ABSTRACT
A recently developed nitrocellulose-based dipstick test, rK39, has been widely used for the diagnosis of kala-azar. In this study, we evaluated its use for the diagnosis of post kala-azar dermal leishmaniasis (PKDL). We also investigated the time taken by patients to develop PKDL after apparent cure of kala-azar (visceral leishmaniasis, VL) and the time taken by patients to come to the hospital after the appearance of symptoms of PKDL. A majority of patients developed the disease within three years after the apparent cure of kala-azar (KA). A majority of patients sought treatment within five years after the onset of PKDL. The amastigotes of Leishmania donovani bodies (LDBs) were demonstrated in 70, 20, and 20% of slit-skin smears (SSS) prepared, respectively, from nodular, papular, and macular forms. The presence of highest density (6+) LDBs in the SSS of 20% of nodular PKDL patients indicated that they may have acted as reservoir in the community. Other reservoirs are not known in Nepal. Only 8% cases were detected by aldehyde test. Although this test is obsolete it is still used in rural parts of Nepal. The dipstick (rK39) was 96% sensitive and 100% specific to diagnose PKDL. Its positive predictive value, negative predictive value, and diagnostic efficacy were 100, 91, and 97% respectively. Due to the advantage of cost compared with the direct agglutination test (DAT), and being easy to use and store in field conditions, rK39 is a good tool to diagnose PKDL in rural situations. All the PKDL patients were cured of the disease after treatment by SAG.
Subject(s)
Agglutination Tests , Animals , Antibodies, Protozoan/blood , Antigens, Protozoan/blood , Humans , Leishmania donovani/immunology , Leishmaniasis, Cutaneous/diagnosis , Leishmaniasis, Visceral/complications , Nepal , Protozoan Proteins/blood , Serologic Tests/methodsABSTRACT
Post kala-azar dermal leishmaniasis (PKDL) is a non-ulcerative lesion of the skin caused by Leishmania donovani, which is usually seen after completion of treatment of the kala-azar. The condition is yet to be reported from Nepal. We document and report for the first time a case of PKDL in Nepal.
Subject(s)
Adult , Female , Humans , Leishmaniasis, Cutaneous/etiology , Leishmaniasis, Visceral/complications , NepalABSTRACT
Post-kala-azar dermal leishmaniasis (PKDL) is condition characterized by non-ulcerative lesions of the skin caused by Leishmania donovani that is usually seen after the completion of treatment of kala-azar (visceral leishmaniasis). We document the first case report of PKDL in Nepal.
Subject(s)
Adult , Antimony Sodium Gluconate/therapeutic use , Antiprotozoal Agents/therapeutic use , Female , Humans , Leishmaniasis, Cutaneous/drug therapy , Leishmaniasis, Visceral/complications , NepalABSTRACT
We report a case of exclusive involvement of lymph node in leishmaniasis presenting as generalized lymphadenopathy. The diagnosis of lymphatic leishmaniasis was confirmed by the presence of Leishmania donovani body in fine needle aspiration cytology, positive direct agglutination test and anti-rK39 antibodies. The bone marrow aspiration was negative for Leishmania donovani body. This is the first case of lymphatic leishmaniasis reported from Nepal.
Subject(s)
Adult , Animals , Female , Humans , Leishmania donovani/isolation & purification , Leishmaniasis, Visceral/diagnosis , Lymphatic Diseases/parasitology , NepalABSTRACT
Twenty-seven cases of Kala-azar were treated with sodium stibogluconate at a dose of 20 mg/kg/day for 20 days (group A) and an equal number of cases were treated with the same dose but for a longer duration of 30 days (group B). Clinical and laboratory evaluation of these cases were carried out before and after therapy, during a follow up of cases every month, upto 6 months. Renal and liver function tests and electrocardiography were carried out of monitor any toxic effect of the drug during therapy. The cure rates of patients were 77.78% and 92.59% in group A and B cases respectively. Six and two patients in group A and B respectively were unresponsive to the treatment and showed relapse. Results of the study show that treatment of cases of Kala-azar with sodium stibogluconate in a dosage of 20 mg/kg/day for a longer period of 30 days is effective with a higher cure rate and minimum side effects, for treatment of cases of Kala-azar in this eastern part of Nepal, endemic for the disease.
Subject(s)
Adolescent , Adult , Antimony Sodium Gluconate/administration & dosage , Antiprotozoal Agents/administration & dosage , Child , Female , Humans , Leishmaniasis, Visceral/drug therapy , Male , Middle Aged , NepalABSTRACT
Phase behaviour and some physicochemical properties of cholesteryl benzoate-contained microemulsions of xylene and heptane with water using sodium deoxycholate and butan-1-ol as surfactant and co-surfactant respectively have been studied. While the microemulsion area of xylene depends insignificantly on the surfactant/co-surfactant ratio, that of heptane shows appreciable dependence. At surfactant + co-surfactant percentage of 50 or above, both the systems become oil continuous. With respect to time and temperature, the microemulsion systems have been found to be very stable. At low percentage of water, the xylene system is considerably viscous; that of heptane is less viscous but shows viscosity maximum at 45% water. Cholesterol in xylene has given greater viscosity than cholesteryl benzoate. The equivalent conductance of both the systems increase with increasing water content and the values are comparable. Unlike normal electrolyte solutions, the products of equivalent conductance and viscosity (the Walden product) sharply rise with increased water content, which suggests a special mechanism of conduction via 'channel' formation. The overall rigidity of the microemulsions is suggested by their lower specific volumes and compressibilities at all compositions. The excess specific volumes and excess compressibilities at different percentages of water are presented.