Showing papers on "Visceral leishmaniasis published in 1986"
TL;DR: During an epidemiological study of visceral leishmaniasis in an endemic region of Brazil, new perspectives emerged on a subclinical form of the disease, where a group of 86 children with antibody to Leishmania were identified.
Abstract: During an epidemiological study of visceral leishmaniasis in an endemic region of Brazil, new perspectives emerged on a subclinical form of the disease. A group of 86 children with antibody to Leishmania were identified. None of these children had a history of leishmaniasis. The children were segregated into four groups: One group remained asymptomatic (n = 20), whereas another developed classic kala-azar within weeks of the index serology (n = 15). The remaining 51 patients initially had subclinical disease; 13 (25%) of these patients progressed to classic kala-azar (mean, five months). The others (75%) resolved their illness after a prolonged period (mean, 35 months). The initial illness in the subclinical group was characterized by hepatomegaly, frequent splenomegaly, intermittent cough, diarrhea, and low-grade fever. Malaise and poor weight gain were common. Giemsa-stained smears and cultures of bone marrow aspirates were usually negative for Leishmania in the absence of symptoms of classic kala-azar.
487 citations
TL;DR: Only patients with kala-azar (visceral leishmaniasis) and malaria were found to have a strikingly increased frequency of raised TNF levels, suggesting that this cytokine may play a part in host defences against parasitic infections.
471 citations
TL;DR: The epidemiology, clinical patterns, and risk factors for visceral leishmaniasis were prospectively studied in an endemic area of Brazil and found that early diagnosis and therapy altered clinical patterns of the disease.
Abstract: The epidemiology, clinical patterns, and risk factors for visceral leishmaniasis were prospectively studied in an endemic area of Brazil. The prevalence of disease was 3.1% for children less than 15 years of age, and the annual incidence was 4.3 cases per 1,000 children. The number of children with disease fluctuated yearly and seasonally, and distribution of the disease varied within the endemic area. Risk factors included young age (median, three years) and malnutrition before the onset of disease. Intestinal parasitism, recent migration into the area, and house location within the area did not influence the progression of infection to disease. Serological testing indicated that 7.5% of children were infected with Leishmania each year and that the ratio of disease to infection was 1:18.5 for the whole area and 1:6.5 for the section with the highest prevalence of disease. Early diagnosis and therapy altered clinical patterns of the disease.
349 citations
TL;DR: A simple and economical direct agglutination test for the detection of visceral leishmaniasis is described and could be used in district hospitals and health centres in endemic areas as an aid in diagnosis of kala-azar and in the field for sero-epidemiological studies.
Abstract: A simple and economical direct agglutination test for the detection of visceral leishmaniasis is described. Trypsin-treated, Coomassie Brilliant Blue-stained, formalin-preserved promastigotes were used as antigen in re-usable V-well microtitre plates. In 21 patients with recent kala-azar, titres of 1:51200 or higher were found. Cured kala-azar patients treated 4 to 14 months before testing, showed titres in the range of 1:3,200 to greater than 1:51,200. Healthy and diseased controls had titres below 1:1,600 with the exception of African trypanosomiasis patients who showed titres of 1:200 to 1:12,800, overlapping with the titres of cured kala-azar patients. Where trypanosomiasis is not a consideration, a titre of 1:1,600 could be considered indicative of visceral leishmaniasis, the sensitivity and specificity were then 100%. The test was applied to sera of 280 inhabitants of Baringo District, a known focus of visceral leishmaniasis in Kenya. When treated cases were included, the test showed a sensitivity of 100% and specificity of 99.3%. This test could be used in district hospitals and health centres in endemic areas as an aid in diagnosis of kala-azar and in the field for sero-epidemiological studies.
247 citations
TL;DR: It is found that positive delayed hypersensitivity response to a soluble Leishmania extract is a sensitive and specific indicator of previous infection with AVL.
Abstract: Studies were designed to examine skin test responses to leishmanial antigens in American visceral leishmaniasis (AVL) in Brazil. We found that after recovery from AVL, patients had positive delayed hypersensitivity reactions to Leishmania. Different amounts of a soluble extract obtained from Leishmania donovani chagasi promastigotes were compared with whole L. d. chagasi promastigotes in persons with past AVL. The most effective soluble preparations tested contained 25 and 50 micrograms leishmanial protein. These produced positive responses in 95%-100% of the individuals with past AVL. The 25 micrograms protein dose was used in further studies. This preparation produced no positive responses in either normal controls, tuberculosis patients, or schistosomiasis patients, and less than 5% positive responses in persons with Chagas' disease. The same amount of soluble extract prepared from L. mexicana amazonensis produced 82% positive skin test responses in persons with past AVL. When persons living in an area endemic for AVL were skin tested with the 25 micrograms preparation of L. d. chagasi extract, 34.1% yielded positive tests with a low number of positive responses in young children and 48% positive in adults. Only 3.1% of the population studied had a history of AVL. We have found that positive delayed hypersensitivity response to a soluble Leishmania extract is a sensitive and specific indicator of previous infection with AVL.
