Calazar (Kala Azar) Outbreak 2009: 10 Critical Questions and Answers

With a new Calazar (Kala Azar) outbreak in Brazil, India, and other parts of the world, here are some of the most common questions and their answers that will help with the dreaded infectious disease.

What is Calazar?

Calazar or Kala Azar (Hindi for Black Fever) or Dumdum Fever are the common names for Visceral Leishmaniasis (VL), a severe infection affecting visceral (internal) organs like liver and spleen. Calazar or VL is a subset of Leishmaniasis, a broad class of infection spread by sand fly bites.

Who Should Take More Care About Kala Azar?

Calazar and its vector (carrier) sand flies are found throughout the tropical and temperate world, but not much in the frigid zones. International travellers to tropics should take special care. It was first identified in India and later in most parts of the world. Tropical and temperate regions of both the Old World (Asia, Africa, parts of Europe) and the New World (South America) are susceptible to Calazar. Especially prone are densely populated and impoverished tropics of Asia and Africa. India’s North Bihar region is the most Calazar prone area.

Does Calazar Affect Everyone?

Around 32% of natives and travellers will contract the L donovani (Leishmania donovani), L infantum, or L chagasi, the protozoan parasites responsible for Kala Azar, and will test positive, but in most of them the disease will be stopped in its tracks by body’s immune system, and will not require treatment. In a minority the disease progresses to Leishmaniasis or its severe form, Visceral Leishmaniasis (VL) or Calazar.

What is New About Kala Azar?

Currently there is an outbreak of Calazar. The chances of Calazar spreading to the Western World is also more now, with many soldiers from North America and Europe serving in Calazar affected regions like Afghanistan and Iraq. Co-incidence of Calazar and HIV is also now more common.

Is Calazar a Deadly Disease?

Yes, Kala Azar or VL is a deadly disease which can kill 100% of patients who doesn’t receive proper treatment. Next to only malaria, it is the largest parasitic killer disease.

How Can We Guard Against Kala Azar?

Since Calazar doesn’t affect everyone, a strong immune system is thought to be of central importance in guarding against Calazar. Everything that boosts the immune system like sound sleep, moderate exercise, and nutritious diet can help guard against Calazar. Avoid travelling to Calazar infected places, and if at all you have to travel, use powerful fly / mosquito repellents, especially while sleeping. Stay away from garbage which is a breeding ground for sand flies and from animals like dogs that carry large concentrations of the protozoa. Sand fly bite is not immediately painful, but can later cause a reddish allergy type response.

What are the Symptoms of Calazar?

Early symptoms of Kala Azar include fever, fatigue, anemia, and weight loss. Mucosal ulcers is a special symptom, and so is blackening of the skin (especially in the Indian strain). If the disease progresses, splenomegaly (enlargement of spleen) and hepatomegaly (enlargement of liver) are seen.

How is Kala Azar Diagnosed?

Calazar is often confused with malaria as both have some similar symptoms. The most common method for diagnosing Calazar is a serological test (K39) for detecting the immune response against the protozoa. For confirming cure from the disease, the better but costlier tests of splenic or bane marrow aspirates can be used.

What are the Treatment Options for Calazar?

The standard treatment for Kala Azar is slow intravenous injections of a class of medicines called pentavalent antimonials. However, resistance to these medicines are common, and new medicines like the antifungal amphotericin B and the antibiotic paromomycin are used. Until recently, there were no oral medicines for Calazar. This has changed somewhat with the introduction of Miltefosine, which is an antiprotozoal drug that can be administered both intravenously or orally.

Are There Further Complications From Kala Azar?

The most common further or later-day complication of Calazar is a secondary form of the disease called Post Kala-Azar Dermal Leishmaniasis (PKDL) which appears first as small measles type lesions that can grow and spread much like leprosy and causing disfigurement and even blindness.