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. 2014 Jan;90(1):33-39.
doi: 10.4269/ajtmh.13-0150. Epub 2013 Nov 11.

Clinical epidemiology, diagnosis and treatment of visceral leishmaniasis in the Pokot endemic area of Uganda and Kenya

Clinical epidemiology, diagnosis and treatment of visceral leishmaniasis in the Pokot endemic area of Uganda and Kenya

Yolanda K Mueller et al. Am J Trop Med Hyg. 2014 Jan.

Abstract

Between 2000 and 2010, Médecins Sans Frontières diagnosed and treated 4,831 patients with visceral leishmaniasis (VL) in the Pokot region straddling the border between Uganda and Kenya. A retrospective analysis of routinely collected clinical data showed no marked seasonal or annual fluctuations. Males between 5 and 14 years of age were the most affected group. Marked splenomegaly and anemia were striking features. An rK39 antigen-based rapid diagnostic test was evaluated and found sufficiently accurate to replace the direct agglutination test and spleen aspiration as the first-line diagnostic procedure. The case-fatality rate with sodium stibogluconate as first-line treatment was low. The VL relapses were rare and often diagnosed more than 6 months post-treatment. Post-kala-azar dermal leishmaniasis was rare but likely to be underdiagnosed. The epidemiological and clinical features of VL in the Pokot area differed markedly from VL in Sudan, the main endemic focus in Africa.

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Figures

Figure 1.
Figure 1.
(Top) Admissions for primary visceral leishmaniasis to Amudat and Kacheliba Treatment Centers, Pokot area, Uganda and Kenya. (Bottom) Monthly admissions, by year, from January 2000 to December 2010.
Figure 2.
Figure 2.
Map of number of primary visceral leishmaniasis cases treated between 2000 and 2010 in Amudat and Kacheliba Treatment Centers, per village of residence. (a total of 4,216 cases with Global Positioning System [GPS] locations out of 4,582 cases; 137 cases from Baringo District are outside the map area).
Figure 3.
Figure 3.
Diagnostic algorithm of visceral leishmaniasis used by Médecins Sans Frontières since March 2005 at Amudat and Kacheliba Treatment Centers, Pokot area, Uganda and Kenya.

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