165 citations
TL;DR: It is suggested that ELISA can be a very convenient, sensitive, and specific test for diagnosis of AVL when soluble antigen, preferably from an isolate from the test area, is used.
Abstract: This study was designed to evaluate the ELISA for diagnosis of American visceral leishmaniasis (AVL) using antigen prepared from different Leishmania isolates and from a strain of Trypanosoma cruzi. Two Leishmania donovani chagasi isolates from Bahia and Maranhao (both states of northern Brazil), one L. donovani from Sudan, one L. mexicana amazonensis isolate, and one T. cruzi isolate were used. A total of 375 sera were tested, including 119 from AVL patients, 96 from nonleishmaniasis hospitalized patients, 20 from healthy persons, 30 from patients with mucocutaneous leishmaniasis, 28 from patients with Chagas' disease, 20 from patients with tuberculosis, 21 from leprosy patients, 27 from schistosomiasis patients and 14 from patients with systemic mycoses. The antigens prepared from L. d. chagasi (Bahia) and L. m. amazonensis showed the highest sensitivity (98% and 99%, respectively) for detecting antibodies in sera from AVL patients. However, the specificity of L. d. chagasi (Bahia) antigen was better than that of L. m. amazonensis (96% vs. 86%). Comparison among the three L. donovani isolates demonstrated that the antigen prepared with the isolate from the same area where the sera originated yielded higher mean absorbance than the others. By using spectrophotometric absorbance values it was possible to use a single dilution of serum (between 1/100–1/400) since a clear separation was seen between AVL patients and controls. No patients with the other diseases who were tested gave positive results.
We suggest that ELISA can be a very convenient, sensitive, and specific test for diagnosis of AVL when soluble antigen, preferably from an isolate from the test area, is used.
129 citations
TL;DR: The distribution of canine leishmaniasis and figures on infection frequency in countries bordering the Mediterranean Sea are given and the methods of investigation and control of canine Leishmania infantum are discussed.
Abstract: The distribution of canine leishmaniasis and figures on infection frequency in countries bordering the Mediterranean Sea are given. The clinical picture and most common laboratory findings are reviewed. Leishmania infantum is the aetiological agent of both human and canine forms of visceral leishmaniasis. The proved or suspected vectors of L. infantum are listed and mention is made of wild animals (fox, rat) as possible primary reservoirs of the parasite. Finally, the methods of investigation and control of canine leishmaniasis are discussed.
111 citations
TL;DR: It is hypothesized that undernutrition is associated with the development of clinically apparent visceral leishmaniasis and that the disease itself has a profound effect on nutritional status, resulting in loss of both muscle and fat, effects that possibly are mediated by interleukin-1 and/or other factors produced by Leishmania donovani-infected macrophages.
Abstract: Little is known about the interrelationship between undernutrition and parasitic infections in areas of the world where both are prevalent. The associations between undernutrition and visceral leishmaniasis, an important protozoal disease, were assessed in a study of residents of an area in Brazil with endemic leishmaniasis. Mid-arm anthropometry was used to assess fat and muscle area. Children with visceral leishmaniasis came from large families (9.6 +/- 1.1 members vs. 6.8 +/- 0.7 members in neighborhood control families), and patient housemates had fat areas that were 78% (P less than .05) those of age- and sex-matched neighborhood controls. The children with visceral leishmaniasis who were studied four months or less after diagnosis had fat areas that were 66% (P less than .05) those of age- and sex-matched household controls or 41% (P less than .01) those of neighborhood controls and muscle areas that were 81% (P less than .025) those of household controls or 75% (P less than .05) those of of neighborhood controls. It is hypothesized, on the basis of these data and other findings, that undernutrition is associated with the development of clinically apparent visceral leishmaniasis and that the disease itself has a profound effect on nutritional status, resulting in loss of both muscle and fat, effects that possibly are mediated by interleukin-1 and/or other factors produced by Leishmania donovani-infected macrophages.
