Treatment, clinical manifestation and biophysical aspects of kala-azar

Abstract

Visceral leishmaniasis (VL), also known as kala-azar, black fever, and Dum-dum fever, is the most severe form of leishmaniasis. It is caused by protozoan parasites of the Leishmania genus. This disease is the second-largest parasitic killer in the world (after malaria), responsible for an estimated 200,000 to 400,000 infections each year worldwide. Kala-azar is an example for harmful positive feedback - interaction between the managing body (immune system) and the object of management (bone marrow) in a biological cyber-netic system. The parasite, due to its characteristics is not degraded by enzymes in phagocytic cell. It starts dividing mitotically. Parasites enter the bloodstream and migrate to the internal organs such as the liver, spleen and bone marrow and if left untreated, almost always results in the death of the host. The most com-mon symptoms are: fever, weight loss, fatigue, anemia, and substantial swelling of the liver and spleen, skin lesions. The available treatment option for visceral leishmaniasis is problematic when it comes to efficacy, adverse effects and cost, making treatment a complex issue. Different methods of treatment are in relation also to toxicity of the drugs, ability to monitor side effects, length of treatment; ability of patients to pay for and stay safe during treatment, ability of the healthcare services to give the right therapy. The main drugs avail-able for treatment of VL are the systemic agents like antimony, amphotericin, paromomycin and now the oral drug miltefosine.