Problems in the treatment of kala-azar: case report
Nyakundi, P.M.; Rashid, J.R.; Wasunna, K.M.; Were, J.B.; Muigai, R.; Kirigi, G.; Mbugua, J.
East African Medical Journal 72(6): 406-408
1995
ISSN/ISBN: 0012-835X PMID: 7498017 Document Number: 454600
The case is reported from Kenya of a 7-year-old boy who presented with a history of fever, weight loss, intermittent headaches and abdominal distension. On examination the patient was afebrile and unjaundiced but had moderate mucosal pallor, tachycardia, was wasted, had cervical lymphadenopathy and a distended non-tender abdomen. Splenic aspirate culture (SAC) was positive for Leishmania donovani promastigotes. The subject was successfully treated intravenously with 20 mg sodium stibogluconate/kg (P20) once daily for 31 days. However, at 2 month follow-up, the patient had a fever and a cough. Bone marrow aspirate had abundant extracellular Kenyan strain L. donovani bodies. After receiving P20 and allopurinol for 38 days initially and then for 11 weeks, the patient had a negative splenic aspirate smear (SASM) and was discharged. At a 4 month follow-up, the patient had positive SASM so P20 and allopurinol were given for 13 weeks. Since fever and parasitaemia persisted, 4 mg pentamidine/kg were given 3 times a week for 15 weeks. A negative SASM followed treatment and the patient was allowed home. At a 6 month follow-up, both SASM and SAC were positive so 10 mg sodium stibogluconate/kg (P10) was given 3 times daily as was 21 mg allopurinol/kg for 13 weeks. No clinical or parasitological response was observed so 4 mg pentamidine isothionate/kg weekly was given for 15 weeks. The patient absconded from hospital with a positive SASM and was readmitted 9 weeks later. At this 8 month follow-up, the subject received P10 and 21 mg allopurinol/kg 3 times daily for 11 weeks. At discharge, the patient had a negative SASM. At a 10 month follow-up his liver was palpable but not his spleen. At both a 16 month and 22 month follow-up, neither the liver nor the spleen were palpable.