99 citations
TL;DR: The demonstration that apparently nontoxic human dosages of L-AmB eliminate essentially all hepatosplenic parasites in hamster and primate models suggests that this preparation should be considered for clinical trial against kala-azar.
Abstract: Visceral leishmaniasis (kala-azar) results from parasitization of the macrophages of the liver, spleen, and the rest of the visceral reticuloendothelial system with Leishmania donovani. Pentavalent antimony is the drug of choice for leishmaniasis chemotherapy; amphotericin B (AmB) is active but is rarely used, because of drug toxicity. AmB encapsulated within macrophage-directed carriers (liposomes) has been used to treat humans with systemic mycoses complicating neoplastic diseases; dosages of up to 5 mg of encapsulated AmB per kg per day for greater than 14 days are without apparent kidney or liver toxicity. In the present work, greater than 99% of L. donovani parasites were eliminated from the liver and spleen of infected hamsters by one administration of 1.5 to 11 mg of liposome-encapsulated AmB (L-Amb) per kg. A total of 98 to 99% of hepatosplenic parasites were eliminated from squirrel monkeys by three administrations of 4 mg of L-AmB per kg. L-AmB was 170 to 750 times as active as antimony in hamsters, and approximately 60 times as active as antimony in monkeys. The demonstration that apparently nontoxic human dosages of L-AmB eliminate essentially all hepatosplenic parasites in hamster and primate models suggests that this preparation should be considered for clinical trial against kala-azar.
96 citations
TL;DR: Leishmania were isolated from bone marrow aspirate material from a typical visceral leishmaniasis patient and characterized by isoenzyme electrophoresis and a panel of species- and subspecies-specific monoclonal antibodies established its classification as L. m.
Abstract: The first documented human case of visceral leishmaniasis caused by L mexicana amazonensis is reported Leishmania were isolated from bone marrow aspirate material from a typical visceral leishmaniasis patient Further characterization by isoenzyme electrophoresis and by a panel of species- and subspecies-specific monoclonal antibodies established its classification as L m amazonensis
76 citations
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TL;DR: The distribution of positive dogs in the island showed to be non-uniform, the frequencies of infection ranging from 2.5% to 39.6% according to communes, and the causes of this distribution and its relationship with the human visceral leishmaniasis cases are discussed.
Abstract: The recent occurrence of infantile cases of visceral leishmaniasis in the Isle of Elba, Italy, has stimulated research on the prevalence of Leishmania infection in dogs. Out of 3,000 dogs present in the island 914 were examined through immunofluorescent antibody test (IFAT) and 175 of them (19.1%) were found positive. 100% parasitological confirmation through isolation of parasite was obtained in a sample of 38 IFAT-positive dogs. The distribution of positive dogs in the island showed to be non-uniform, the frequencies of infection ranging from 2.5% to 39.6% according to communes. The causes of this distribution and its relationship with the human visceral leishmaniasis cases are discussed.
TL;DR: L.d. chagasi seems to be the first well documented case in the New World of a "viscerotropic" Leishmania inducing a case of cutaneous leishmaniasis.
Abstract: L.d. chagasi was isolated from active cutaneous leishmaniasis in both human and canine infections in an endemic area in Rio de Janeiro, Brazil. Both isolates were identified by molecular and immunological characterization of the parasite using three different methods: electrophoretic mobility of isoenzymes; restriction endonuclease fragment analysis of kDNA and serodeme analysis using monoclonal antibodies. This seems to be the first well documented case in the New World of a "viscerotropic" Leishmania inducing a case of cutaneous leishmaniasis. This observation emphasizes that the diagnosis of the etiologic agent of human or canine visceral leishmaniasis based solely upon clinical and epidemiological critwria may lead to erroneous conclusions.
TL;DR: Serum inhibited lymphocyte proliferation of patients' peripheral blood mononuclear cells when stimulated by either phytohemagglutinin, Concanavalin A or pokeweed mitogen, and the effect of the serum was not due to cytotoxicity, inadequate nutritional support or altered kinetics of DNA synthesis.
Abstract: We examined the effect of sera from 11 patients with American visceral leishmaniasis on mitogen-driven lymphocyte proliferative capacity. All sera inhibited lymphocyte proliferation of patients' peripheral blood mononuclear cells (PBMC) when stimulated by either phytohemagglutinin, Concanavalin A or pokeweed mitogen. Serum was also strongly inhibitory for Concanavalin A-pulsed normal volunteers' PMBC. The effect of the serum was not due to cytotoxicity, inadequate nutritional support or altered kinetics of DNA synthesis. High levels of IgM or IgG (both total and antiparasite) and high levels of triglycerides were found in patients' sera.
