Sensitivity of splenic and bone marrow aspirate study for diagnosis of kala-azar.

Fifty adult patients of kala-azar were included in this prospective study from Medicine Unit-I of Mymensingh Medical College Hospital. Splenic and bone marrow aspiration were done simultaneously to compare the sensitivity and other related merits and demerits of each procedure. Splenic aspiration appeared to be more sensitive procedure than bone marrow aspiration. Leishman - Donovan (LD) bodies were found in 90 percent and 72 percent of the spleen and bone marrow aspirates respectively. Splenic aspiration was found more acceptable to patients (96%) as it was less painful. Both the procedures were hazardless. There was no major complication except mild pain after splenic aspiration; even a few patients had history of epistaxis. Splenic aspiration was also more acceptable by the physicians because of an easy and reliable diagnostic procedure.

Immunochromatographic (rK39) strip test in the diagnosis of visceral leishmaniasis in Bangladesh.

Immunochromatographic strip test (ICT strip test) for the diagnosis of visceral leishmaniasis was evaluated in this study in the context of a case-control study. A total sixty consecutive cases of kala-azar admitted in all four Medicine Units of Mymensingh Medical College Hospital during the period of May 2002 to February 2003 was included here. Parasitological confirmation was done by demonstration of leishmania donovani bodies in bone marrow or splenic aspiration in all cases. A total 120 controls was taken of which sixty were asymptomatic endemic controls with no previous history of kala-azar and sixty were admitted patients suffering from diseases other than kala-azar (malaria, tuberculosis, enteric fever and chronic liver disease). ICT strip test for kala-azar was done in all cases and controls. Only 2 of the confirmed kala-azar cases were negative and the remaining 58 cases were positive for ICT strip test which gives the sensitivity of this test 96.6%. Among the controls, 118 were negative for ICT strip test and two of the asymptomatic controls were positive for this test with no clinical evidence of kala-azar. So, the estimated specificity of ICT strip test is 98.3%. The predictive value for a negative result was 98.3% and for a positive result was 96.6%. The ICT strip test is easy, quick, requires no technical facilities with higher sensitivity and specificity entails it to be the ideal test for the diagnosis of kala-azar in field level.

Hairy cell leukaemia with advanced treatment - a case report.

A case of hairy cell leukaemia (HCL), a rare leukaemia, is reported here. The patient was presented with high grade continuous fever with left upper abdominal discomfort for 6 days. He was moderately anaemic, had no peripheral lymphadenopathy with mild hepatosplenomegaly. He was anaemic (Hb-7.8 gm/dl), total leukocyte count was 20 x 109/L. Peripheral blood film showed lymphocytosis (92%) with neutropenia (8%) and absolute neutophil count (ANC) was 1 x 109/L. On review, 88% of the peripheral cells had peripheral hairy projections resembling hairy cell (HC). Bone marrow examination was consistent with HCL (morrow hairy cell = 52%) including marker studies. Tartrate resistant acid phosphatase test (TRAP) was also positive. He had opportunistic mycobecterial infection giving a positive bronchial lavage for acid fast bacilli. After controlling the infection he was advised a single dose chemotherapy of 2-chlorodeoxyadenosine (2-CDA). After that he was in partial remission and after 25 months clinical and pathological relapses occurred and a second dose of 2-CDA was given and the patient went into complete remission.

Clinical profile of Kala-azar in adults: as seen in Mymensingh Medical College Hospital, Mymensingh, Bangladesh.

A total of eighty-one consecutive cases of Kala-azar admitted in all four medicine units of Mymensingh Medical College Hospital during the period from January 2002 to mid August 2002 were included in this study. The number of the patients clearly indicates that the burden of Kala-azar in this region is significant and expanding, which constituted 1.90% of total admission in all 4 medicine units during this period. Majority of the patients were of 20-29 years of age. Male to female ratio was 1.38:1. Maximum number of the patients were of poor socio-economic group with history of housing made up of mud and having close proximity with cattle house. Fever and splenomegaly (100%) were the predominant features. Hepatomegaly was found in 91.36% of the cases. Other clinical manifestations were weight loss (79.01%), normal or increased appetite (65.43%), generalized weakness (72.84%), pallor (69.13%), cough (25.92%), jaundice (17.28%), abdominal Pain (12.34%), hyperpigmentation (9.88%), ascites (4.94%) and bleeding manifestations (4.94%). Notable concomitant illnesses were urinary tract infection (7.40%), pulmonary tuberculosis (3.70%), malaria (1.23%), scabies (4.94%), heart failure (3.70%) and chronic liver disease (2.47%). Due to wide diversity of clinical presentations, clinical features of kala-azar should be evaluated in details which will pave the hidden cases into light.