Since 1990, South Asia has experienced a resurgence of kala-azar (visceral leishmaniasis). To determine risk factors for kala-azar, we performed cross-sectional surveys over a 3-year period in a Bangladeshi community. By history, active case detection, and serologic screening, 155 of 2,356 residents had kala-azar with onset from 2000 to 2003. Risk was highest for persons 3–45 years of age, and no significant difference by sex was seen. In age-adjusted multivariable models, 3 factors were identified: proximity to a previous kala-azar patient (odds ratio [OR] 25.4, 95% confidence interval [CI] 15–44 within household; OR 3.2 95% CI 1.7–6.1 within 50 m), bed net use in summer (OR 0.7, 95% CI 0.53–0.93), and cattle per 1,000 m2 (OR 0.8, 95% CI 0.70–0.94]). No difference was seen by income, education, or occupation; land ownership or other assets; housing materials and condition; or keeping goats or chickens inside bedrooms. Our data confirm strong clustering and suggest that insecticide-treated nets could be effective in preventing kala-azar.
We examined the epidemiology of kala-azar and asymptomatic leishmanial infection measured by serologic and leishmanin skin test results in a Bangladeshi community. In a subset, we measured serum retinol, zinc and C-reactive protein (CRP). Kala-azar and seroconversion incidence were 15.6 and 63.1 per 1,000 person-years, respectively. Proximity to a previous kala-azar case increased the likelihood of both kala-azar and asymptomatic infection. Bed net use protected against kala-azar (rate ratio = 0.35, P < 0.01), but not subclinical infection (rate ratio = 1.1, P = 0.82). Kala-azar patients were younger (P < 0.001) and reported lower red meat consumption (P < 0.01) than asymptomatic seropositive individuals. Retinol and zinc levels were lower in current kala-azar patients and those who later developed kala-azar compared with uninfected and asymptomatically infected subjects. The CRP levels were higher in kala-azar patients compared with the other two groups. Low red meat intake and poor zinc and retinol status may characterize a group at higher risk of symptomatic disease.
The clinical features, pathology, immune responses, diagnosis and treatment of post kala-azar dermal leishmaniasis (PKDL) in the Sudan are described and discussed. The disease is characterized by maculopapular or nodular lesions on the face, limbs or trunk. Lesions appear during or within months after the treatment of visceral leishmaniasis, but in 2 of 19 patients there was no previous history of kala-azar. PKDL may be confused with leprosy both clinically and pathologically. Similarities and differences between the 2 diseases are discussed. Unlike visceral leishmaniasis, the peripheral lymphoid cells of patients with PKDL respond to Leishmania antigen and some are leishmanin positive. The response to intravenous sodium stibogluconate (20 mg/kg for 30 d) was reasonably good but some patients required repeated or more prolonged treatment. Ketoconazole in a dose of 10 mg/kg daily for 4 weeks had no effect on PKDL.
Abstract. Visceral leishmaniasis, or kala azar (KA), affects the rural poor, causing significant morbidity and mortality. We examined the epidemiologic, social, and economic impact of KA in a village in Bangladesh. A populationbased survey among 2,348 people demonstrated a KA incidence of 2% per year from 2000 to 2002, with a case-fatality rate of 19% among adult women, compared with 6−8% among other demographic groups. Kala azar cases were geographically clustered in certain sections of the village. Anti-leishmanial drug shortages and the high cost of diagnosis and treatment caused substantial emotional and economic hardship for affected families. Communities wanted to learn more about KA, and were willing to take collective action to confront the problems it causes. To decrease the KA burden in endemic areas, community efforts should be supplemented with effective treatment programs to ensure access to appropriate and affordable diagnosis and case management.
In order to investigate specific and general adaptation of chickpea in India, a wide range of sub-continental, Australian and Mediterranean genotypes were grown across seven sites characterizing the major chickpea growing areas over 3 years, and extensive data on plant stand, early vigour, phenology, productivity and yield components collected. High and low yielding sites were clearly separated by a range of physical and biological characters, low yield being associated with low latitude and pre-season rainfall, high temperature, early phenology, short crop duration, low biomass and fecundity. Genotype by environment interactions for yield were highly significant (P < 0.001), and accounted for more variance than that attributed to genotypes alone. Ward's hierarchical clustering indicated that the genotypes could be separated into discrete groups, comprising material specifically adapted to the north (Clusters 2 and 3) or south (Cluster 5), widely or consistently poorly adapted germplasm (Clusters 1 and 4, respectively).Cluster 5, comprising germplasm from southern and central India, was characterized by early phenology, confirming the role of drought escape in southern India. With increasing latitude Cluster 5 genotypes remained early, but had the capacity to delay maturity considerably, resulting in average, and occasionally above average yields. However, compared to well-adapted material in the north, Cluster 5 biomass was low, and the time interval between flowering and podding up to 50 days, representing repeated cycles of flowering and subsequent abortion. Clusters 2 and 3, dominated by northern Indian genotypes, were characterized by later phenology, and were able to delay the onset of flowering significantly more than the remaining germplasm at late flowering northern sites. In Cluster 3, the second highest yielding group overall, this increased both source and sink potential at productive northern sites. Cluster 2 was uniformly later than Cluster 3, and lower yielding at most sites. Cluster 1 was characterized by intermediate flowering and relatively early, responsive maturity, a phenological compromise responsible for wide adaptation, by providing sufficient drought escape in the south, and enough biomass in the north to produce above average yields in these contrasting environments. ICCV 10 from the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT), and 2 Indian Agricultural Research Institute (IARI) lines, BG 391 and BG 1006, were the most consistently high yielding, ranking www.elsevier.com/locate/fcr Field Crops Research 98 (2006) 230-244 in the top 10 at 10 and 8 sites, respectively. Cluster 4, comprising largely Australian cultivars, was characterized by late, unresponsive phenology and the lowest yield at each site. Crown
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