Kala azar (English spelling)

Japanese: カラアザール（英語表記）Kala azar
Kala azar (English spelling)

What kind of infection is it?

Also known as visceral leishmaniasis, this infectious disease is distributed in parts of China, South Asia, the Middle East, North Africa and Central and South America. It is transmitted by the bite of sandflies infected with the protozoan Leishmania.

Depending on the country or region where it is prevalent, multiple species of Leishmania, most notably Leishmania donovani, cause diseases with similar symptoms.

There are no insects in Japan that transmit the Leishmania parasite, so there are no cases of leishmaniasis, but there are very rare cases of the disease being imported from endemic areas. Reticuloendothelial system ( The latest news ) The virus invades cells (such as macrophages) and causes infection and disease by dividing and multiplying.

How symptoms manifest

After a 2-6 month incubation period, the patient develops a fever and develops symptoms. spleen ( Hizo ) The abdomen becomes larger Bloating ( Boom! ) At the same time, severe anemia occurs, and the skin becomes dry and dark gray in color.

As the symptoms progress, the patient's overall condition deteriorates and may develop pneumonia or tuberculosis ( Results ) This can lead to a variety of infections, including those mentioned above, which can lead to death.

Testing and diagnosis

Bone marrow aspiration ( Kotsui Senshi ) (inserts needle) spleen ( Hizo ) The diagnosis is made by demonstrating the presence of the protozoa in samples obtained by puncture or lymph node aspiration. fluorescence ( Practice ) There are various methods for detecting antibodies in serum, such as antibody techniques and immunoenzyme antibody techniques.

However, serum reactions have problems with specificity and are susceptible to infections caused by other infectious diseases. False positive ( Worker ) In addition, some research institutions are able to detect antigens in the blood and DNA of the protozoan by PCR.

Treatment methods

There is no safe treatment. A highly toxic antimony drug (Pentostam) is commonly used, but it has various side effects such as vomiting, abdominal pain, and headache.

What to do if you notice an illness

If you have traveled to an area where the infection is prevalent, remember being bitten by an insect, and develop a fever, do not hesitate to see an infectious disease specialist.

Tomoyoshi Nozaki

Source: Houken “Sixth Edition Family Medicine Encyclopedia” Information about the Sixth Edition Family Medicine Encyclopedia

Japanese:

どんな感染症か

　中国、南アジア、中近東、北アフリカや中南米の一部に分布している、別名内臓リーシュマニア症とも呼ばれる感染症です。リーシュマニアという原虫に感染したサシチョウバエに刺されることにより感染します。

　流行している国および地域によって、ドノバンリーシュマニアに代表されるリーシュマニアの複数の種類の原虫が原因となって、似たような症状の病気を起こします。

　日本にはリーシュマニア原虫を媒介する昆虫はいないので、リーシュマニア症の発生はありませんが、ごくまれに感染流行地からの輸入例がみられます。原虫が細網内皮系(さいもうないひけい)細胞（マクロファージなど）に侵入し、分裂・増殖することで感染・発症します。

症状の現れ方

　感染して2～6カ月の潜伏期ののちに発熱で発症します。その後、肝臓・脾臓(ひぞう)が大きくなり、腹部が膨満(ぼうまん)します。同時に高度の貧血を起こし、皮膚が乾燥し濃灰色になります。

　症状が進むと全身状態が悪化し、肺炎・結核(けっかく)を始めとするさまざまな感染症を併発して死に至ります。

検査と診断

　骨髄穿刺(こつずいせんし)（針を刺す）、脾臓(ひぞう)穿刺、リンパ節吸引などで得られた検体から、原虫を証明することで診断が行われます。また、間接蛍光(けいこう)抗体法・免疫酵素抗体法などによって血清中の抗体を検出するさまざまな方法があります。

　しかし、血清反応は特異性に問題があり、ほかの感染症による擬陽性(ぎようせい)が多く知られています。また、血液中の抗原を検出したり、PCR法によって原虫のDNAを検出することも一部の研究機関では可能です。

治療の方法

　安全な治療法はありません。毒性の高いアンチモン剤（ペントスタム）が一般に用いられますが、嘔吐・腹痛・頭痛などさまざまな副作用があります。

病気に気づいたらどうする

　感染流行地に渡航し、虫に刺された覚えがあって発熱したら、迷わず感染症の専門医を受診してください。

野崎　智義

出典　法研「六訂版 家庭医学大全科」六訂版 家庭医学大全科について　情報

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