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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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References

REFERENCES

Alving, C. R., Steck, E. A., Chapman, W. L. Jr, Waits, V. B., Hendricks, L. D., Swartz, G. M. and Hanson, W. L. (1978) Therapy of leishmaniasis: superior efficacies of liposome-encapsulated drugs. Proc. natn. Acad. Sci. U.S.A. 75, 2959–2963.CrossRefGoogle ScholarPubMed
Anabwani, G. M. and Bryceson, A. D. M. (I982) Visceral leishmaniasis in Kenyan children. Indian Pediat. 19, 819–822.Google Scholar
Anabwani, G. M., Ngira, J. A., Dimiti, G. and Bryceson, A. D. M. (1983) Comparison of two dosage schedules of sodium stibogluconate in the treatment of visceral leishmaniasis in Kenya. Lancet i, 210–213.CrossRefGoogle Scholar
Anderson, T. F. (1943) Kala azar in the East African forces. E. Afr. med. J. 20, 172–175.Google Scholar
Beach, R., Kiilu, G., Hendricks, L., Oster, C. and Leeuwenburg, J. (1984) Leishmania major in Kenya (East Africa); transmission to a human by bite of a naturally infected Phlebotomus duboscqi sandfly. Trans. R. Soc. trop. Med. Hyg. 78, 747–751.CrossRefGoogle Scholar
Caronia, G. (1916) L'impiego di nuovi preparati di antimonio per via intramuscolari nella cura della Leishmaniosi infantile. Pediatria, Naples 24, 65–81.Google Scholar
Christina, G. di and Caronia, G. (1915) Sulla terapia della Leishmaniosi interna. Bull. Soc. Path. exot. 8, 63–66.Google Scholar
Chulay, J. D. and Bryceson, A. D. M. (1983) Quantitation of amastigotes of Leishmania donovani in smears of splenic aspirates from patients with visceral leishmaniasis. Am. J. trop. Med. Hyg. 32, 475–479.CrossRefGoogle ScholarPubMed
Chulay, J. D., Anzeze, E. M., Koech, D. K. and Bryceson, A. D. M. (1983a) High-dose sodium stibogluconate treatment of cutaneous leishmaniasis in Kenya. Trans. R. Soc. trop. Med. Hyg. 77, 717–721.CrossRefGoogle ScholarPubMed
Chulay, J. D., Bhatt, S. M., Muigai, R., Ho, M., Gachihi, G., Were, J. B. O., Chunge, C. and Bryceson, A. D. M. (1983b) A comparison of three dosage regimens of sodium stibogluconate in the treatment of visceral leishmaniasis in Kenya. J. infect. Dis. 148, 148–155.CrossRefGoogle ScholarPubMed
Chulay, J. D., Adoyo, M. A. and Githure, J. I. (1985) Leishmania donovani parasitemia in Kenyan visceral leishmaniasis. Trans. R. Soc. trop. Med. Hyg. 79, 218–222.CrossRefGoogle ScholarPubMed
Chunge, C. N., Gachihi, G., Muigai, R., Wasunna, K., Rashid, J. R., Chulay, J. D., Anabwani, G., Oster, C. N. and Bryceson, A. D. M. (1985) Visceral leishmaniasis unresponsive to antimonial drugs. III. Successful treatment using a combination of sodium stibogluconate plus allo-purinol. Trans. R. Soc. trop. Med. Hyg. 79, 715–718.CrossRefGoogle Scholar
Cole, A. C. E. (1944) Kala-azar in East Africa. Trans. R. Soc. trop. Med. Hyg. 37, 409–435.CrossRefGoogle Scholar
Forkner, C. E. and Zia, L. S. (1934) Viable Leishmania donovani in nasal and oral secretions of patients with kala-azar and the bearing of this finding on the transmission of the disease. J. exp. Med. 59, 491–499.CrossRefGoogle ScholarPubMed
Gachihi, G., Chunge, C. N., Oster, C. N., Wasunna, K. and Rashid, J. R. (1984) Heat treatment in cutaneous leishmaniasis patients: experience at the Clinical Research Centre. In Proceedings of the 5th Annual Medical Scientific Conference of the Kenya Medical Research Institute and Kenya Trypanosomiasis Research Institute, p. 151.Google Scholar
Githure, J. I., Beach, R. F. and Lightner, L. K. (1984a) The isolation of Leishmania major from rodents in Baringo District, Kenya. Trans. R. Soc. trop. Med. Hyg. 78, 283.CrossRefGoogle ScholarPubMed
Githure, J. I., Oster, C. N. and Chulay, J. D. (1984b) Comparison of three culture media for isolating Leishmania donovani from splenic aspirates in Kenyan visceral leishmaniasis. E. Afr. med. J. 61, 539–543.Google ScholarPubMed
Hockmeyer, W. T., Kager, P. A., Rees, P. H. and Hendricks, L. D. (1981) The culture of Leishmania donovani in Schneider's insect medium: its value in the diagnosis and management of patients with visceral leishmaniasis. Trans. R. Soc. trop. Med. Hyg. 75, 861–863.CrossRefGoogle ScholarPubMed
