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PROBLEMS IN MANAGEMENT OF KALA AZAR: EXPERIENCE FROM BIHAR
1Classified Specialist (Medicine and Respiratory Medicine), Army Hospital (R&R) Delhi Cantt -110010.
Medical Journal, Armed Forces India
|July 14, 2016
Summary
This study managed 35 Kala-Azar cases in Bihar, finding sodium stibogluconate (SSG) effective but noting cardiac toxicity. Alternative treatments like pentamidine and amphotericin-B were successful for unresponsive patients.
Area of Science:
- Tropical Medicine
- Infectious Diseases
- Parasitology
Background:
- Kala-Azar, a severe form of leishmaniasis, is endemic in Bihar, India.
- Effective management of Kala-Azar is crucial, especially in peripheral healthcare settings.
- Understanding treatment responses and adverse effects is vital for patient outcomes.
Purpose of the Study:
- To report the management of 35 Kala-Azar cases in a peripheral hospital in Bihar.
- To evaluate the efficacy and safety of sodium stibogluconate (SSG) and alternative treatments.
- To document associated comorbidities in Kala-Azar patients.
Main Methods:
- Retrospective analysis of 35 Kala-Azar cases managed between January 1994 and January 1998.
- Diagnosis confirmed by demonstrating Leishmania amastigotes in bone marrow or splenic aspirates.
- Initial treatment with SSG (20 mg/kg/day for 20-40 days); unresponsive cases treated with pentamidine isethionate or amphotericin-B.
Main Results:
- Sodium stibogluconate (SSG) was the primary treatment, with 6 cases (17%) experiencing cardiac toxicity, including one fatality.
- Nine patients were unresponsive to SSG; 8 were successfully treated with pentamidine isethionate and 1 with amphotericin-B.
- All treated patients showed clinical and parasitological improvement with no relapses at 6-month follow-up.
- Associated conditions included tuberculosis (6 cases), pneumonia (2 cases), HIV infection (1 case), and erythema nodosum leprosum (1 case).
Conclusions:
- Sodium stibogluconate (SSG) is effective for Kala-Azar but carries a risk of cardiac toxicity.
- Pentamidine isethionate and amphotericin-B are viable alternatives for SSG-unresponsive Kala-Azar cases.
- Kala-Azar patients frequently present with significant comorbidities, necessitating comprehensive management strategies.
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