania donovani complex transmitted by sandfly bite, characterized by prolonged fever, hepatosplenomegaly, pancytopenia, and progressive wasting; fatal if untreated, requires antileishmanial therapy with liposomal amphotericin B, miltefosine, or pentavalent antimonials.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

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This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Internal Medicine department. Book Appointment →

What is Visceral Leishmaniasis (Kala-Azar)?

Visceral leishmaniasis (VL) is caused by intracellular protozoan parasites Leishmania donovani (Indian subcontinent, East Africa) and Leishmania infantum (Mediterranean, Brazil, Central Asia), transmitted by female Phlebotomus or Lutzomyia sandflies. Promastigotes inoculated into skin transform into amastigotes within macrophages, disseminate via bloodstream to reticuloendothelial system (spleen, liver, bone marrow, lymph nodes), causing progressive systemic disease.

Clinical features develop over weeks to months: prolonged irregular fever (often double quotidian), massive splenomegaly (sometimes crossing midline), hepatomegaly, lymphadenopathy, progressive pancytopenia (anemia, leukopenia, thrombocytopenia), hypergammaglobulinemia (polyclonal), and cachexia with hyperpigmentation (kala-azar means 'black fever' in Hindi). Untreated mortality exceeds 95%. Post-kala-azar dermal leishmaniasis (PKDL) develops in 5-10% after Indian VL treatment.

Diagnosis includes direct visualization of Leishman-Donovan bodies in splenic, bone marrow, or lymph node aspirates (gold standard, sensitivity 70-95%), rK39 antigen rapid test (95% sensitivity in Indian VL), serology (DAT, ELISA), and PCR. Treatment: liposomal amphotericin B is preferred globally (single dose 10 mg/kg in India, total 20-30 mg/kg in East Africa and Mediterranean), miltefosine (oral, teratogenic), pentavalent antimonials (sodium stibogluconate, meglumine antimoniate, increasing resistance), and paromomycin. HIV-VL co-infection requires combination therapy and lifelong secondary prophylaxis.

Symptoms

Prolonged irregular fever (weeks to months)
Massive splenomegaly (often crossing midline)
Hepatomegaly
Marked weight loss and cachexia
Hyperpigmentation of skin (especially face, hands)
Pallor (anemia), bleeding (thrombocytopenia)
Lymphadenopathy

Risk Factors

Residence or travel to endemic areas (India, East Africa, Brazil, Mediterranean, Middle East)
Outdoor exposure during sandfly active hours
Poverty, malnutrition, poor housing
HIV/AIDS co-infection (lower threshold for VL development)
Immunosuppression (transplantation, biologic therapy)
Living conditions facilitating sandfly breeding
Occupational exposure (forestry, agriculture)

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Prolonged unexplained fever in returned traveler from endemic area
  • Massive splenomegaly with fever and cytopenia
  • Weight loss, fever, and hyperpigmentation in HIV patient
  • Pancytopenia of unclear etiology
  • Visceral leishmaniasis suspected in endemic region
  • Skin lesions developing months-years after VL treatment (PKDL)
  • Travel-related illness with hepatosplenomegaly

Treatment Methods

01
Liposomal amphotericin B (preferred): 10 mg/kg single dose (India), 20-30 mg/kg total (Africa)
02
Miltefosine 2.5 mg/kg/day for 28 days (oral, teratogenic)
03
Pentavalent antimonials (sodium stibogluconate, meglumine antimoniate)
04
Paromomycin 11 mg/kg IM for 21 days
05
Combination therapy for HIV-VL co-infection
06
Lifelong secondary prophylaxis in HIV patients
07
Treat PKDL with miltefosine or amphotericin B

Which Department to Visit?

You can visit our Enfeksiyon Hastalıkları department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

Learn About Enfeksiyon Hastalıkları Department

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.