Jaffe, C. L., Bennett, E., Grimaldi, G. Jr and McMahon-Pratt, D. (1984) Production and characterization of species-specific monoclonal antibodies against Leishmania donovani for immunodiagnosis. J. Immun. 133, 440–447.CrossRefGoogle ScholarPubMed
Jha, T. K. (1983) Evaluation of allopurinol in the treatment of kala-azar occurring in North Bihar, India. Trans. R. Soc. trop. Med. Hyg. 77, 204–207.CrossRefGoogle ScholarPubMed
Kager, P. A., Rees, P. H., Wellde, B. T., Hockmeyer, W. T. and Lyerly, W. H. (1981) Allopurinol in the treatment of visceral leishmaniasis. Trans. R. Soc. trop. Med. Hyg. 75, 556–559.CrossRefGoogle ScholarPubMed
Kager, P. A. and Rees, P. H. (1983a) History and distribution of visceral leishmaniasis in Kenya. In Clinical Aspects of Kalar Azar in Kenya (Edited by Kager, P. A. and Rees, P. H.), pp. 5–8. ICG Printing, Dordrecht, The Netherlands.Google Scholar
Kager, P. A. and Rees, P. H. (1983b) Clinical aspects of visceral leishmaniasis in Kenya: review of the literature until 1978. In Clinical Aspects of Kala Azar in Kenya (Edited by Kager, P. A. and Rees, P. H), pp. 9–17. ICG Printing, Dordrecht, The Netherlands.Google Scholar
Kung'u, A., Mutinga, M. J. and Ngoka, J. M. (1972) Cutaneous leishmasniasis in Kenya. E. Afr. med. J. 49, 458–465.Google ScholarPubMed
Lawrie, J. M., Jackson, P. R., Stiteler, J. M. and Hockmeyer, W. T. (1985) Identification of pathogenic Leishmania promastigotes by DNA-DNA hybridization with kineto-plast DNA cloned into E. coli plasmids. Am. J. trop. Med. Hyg. 34, 257–265.CrossRefGoogle ScholarPubMed
Lightner, L. K., Chulay, J. D. and Bryceson, A. D. M. (1983) Comparison of microscopy and culture in the detection of Leishmania donovani from splenic aspirates. Am. J. trop. Med. Hyg. 32, 296–299.CrossRefGoogle ScholarPubMed
Manson-Bahr, P. E. C. and Heisch, R. B. (1956) Studies in leishmaniasis in East Africa. III. Clinical features and treatment. Trans. R. Soc. trop. Med. Hyg. 50, 465–471.CrossRefGoogle Scholar
Manson-Bahr, P. E. C. (1959) East African kala-azar with special reference to the pathology, prophylaxis and treatment. Trans. R. Soc. trop. Med. Hyg. 53, 123–137.CrossRefGoogle Scholar
Manson-Bahr, P. E. C., Southgate, B. A. and Harvey, A. E. C. (1963) Development of kala-azar in man after inoculation with a Leishmania from a Kenyan sandfly. Br. med. J. 1, 1208–1210.CrossRefGoogle Scholar
Marr, J. J. and Berens, R. L. (1977) Antileishmanial effect of allopurinol. II. Relationship of adenine metabolism in Leishmania species to the action of allopurinol. J. infect. Dis. 136, 724–732.CrossRefGoogle Scholar
Rees, P. H., Keating, M. I., Kager, P. A. and Hockmeyer, W. T. (1980) Renal clearance of pentavalent antimony (sodium stibogluconate). Lancet ii, 226–229.CrossRefGoogle Scholar
Sang, D. K. and Arap Siongok, T. K. (1984) Cadastre Report on Leishmaniasis in Kenya. UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases, WHO, Geneva, Switzerland.Google Scholar
Southgate, B. A. and Oriedo, B. V. E. (1962) Studies in the epidemiology of East Africa leishmaniasis. 1. The circumstantial epidemiology of kala-azar in the Kitui District of Kenya. Trans. R. Soc. trop. Med. Hyg. 56, 30–47.CrossRefGoogle ScholarPubMed
Tobias, R. L. (1941) Two cases of severe agranulocytosis following on kala azar. E. Afr. med. J. 18, 341–344.Google Scholar
Vianna, G. (1912) Sociedade Brasileira de Dermatologia, 4a Sessao Ordinaria. Arch. Brasil Med. 2, 422.Google Scholar
Wijers, D. J. B. (1971) A ten years’ study of kala-azar in Tharaka (Meru District, Kenya). Part II. Relapses. E. Afr. med. J. 48, 551–558.Google Scholar
World Health Organization (1982) Report on the Informal meeting on the Chemotherapy of Visceral Leishmaniasis. UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. TDR/CHEMLEISH/VL/82.3.Google Scholar
World Health Organization (1984) The Leishmaniases. Technical Report Series 701, World Health Organization, Geneva, Switzerland.Google Scholar