TL;DR: The mechanism of a transfusion-dependent anaemia found in a two-year-old Maltese girl with visceral leishmaniasis that was resistant to multiple courses of antimonial therapy was studied, suggesting that reticuloendothelial hyperplasia was accompanied by abnormal iron retention by macrophages typical of the 'anaemia of chronic disorders'.
Abstract: We have studied the mechanism of a transfusion-dependent anaemia found in a two-year-old Maltese girl with visceral leishmaniasis that was resistant to multiple courses of antimonial therapy. Major factors contributing to the anaemia were haemolysis occurring in both the massively enlarged spleen and liver and haemodilution resulting from expansion of the plasma volume. There was no evidence of significant ineffective erythropoiesis, but a reduced plasma iron in the presence of greatly increased iron stores suggested that reticuloendothelial hyperplasia was accompanied by abnormal iron retention by macrophages typical of the 'anaemia of chronic disorders'. This may limit the erythropoietic response to anaemia in chronic visceral leishmaniasis.
TL;DR: The owl monkey was highly susceptible to L. donovani infection and should be a useful animal model for the study of visceral leishmaniasis.
Abstract: Visceral leishmaniasis developed in eight owl monkeys (Aotus trivirgatus) after intravenous inoculation with a Khartoum strain (WR378) of Leishmania donovani. Six monkeys died within 93 days, and two monkeys recovered from the disease. Clinically, signs were weight loss, anemia, and hepatosplenomegaly. Hematologic findings included anemia, granulocytopenia, thrombocytopenia, and lymphocytosis. Analysis of serum or plasma revealed hyperbilirubinemia, azotemia, hyperglobulinemia, hypoalbuminemia, and altered hemostasis. All monkeys developed positive antibody titers to promastigotes of L. donovani and had increases in immunoglobulins M and subsequently G. Liver, spleen, bone marrow, and lymph nodes were the principal organs containing numerous parasitized macrophages. The owl monkey was highly susceptible to L. donovani infection and should be a useful animal model for the study of visceral leishmaniasis.
TL;DR: In this article, the vectorial capacity of wild-caught Phlebotomus pedifer by feeding them on volunteer patients were carried out inside one of the caves of Mt Elgon.
Abstract: Investigations into the vectorial capacity of wild caught Phlebotomus pedifer by feeding them on volunteer patients were carried out inside one of the caves of Mt Elgon. Female P. pedifer were fed on lesions of cutaneous leishmaniasis patients to determine the route of infection and infection rates in the flies and hence their vectorial capacity. The flies were kept for periods of 3–8 and 9–13 days before dissections were carried out. The results indicate that the longer period (9–13 days) yielded a higher infection rate. All parasite isolations from flies which were injected subcutaneously caused cutaneous lesions in the nose of the experimental hamsters. All infections were concentrated in the anterior stations of the gut of the experimental sandfly species P. pedifer.
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TL;DR: The co-operation of monocytes, T cells and B cells was required in order to obtain maximal stimulation and the importance of polyclonal B-cell activation for the genesis and occurrence of autoantibodies in visceral leishmaniasis is discussed.
Abstract: Fifteen sera of patients with visceral leishmaniasis were investigated for the occurrence of autoantibodies. They were found in high incidence and titre, and with specificity to the intermediate filament (INFIL) proteins vimentin (12 out of 15 with a titre higher than 1:10) and keratin (9 out of 15 with a titre higher than 1:10) as well as to speckled anti-nuclear antigens (ANA). Additionally, supernatants of Leishmania major and Leishmania donovani cultures containing soluble parasite-derived antigens were mitogenic to cultures of mononuclear cells (MNC) obtained from healthy donors without specific antibodies to leishmanial antigens. The activation of MNC resulted in significant immunoglobulin production, some of which demonstrated autoantibody specificity to INFIL. The co-operation of monocytes, T cells and B cells was required in order to obtain maximal stimulation. The importance of polyclonal B-cell activation for the genesis and occurrence of autoantibodies in visceral leishmaniasis is discussed.
TL;DR: The outcome of leishmanial infection of macrophages in vitro varies not only with the parasite stage, species, and strain but also with the tissue source and culture condition of the host cell.
