Clinical and laboratory study of Kala-azar in children in Nepal

Abstract

Reports are scanty regarding kala-azar in children in Nepal. In this communication we document 20 children diagnosed to have kala-azar who were admitted and treated at B. P. Koirala Institute of Health Sciences, Dharan, Nepal. The children were between 2 and 14 years old. The duration of illness varied between 12 days and 24 months with a majority (65 per cent) of children being ill for less than 6 months. Hepatomegaly and splenomegaly were seen in 95 and 90 per cent of cases respectively. Splenomegaly was not found in two (10 per cent) children. Anaemia, leucopenia, and thrombocytopenia were seen in 95, 60, and 75 per cent of children respectively. Amastigotes of Leishmania donovani (LD bodies) were demonstrated in Giemsa-stained smears of bone marrow aspirates in 16 (80 per cent) children. All the children responded to treatment with sodium stibogluconate. No mortality was observed. This study emphasizes the importance of kala-azar in children in endemic areas of eastern Nepal.

Hematological profile in visceral leishmaniasis

“…Positive findings like pallor, splenomegaly, hepatomegaly were observed but less common than to the Dash S et al 7 and Hamid GA et al 18 Visceral leishmaniasis should be strongly suspected in patients with unexplained fever, being longer than 2 weeks, pallor, splenomegaly, hepatomegly and potential exposure in an endemic area or from areas from where On complete blood count (CBC), the majority of patients had anemia, leucopenia, and thrombocytopenia (90%, 67.5% and 72.5%, respectively) followed by neutropenia (27.5%), and lymphocytosis (65%). Similar finding were observed by various authors such as Dash S et al 7 , Singh K et al, 12 and Petrela R et al 20 series have reported a normocytic normochromic anemia in peripheral smear examination. 11,13,14 In this study we observed normocytic normochromic and anisocytosis hypochromic in equal frequency (35%) followed by anisopoikilocytosis hypochromia (20%), normocytic hypochromia (5%) and anisopoikilocytosis normochromic (2.5%).…”

“…The majority of cases of kala azar seen in our study were from Eastern Nepal such as Morang, Sunsari and Saptari. Similar study was done by Singh K et al 12 The condition affects the poorest of the poor section of people residing in this part of Nepal. Concentrated cases lie nearby to BPKIHS which is not an accidental finding as BPKIHS is only the treatment centre in Eastern reagion hence cases from Eastern district are least likely to be missed.…”

“…It is the second largest parasitic killer in the world after malaria. 5 A large number of patients are referred for diagnosis and treatment in B. P Koirala institute of Health Sciences (BPKIHS), Dharan a referral tertiary teaching hospital located in the Eastern part of Nepal. When the patient has not come from a known endemic area, the clinical picture can confuses with a number of conditions that occur more commonly and without the suspicion of kala azar.…”

“…More than 5.5 million people are estimated to be at risk of the disease and presently 12 districts in Southern plains of terai region in Nepal-boarding the state of Bihar-and few more district showing sporadic cases 12. Socio-demographic characteristics of Kala-azar patients admitted at BPKIHS district showing sporadic cases 12.…”

Visceral leishmaniasis in Omani children: a review

“…3 In the Indian form, caused by L. d. donovanum, man appears to be the main reservoir and the incidence is high in children aged 5-10 years and young adults. 4 In Oman, most cases of kala-azar come from the mountainous or rural areas in the east. Between 1972 and 1977, 61 cases of visceral leishmaniasis were diagnosed on histological demonstration of amastigotes in bone marrow and, between 1978 and 1998, 240 patients were reported nationally.…”