A Killing Disease Epidemic Among Displaced Sudanese Population Identified as Visceral Leishmaniasis.

Hdl Handle:
http://hdl.handle.net/10144/17669
Title:
A Killing Disease Epidemic Among Displaced Sudanese Population Identified as Visceral Leishmaniasis.
Authors:
de Beer, P; el Harith, A; Deng, L; Semiao-Santos, S J; Chantal, B; van Grootheest, M
Journal:
The American Journal of Tropical Medicine and Hygiene
Abstract:
A fatal disease epidemic affected the Bentiu area in southern Sudan and led to a mass migration of the Nuer tribe searching for treatment. The initially available information revealed a high mortality rate due to a possible occurrence of tuberculosis, malaria, enteric fever or visceral leishmaniasis (VL). Serological screening of 53 of the most severely affected patients in an enzyme-linked immunosorbent assay (ELISA) or an improved direct agglutination test (DAT) revealed positivity for VL. In 39 of those patients, diagnosis was confirmed by identification of Leishmania donovani amastigotes in lymph node or bone-marrow aspirates. In a total of 2714 patients observed, 1195 (44.0%) had clinical symptoms suggesting VL: DAT positive titers (1:3200-greater than or equal to 1:12800) were obtained in 654 (24.1%), of whom 325 were confirmed parasitologically. Forty-two VL cases died before or during treatment, giving a mortality rate of 6.4%. Among the intercurrent infections diagnosed in the VL population (654), respiratory involvements (31.7%) and malaria (10.7%) were most prevalent. With the exception of four (0.6%), all other VL patients (509) responded readily to sodium stibogluconate. The factors initiating the outbreak are discussed. Malnutrition and nomadic movements to potential VL endemic areas appeared to be the most important. HIV infection as a possible predisposition seemed remote considering the clinical and epidemiological similarity to VL occurring in East Africa, adequate humoral response in DAT, and immediate positive response to specific anti-Leishmania chemotherapy.
Affiliation:
Medecins Sans-Frontieres-Holland, Amersterdam, The Netherlands.
Publisher:
Published by: American Society of Tropical Medicine and Hygiene
Issue Date:
Mar-1991
URI:
http://hdl.handle.net/10144/17669
PubMed ID:
1852133
Additional Links:
http://www.ajtmh.org
Language:
en
ISSN:
0002-9637
Appears in Collections:
Leishmaniasis/Kala Azar

Full metadata record

DC FieldValue Language
dc.contributor.authorde Beer, P-
dc.contributor.authorel Harith, A-
dc.contributor.authorDeng, L-
dc.contributor.authorSemiao-Santos, S J-
dc.contributor.authorChantal, B-
dc.contributor.authorvan Grootheest, M-
dc.date.accessioned2008-02-07T11:55:17Z-
dc.date.available2008-02-07T11:55:17Z-
dc.date.issued1991-03-
dc.identifier.citationA Killing Disease Epidemic Among Displaced Sudanese Population Identified as Visceral Leishmaniasis. 1991, 44 (3):283-9 Am. J. Trop. Med. Hyg.en
dc.identifier.issn0002-9637-
dc.identifier.pmid1852133-
dc.identifier.urihttp://hdl.handle.net/10144/17669-
dc.description.abstractA fatal disease epidemic affected the Bentiu area in southern Sudan and led to a mass migration of the Nuer tribe searching for treatment. The initially available information revealed a high mortality rate due to a possible occurrence of tuberculosis, malaria, enteric fever or visceral leishmaniasis (VL). Serological screening of 53 of the most severely affected patients in an enzyme-linked immunosorbent assay (ELISA) or an improved direct agglutination test (DAT) revealed positivity for VL. In 39 of those patients, diagnosis was confirmed by identification of Leishmania donovani amastigotes in lymph node or bone-marrow aspirates. In a total of 2714 patients observed, 1195 (44.0%) had clinical symptoms suggesting VL: DAT positive titers (1:3200-greater than or equal to 1:12800) were obtained in 654 (24.1%), of whom 325 were confirmed parasitologically. Forty-two VL cases died before or during treatment, giving a mortality rate of 6.4%. Among the intercurrent infections diagnosed in the VL population (654), respiratory involvements (31.7%) and malaria (10.7%) were most prevalent. With the exception of four (0.6%), all other VL patients (509) responded readily to sodium stibogluconate. The factors initiating the outbreak are discussed. Malnutrition and nomadic movements to potential VL endemic areas appeared to be the most important. HIV infection as a possible predisposition seemed remote considering the clinical and epidemiological similarity to VL occurring in East Africa, adequate humoral response in DAT, and immediate positive response to specific anti-Leishmania chemotherapy.en
dc.language.isoenen
dc.publisherPublished by: American Society of Tropical Medicine and Hygiene-
dc.relation.urlhttp://www.ajtmh.org-
dc.rightsArchived on this site with the kind permission of the American Society of Tropical Medicine and Hygiene, www.astmh.orgen
dc.subject.meshAdolescenten
dc.subject.meshAdulten
dc.subject.meshAge Factorsen
dc.subject.meshAgglutination Testsen
dc.subject.meshAntimony Sodium Gluconateen
dc.subject.meshChilden
dc.subject.meshDisease Outbreaksen
dc.subject.meshEnzyme-Linked Immunosorbent Assayen
dc.subject.meshFemaleen
dc.subject.meshHumansen
dc.subject.meshIncidenceen
dc.subject.meshLeishmaniasis, Visceralen
dc.subject.meshMaleen
dc.subject.meshPrevalenceen
dc.subject.meshSex Factorsen
dc.subject.meshSudanen
dc.titleA Killing Disease Epidemic Among Displaced Sudanese Population Identified as Visceral Leishmaniasis.en
dc.contributor.departmentMedecins Sans-Frontieres-Holland, Amersterdam, The Netherlands.en
dc.identifier.journalThe American Journal of Tropical Medicine and Hygieneen

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