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Year : 2014  |  Volume : 32  |  Issue : 1  |  Page : 94--95

Visceral leishmaniasis (kalazar) migrating West: A new autochthonous case from sub-Himalayas

KJ Bhat1, KK Pandita1, A Khajuria2, SM Wani2,  
1 Department of Medicine, Acharya Shri Chander College of Medical Sciences and Hospitals, Sidhra, Jammu, Jammu and Kashmir, India
2 Department of Pathology, Acharya Shri Chander College of Medical Sciences and Hospitals, Sidhra, Jammu, Jammu and Kashmir, India

Correspondence Address:
K J Bhat
Department of Medicine, Acharya Shri Chander College of Medical Sciences and Hospitals, Sidhra, Jammu, Jammu and Kashmir
India

How to cite this article:
Bhat K J, Pandita K K, Khajuria A, Wani S M. Visceral leishmaniasis (kalazar) migrating West: A new autochthonous case from sub-Himalayas.Indian J Med Microbiol 2014;32:94-95

How to cite this URL:
Bhat K J, Pandita K K, Khajuria A, Wani S M. Visceral leishmaniasis (kalazar) migrating West: A new autochthonous case from sub-Himalayas. Indian J Med Microbiol [serial online] 2014 [cited 2019 Sep 18 ];32:94-95
Available from: http://www.ijmm.org/text.asp?2014/32/1/94/124344

Full Text

Dear Editor,

Although visceral leishmaniasis is endemic in 62 countries, about 90% of the estimated 500,000 new cases, which occur annually, are reported from India, Nepal, Bangladesh, Sudan and Brazil; as many as one-half of these cases occur in India especially the eastern states. [1] Visceral leishmaniasis is a disease of low altitude low altitude zones, however, cases from sub-Himalayan regions including upper reaches of Himachal Pradesh and Uttarakhand have been reported, hence documenting its increasing western migration in India. [2] We present a rare indigenous case of kalazar (visceral leishmaniasis) in a young male belonging to Bani, a small town situated in the upper terrains of district Kathua, Jammu who had pyrexia with splenomegaly. This autochthonous case is being reported because of its rarity in this non-endemic zone and vindicates meticulous research into the epidemiology.

A 29 year old male , a farmer from district Kathua, Jammu was referred from community hospital in May 2012 with complaints of fever for the last 4 months. It was low grade and continuous. He also felt dragging pain in upper abdomen which was progressively increasing over the last 2 months along with weight loss and anorexia. He gave no history of any contact with obviously sick animals or migrant workers. He refuted any history of recent travel to Kashmir or outside the state. On examination he looked emanciated with rough skin. He had moderate pallor but no icterus or lymphadenopathy. His blood pressure was 110/86 mmHg and body core temperature of 99.9 F. On abdominal examination only spleen was palpable about 12 cm from the mid-costal margin, non-tender and firm in consistency. Respiratory system, cardiovascular and neurological examination were unremarkable. Initial haematological investigations revealed haemoglobin of 7.7 g/dl, total leucocyte count (TLC) of 2,600/mm 3 predominantly lymphocytic with platelet count of 90,000/mm 3 and ESR of 100 mm at the end of 1 st hr. Peripheral smear showed normocytic to microcytic erythrocytes with sparse platelets. Liver, renal function and other biochemistry data were within the normal range. IgM antibodies for malaria, HBsAg and ELISA testing for HIV-1 and 2 were negative. Abdominal ultrasonography revealed enlarged liver with normal echostructure, normal gall bladder and biliary system. Gross splenomegaly was present and there was no evidence of any portal hypertension. CT imaging ruled out any lymphoid malignancy. In view of febrile illness, splenomegaly and pancytopenia, bone marrow biopsy was performed. Bone marrow smear revealed erythroid hyperplasia with normoblastic erythropiesis with a myeloid/erythroid ratio of 1:2 with depressed thrombopoiesis. Plasma cell count was raised slightly upto 5%. Meticulous observation revealed amastigote forms of Leishmania donovani (also known as LD bodies) both intracellularly within the macrophages as well as extracellularly [Figure 1]. He tested positive for anti-rK-39 strip test. A diagnosis of kalazar was made and the patient was put on sodium stibogluconate therapy with a dose of 20 mg/kg daily 30 days. He responded to the treatment and showed visible signs of improvement with increase in weight progressive regression of spleen size within 3 weeks. Repeat blood count profile showed haemoglobin of 12 mg/dl, TLC of 5000/mm 3 , platelets of 1.5 lakhs with normocytic normochromic blood picture.

Apart from Indian eco-climatic zones visceral and cutaneous leishmaniasis is also quite common in Pakistan including Muzaffarabad. [3] It has also been recently reported from the Uri belt of Kashmir division as well. [4] Our patient hails from Bani, a small glaciated valley in the Kathua district located at a height of 4200 ft above sea level. He refuted any history of recent travel, any contact with sick animals or migrant workers. To the best of our knowledge after literature search, visceral leishmaniasis has been rarely reported so far from Jammu. Six species of Phlebotomus and 15 species of Sergentomyia have been found in the northern mountain ranges of the Himalayas in general. [2] However, in Jammu region itself such data is limited. Epidemiological studies state that for every case of classical visceral leishmaniasis, there are about 30 subclinical infections that cause leishmanin positivity and lifelong immunity to L. donovani. [5] The apparent fact that our patient had contracted the disease indigenously is suggestive of a local vector and probably a zoonotic reservoir as concerns of potential animal reservoirs in India are rising as evident by the increasing seroprevalance of rK 39 antigen test in animals. [6] Again no such seroprevalance data is available in this region. Our report not only merits documentation but also vindicates meticulous research into the epidemiology, geographic distribution and warrants entomologic surveillance in this previously "thought to be" non-endemic area.{Figure 1}

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