Abstract: Publisher Summary This chapter describes various Leishmania –macrophage in vitro systems and their applications. The trypanosomatid protozoa of the genus Leishmania cause leishmaniases. The clinical manifestations of leishmaniases often vary with the individual hosts and with the leishmanial species involved. The diseases may be manifested as self-healing simple cutaneous lesions, disseminating cutaneous nodules, facial disfiguring mucocutaneous infection, and the potentially fatal visceral form. Most species of Leishmania can be passaged as amastigotes in laboratory animals. Leishmania mexicana amazonensis cause simple cutaneous, diffuse cutaneous, or, on rare occasion, the mucocutaneous leishmaniasis of humans in South and Central America. The species Leishmania donovani is the agent of kala azar or human visceral leishmaniasis. Amastigotes are isolated from spleens of animals infected 6–8 weeks previously. Hamsters are anesthetized and exsanguinated before splenectomy. Promastigotes have also been used after one or two passages into fresh growth medium, minimal essential medium (MEM), at 7 to 10 day intervals. The outcome of leishmanial infection of macrophages in vitro varies not only with the parasite stage, species, and strain but also with the tissue source and culture condition of the host cell.
TL;DR: Three types of lung involvement due to visceral leishmaniasis were characterized; a cellular, a cellular-fibrotic and a fibrotic type that seem to represent a sequential evolutive proce'as.
Abstract: Forty-one naturally infected dogs with visceral leishmaniasis from an urban area of Corumba (Mato Grosso do Sul-BRAZIL) were studied and three types of lung involvement due to visceral leishmaniasis were characterized; a cellular, a cellular-fibrotic and a fibrotic type. These types seem to represent a sequential evolutive proce'as. Visceral leishmaniasis frequently causes an interstitial pneu monitis in naturally infected dogs (80.5%) as well as in man and experimentally infected hamsters.
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TL;DR: It is suggested that the pathogenesis of anaemia in American visceral leishmaniasis is multifactorial and the IgG may be a component of Leishmania antigens-anti-Leishmania immune complexes.
Abstract: IgG molecules were found associated with erythrocyte membranes in all patients with American visceral leishmaniasis. They were detected by two different immunoradiometric assays and by one enzyme-linked immunosorbent assay. Although autoimmune phenomena seem to be constant features of American visceral leishmaniasis, the erythrocyte-bound IgG are not erythrocyte-specific autoantibodies. Moreover, anti-Leishmania activity was found associated with the erythrocyte-bound IgG, indicating that the IgG may be a component of Leishmania antigens-anti-Leishmania immune complexes. No associations were found between the amounts of erythrocyte-bound IgG and the degree of anaemia or between spleen dimensions and the degree of anaemia. These findings suggest that the pathogenesis of anaemia in American visceral leishmaniasis is multifactorial.
TL;DR: The susceptibility of four East African primate species to experimental infection with Leishmania donovani was investigated and the significance of hepatic histiocytic nodules in the infected primates, similar to those observed in asymptomatic human visceral leishmaniasis, and the susceptibility of Old World primates are discussed.
Abstract: The susceptibility of four East African primate species to experimental infection with Leishmania donovani was investigated. Vervet monkeys (Cercopithecus aethiops), Sykes monkeys (C. mitis) and baboons (Papio cynocephalus) all supported low grade infections for periods ranging between four and eight months and subsequently showed evidence of self-cure. Greater bushbabies (Galago crassicaudatus) remained completely refractory throughout the course of the experiment. The significance of hepatic histiocytic nodules in the infected primates, similar to those observed in asymptomatic human visceral leishmaniasis, and the susceptibility of Old World primates to experimental infection are discussed.
TL;DR: The dot ELISA proved to be economical with respect to use of reagents and was easy to perform, and its most remarkable feature was the high specificity compared with that of the IgG ELISA.
Abstract: A dot enzyme-linked immunosorbent assay (dot ELISA) was evaluated and compared with a standard microplate ELISA (immunoglobulin G [IgG] ELISA) for the serological diagnosis of mucocutaneous leishmaniasis. The two assays were used to test 113 serum specimens from the following groups: normal individuals and patients with deep mycoses, toxoplasmosis, mucocutaneous leishmaniasis, visceral leishmaniasis, Chagas' disease, malaria, and schistosomiasis. Both tests exhibited cross-reactivity when testing specimens from cases of visceral leishmaniasis and Chagas' disease. The dot ELISA proved to be economical with respect to use of reagents and was easy to perform. Interpretation could easily be made by visual inspection of reaction endpoints in the nitrocellulose disks, obviating the need for spectrophotometric readings. There were no significant differences in sensitivity between the dot ELISA and the IgG ELISA at a cutoff level either of 20 or 40. However, its most remarkable feature was the high specificity compared with that of the IgG ELISA. Because of its ease of performance and high sensitivity and specificity, the dot ELISA should be an excellent test to be executed in the field during seroepidemiological surveys.
