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Advances in clinical diagnosis and chemotherapy of leishmaniasis in Kenya

Published online by Cambridge University Press:  19 September 2011

Charles N. Oster
Charles N. Oster*
Affiliation:
Clinical Research Centre, Kenya Medical Research Institute, P.O. Box 20778, Nairobi, Kenya and U.S. Army Medical Research Unit-Kenya, Walter Reed Army Institute of Research, P.O. Box 401, APO, NY 09675, U.S.A.
*
* Charles N. Oster, P.O. Box 30137, Nairobi, Kanya.
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Abstract

The diagnosis of visceral leishmaniasis must be based upon a demonstration of the parasite in tissues of the patient. The best diagnostic test is a splenic aspirate, which is safe, highly sensitive and specific if the technique described in this paper is used and both smears and cultures of the aspirate are performed. Peripheral blood and nasal exudate have parasites in smears and/or cultures in 75 and 40% of Kenyan visceral leishmaniasis patients, respectively. Sodium stibogluconate (Pentostam) is the preferred treatment for visceral leishmaniasis. Recent Clinical Research Centre trials of different schedules of treatment with sodium stibogluconate are discussed. Currently, we recommend sodium stibogluconate, 20 mg/kg once daily for 30 days, for initial treatment. For patients who have not responded to initial treatment with sodium stibogluconate or have relapsed after initially responding to this treatment, we recommend sodium stibogluconate, 20 mg/kg once daily for 60 days. Further studies are now underway comparing the combination of allopurinol plus sodium stibogluconate versus sodium stibogluconate alone for unresponsive or relapsed patients.

Résumé

Le diagnostic de la leishmaniose viscérale doit être fondé sur la démonstration du parasite dans les tissus du malade. La meilleure méthode de diagnostic est une aspiration de la rate, qui est sans danger, très sensible et précise si on utilise la technique décrite dans cette étude et si on met des échantillons à la fois sur lamelles et en cultures. Le sang périphérique et l'exsudat nasal montrent des parasites sur des lamelles et/ou dans des cultures chez 75% et 40%, respectivement, des malades kényans qui ont la leishmaniose viscérale. Le stibogluconate de sodium (Pentostam) est le meilleur traitement pour soigner la leishmaniose viscérale. Les récents essais du “Clinical Research Center” sur les différentes formes de traitement par stibogluconate de sodium sont discutés. Actuellement, nous recommandons de commencer le traitement en prenant du stibogluconate de sodium, 20 mg/kg une fois par jour pendant 30 jours. Pour les malades qui n'ont pas réagi favorablement au premier traitement par le stibogluconate de sodium ou qui ont rechuté après une première réaction favorable à ce traitement, nous recommandons d'employer le stibogluconate de sodium à raison de 20 mg/kg une fois par jour pendant 60 jours. Des recherches complémentaires sont en cours, comparant un traitement qui combine l'allopurinol et le stibogluconate de sodium, et un traitement au stibogluconate de sodium seul, pour des malades qui ne réagissent pas favorablement ou qui rechutent.

Keywords

Visceral leishmaniasisKala-azarcutaneous leishmaniasissodium stibogluconateallopurinolLeishmania donovaniLeishmania majorLeishmania aethiopicaLeishmaniose viscéraleKala-azarleishmaniose cutanéstibogluconate de sodiuml'allopurinolLeishmania donovaniLeishmania majorLeishmania aethiopica
Type
Special Section: Leishmaniasis Epidemiology
Information
International Journal of Tropical Insect Science , Volume 7 , Issue 2 , April 1986 , pp. 235 - 240
Copyright
Copyright © ICIPE 1986

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