It is important to realize that leishmaniasis guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. The IDSA and ASTMH consider adherence to these guidelines to be voluntary, with the ultimate determinations regarding their application to be made by the physician in the light of each patient's individual circumstances.

Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)

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Diagnosis and Treatment of Leishmaniasis: Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA) and the American Society of Tropical Medicine and Hygiene (ASTMH)*

Sitamaquine (WR6026) is an 8-aminoquinoline in development for the oral treatment of visceral leishmaniasis (VL). This was an open-label, dose-increasing study to determine the dose-response and safety profile for sitamaquine in Kenyan patients with VL caused by Leishmania donovani. Patients (mean age 15.9 [range = 5-47] years) received sitamaquine daily for 28 days at one of four doses: 1.75 (n = 12), 2.0 (n = 61), 2.5 (n = 12), or 3.0 (n = 12) mg/kg/day. The primary efficacy outcome was cure (absence of parasites on splenic aspirate) in the intent-to-treat population at day 180. Cure was achieved in 79 (83%) of 95 patients overall, and in 11 (92%) of 12, 49 (80%) of 61, 9 (82%) of 11, and 10 (91%) of 11 patients at sitamaquine doses of 1.75, 2.0, 2.5, or 3.0 mg/kg/day, respectively. The most frequent adverse events during active treatment were abdominal pain (12 [12%] of 97) and headache (11 [11%] of 97), and one patient in each of the 2.5 mg/kg/day and 3.0 mg/kg/day dose groups had a severe renal adverse event. The effects of sitamaquine on the kidney need further investigation. Sitamaquine was efficacious and generally well tolerated in Kenyan patients with VL.

A phase ii dose-increasing study of sitamaquine for the treatment of visceral leishmaniasis in kenya

The collection and use of timely and reliable health information in support of health policies and programmes have been actively promoted by the World Health Organization since its foundation. Valid health statistics are required at all levels of the health system, ranging from data for health services support at the local community level, through to national statistics and information used to monitor the effectiveness of national health strategies. Equally, regional and global data are required to monitor global epidemics and to continuously assess the effectiveness of global public health approaches to disease and injury prevention and control, as coordinated by WHO technical programmes. Despite the clear need for epidemiological data, reliable and comprehensive health statistics are not available in many Member states of WHO, and, indeed, in many countries the ascertainment of disease levels, patterns and trends is still very uncertain.

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The Global epidemiology of infectious diseases

OBJECTIVES To identify characteristics that increased the risk of mortality in Ethiopian visceral leishmaniasis patients in a treatment programme managed by Medecins sans Frontieres, in Tigray, Northern Ethiopia. METHODS Retrospective review of a cohort of 791 patients treated for visceral leishmaniasis. RESULTS The cohort displayed all the classical signs and symptoms of the disease. The case fatality rate was 18.5% (146) (95% CI: 15.8-21.3%). Logistic regression showed that individuals who experienced at least one episode of vomiting or haemorrhage were more likely to die than those who did not. A subcohort of individuals who tested human immunodeficiency virus (HIV)-positive were more than four times more likely to die than those who tested HIV-negative (OR 4.5, 95% CI: 1.8-11.4). CONCLUSION This study identifies characteristics associated with death in this population and highlights the devastating effect of co-infection with visceral leishmaniasis and HIV in the African context.

https://onlinelibrary.wiley.com/doi/pdf/10.1046/j.1365-3156.2003.01088.x

Visceral leishmaniasis and HIV in Tigray, Ethiopia.

The clinical and laboratory features, and the response to treatment of visceral leishmaniasis were studied in 18 hospitalized patients. Clinical and laboratory findings were similar to those in patients with kala-azar in the Sudan and East Africa. Fever, heptosplenomegaly, relative lymphocytosis, leukopenia, low platelet counts, and severe anemia were common findings. Pentostam (sodium stibogluconate) was used to treat 17 patients and Neostibosam (ethylstibamine) for one. Three patients died. Four out of the 18 patients had not visited any known endemic area but the significance of this finding has not been fully evaluated.

Clinical and laboratory features and treatment of visceral leishmaniasis in hospitalized patients in Northwestern Ethiopia.

A house-to-house survey was carried out to determine the prevalence of poliomyelitis. During the survey 37,219 households were visited and 17,941 children 5–9 years old were found. Of 231 lame children, lameness compatible with paralytic poliomyelitis was found in 131, of these 91% had their condition before the age of 3 years. Nineteen percent ndeded a stick support for walking while 12% were unable to walk even with support. This problem was more common in rural populations. The prevalence of paralytic poliomyelitis was 7.3/1,000 children 5–9 years old.

Mallede Maru

Papers

Clinical and laboratory features and treatment of visceral leishmaniasis in hospitalized patients in Northwestern Ethiopia.

Prevalence of paralytic poliomyelitis in rural and urban populations in Ethiopia: report of a house-to-house survey.