PROBLEMS IN MANAGEMENT OF KALA AZAR: EXPERIENCE FROM BIHAR

35 cases of Kala-Azar were managed at 200 bedded peripheral hospital, Bihar from Jan 1994 to Jan 1998. Patients presenting with history of fever for more than 3 weeks duration with splenomegaly or hepatosplenomegaly were investigated for Kala-Azar. A confirmative diagnosis of Kala-Azar was made in all cases by demonstrating Leishmania amastigote (LD body) in bone marrow or splenic aspirate. All patients were initially treated by sodium stibogluconate (SSG) 20 mg/kg body wt daily for 20 to 40 days depending on response. SSG induced cardiac toxicity was seen in 6 cases (VT-2, ST-T changes-2, QTc Prolongation-2) out of which 1 patient died of refractory ventricular tachyacarida. 9 patients were unresponsive to SSG,8 patients were treated with pentamidine isoethionate (4 mg/kg body wt IV alternate day) 10-15 dosage. 1 patient was treated with amphotericin-B. All the patients showed clinical and parasitological improvement and no relapse was noted at 6 month follow up. 6 patients had associated tuberculosis (Disseminated TB-2, Miliary TB-1, Pulmonary TB-1. Pleural TB-2). 2 patients had associated pneumonia, 1 patient had HIV infection and 1 patient had erythema nodosum leperosum.