TL;DR: During epidemiological studies on an outbreak of visceral leishmaniasis in Santarém, Pará State, north Brazil, isolates of Leishmania from two children, three dogs and six naturally infected specimens of the sandfly Lutzomyia longipalpis were compared, biochemically, by starch-gel enzyme electrophoresis.
Abstract: During epidemiological studies on an outbreak of visceral leishmaniasis in Santarem, Para State, north Brazil, isolates of Leishmania from two children, three dogs and six naturally infected specimens of the sandfly Lutzomyia longipalpis were compared, biochemically, by starch-gel enzyme electrophoresis. They have proved to be indistinguishable from each other, and from a reference strain of Leishmania chagasi Cunha & Chagas, 1937 from a case of human visceral leishmaniasis from Bahia State, north-east Brazil, on their enzyme profiles for ASAT, ALAT, PGM, GPI, MDH and MPI. Lu. longipalpis is the principal, and possibly the only vector to man in the Amazon Region of Brazil.
TL;DR: Results suggest that a single injection of a preparation consisting of ghosts of a patient's own red cells and the amount of pentamidine in one standard dosage would eliminate 80%-100% of L. donovani from the spleen and liver.
Abstract: A recent approach to the chemotherapy of visceral leishmaniasis has been the encapsulation of clinical agents within macrophage directed carriers such as liposomes. Because in mammals Leishmania are obligate intramacrophage microorganisms, injection of an encapsulated drug should deliver large quantities of drug to the organisms, thus decreasing both the number of drug administrations needed for cure and drug toxicity. Drugs contained within red cell ghosts have been used clinically to treat other macrophage disorders. We encapsulated the clinical antileishmanial agent pentamidine within human red cell ghosts and administered it to hamsters infected with Leishmania donovani. The ED50 and ED90 of single injections of this preparation were 231-240 times lower than that of the positive control drug, sodium stibogluconate (Pentostam), and essentially all parasites could be eliminated by 2.5 mg encapsulated drugs/kg. Against splenic parasites, the ED50 was 195 times lower than that of antimony, although only 80% of parasites were eliminated by the highest doses of encapsulated drug (2.5-6.4 mg/kg). The difference in liver vs. splenic parasite killing is probably related to the greater uptake of encapsulated drug by the liver (11-14 micrograms/g tissue) vs. the spleen (2-3 micrograms/g). If activity in this model is comparable to activity in humans, these results suggest that a single injection of a preparation consisting of ghosts of a patient's own red cells and the amount of pentamidine in one standard dosage (4 mg/kg) would eliminate 80%-100% of L. donovani from the spleen and liver.
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TL;DR: Nine out of these fourteen cases of Visceral Leishmaniasis, all children below 8 years of age, were diagnosed at Rawalpindi from March 1983 to September 1985, came from Azad Kashmir, a hitherto unreported endemic area.
Abstract: Fourteen cases of Visceral Leishmaniasis, all children below 8 years of age, were diagnosed at Rawalpindi from March 1983 to September 1985. Nine out of these fourteen cases came from Azad Kashmir, a hitherto unreported endemic area. All the cases were severly toxic with irregular fever, anaemia and hepatosplenomegaly. The diagnosis in each case was made by bone marrow examination. Some of these cases were treated with sodium stibogluconate with satisfactory response (JPMA 36: 230, 1986).
TL;DR: Visceral leishmaniasis is the most important of the three in eastern Africa, not only because it is fatal but also because several epidemics have occurred periodically since the disease appeared in the country about 40 years ago resulting in many deaths.
Abstract: Three types of human leishmaniases are known to occur in Kenya: visceral leishmaniasis, caused by Leishmania donovani, and cutaneous leishmaniasis caused by L. aethiopica and L. major. Visceral leishmaniasis is the most important of the three in eastern Africa, not only because it is fatal but also because several epidemics have occurred periodically since the disease appeared in the country about 40 years ago resulting in many deaths. L. aethiopica and L. major are chiefly zoonotic and people contract the disease when they wander into areas containing animal reservoirs and infected vectors. Control measures were undertaken against vectors and reservoirs during an epidemic outbreak of kala-azar in Machakos District.