• Burden of visceral leishmaniasis in villages of eastern gedaref state, Sudan: an exhaustive cross-sectional survey.

      Mueller, Yolanda Kathrin; Nackers, Fabienne; Ahmed, Khalid A; Boelaert, Marleen; Djoumessi, Jean-Claude; Eltigani, Rahma; Gorashi, Himida Ali; Hammam, Omer; Ritmeijer, Koert; Salih, Niven; et al. (2012-11)
      Since December 2009, Médecins Sans Frontières has diagnosed and treated patients with visceral leishmaniasis (VL) in Tabarak Allah Hospital, eastern Gedaref State, one of the main endemic foci of VL in Sudan. A survey was conducted to estimate the VL incidence in villages around Tabarak Allah.
    • Clinical Epidemiology, Diagnosis and Treatment of Visceral Leishmaniasis in the Pokot Endemic Area of Uganda and Kenya

      Mueller, Yolanda K; Kolaczinski, Jan H; Koech, Timothy; Lokwang, Peter; Riongoita, Mark; Velilla, Elena; Brooker, Simon J; Chappuis, François; Epicentre, Paris, France; Faculty of Infectious and Tropical Disease, London School of Hygiene and Tropical Medicine, Keppel Street, London, United Kingdom; Médecins Sans Frontières, Operational Centre, Geneva, Switzerland; Geneva University Hospitals and University of Geneva, Geneva, Switzerland. (2013-11-11)
      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.
    • High mortality among older patients treated with pentavalent antimonials for visceral leishmaniasis in East Africa and rationale for switch to liposomal amphotericin B

      Chappuis, François; Alirol, Emilie; Worku, Dagemlidet T; Mueller, Yolanda; Ritmeijer, Koert; Médecins Sans Frontières, Geneva, Switzerland; Médecins Sans Frontières, Amsterdam, The Netherlands (2010-11-15)
      Visceral leishmaniasis (VL; kala azar), a fatal disease if left untreated, is one of the most neglected tropical diseases....
    • Liposomal amphotericin B as a treatment for human leishmaniasis

      Balasegaram, Manica; Ritmeijer, Koert; Lima, Maria Angeles; Burza, Sakib; Ortiz Genovese, Gemma; Milani, Barbara; Gaspani, Sara; Potet, Julien; Chappuis, François; Drugs for Neglected Diseases Initiative, Geneva, Switzerland;2 Médecins Sans Frontières, Operational Centre Amsterdam, Amsterdam, The Netherlands; Médecins Sans Frontières, Operational Centre Barcelona Athens, Barcelona, Spain; Médecins Sans Frontières, Access Campaign, Paris, France; Médecins Sans Frontières, Operational Centre Geneva, Geneva, Switzerland;Médecins Sans Frontières, Access Campaign, Geneva, Switzerland; University of Geneva, andGeneva University Hospitals, Division of International and Humanitarian Medicine, 6, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland. (Informa, 2012-12-11)
    • Liposomal amphotericin B for complicated visceral leishmaniasis (kala-azar) in eastern Sudan: how effective is treatment for this neglected disease?

      Salih, Niven A; van Griensven, Johan; Chappuis, François; Antierens, Annick; Mumina, Ann; Hammam, Omar; Boulle, Philippa; Alirol, Emilie; Alnour, Mubarak; Elhag, Mousab S; et al. (John Wiley & Sons Ltd, 2014-02)
      The aim of this study was to report the patient profile and treatment outcomes, including relapses, of patients with visceral leishmaniasis (VL) treated with liposomal amphotericin B (AmBisome) in Gedaref, Sudan.
    • Risk factors for in-hospital mortality of visceral leishmaniasis patients in eastern Uganda.

      Mueller, Y; Mbulamberi, Dawson B; Odermatt, Peter; Hoffmann, Axel; Loutan, Louis; Chappuis, François; Médecins Sans Frontières, Geneva, Switzerland. yolanda.muller@geneva.msf.org (2009-08)
      OBJECTIVE: To identify risk factors for in-hospital mortality in patients treated for visceral leishmaniasis (VL) in Uganda. METHODS: Retrospective analysis of VL patients' clinical data collected for project monitoring by Médecins Sans Frontières in Amudat, eastern Uganda. RESULTS: Between 2000 and 2005, of 3483 clinically suspect patients, 53% were confirmed with primary VL. Sixty-two per cent were children <16 years of age with a male/female ratio of 2.2. The overall case-fatality rate during pentavalent antimonial (n = 1641) or conventional amphotericin B treatment (n = 217) was 3.7%. There was no difference in the case-fatality rate between treatment groups (P > 0.20). The main risk factors for in-hospital death identified by a multivariate analysis were age <6 years and >15 years, concomitant tuberculosis or hepatopathy, and drug-related adverse events. The case-fatality rate among patients >45 years of age was strikingly high (29.0%). CONCLUSION: Subgroups of VL patients at higher risk of death during treatment with drugs currently available in Uganda were identified. Less toxic drugs should be evaluated and used in these patients.
    • Validation of Two Rapid Diagnostic Tests for Visceral Leishmaniasis in Kenya

      Mbui, Jane; Wasunna, Monique; Balasegaram, Manica; Laussermayer, Adrian; Juma, Rashid; Njenga, Simon Njoroge; Kirigi, George; Riongoita, Mark; de la Tour, Roberto; van Peteghem, Joke; et al. (Public Library of Science, 2013-09-26)
    • Who Is a Typical Patient with Visceral Leishmaniasis? Characterizing the Demographic and Nutritional Profile of Patients in Brazil, East Africa, and South Asia

      Harhay, Michael O; Olliaro, Piero L; Vaillant, Michel; Chappuis, François; Lima, María Angeles; Ritmeijer, Koert; Costa, Carlos Henrique; Costa, Dorcas Lamounier; Rijal, Suman; Sundar, Shyam; et al. (2011-04-01)
      Abstract. Drug-dosing recommendations for visceral leishmaniasis (VL) treatment are based on the patients' weight or age. A current lack of demographic and anthropometric data on patients hinders (1) the ability of health providers to properly prepare for patient management, (2) an informed drug procurement for disease control, and (3) the design of clinical trials and development of new drug therapies in the different endemic areas. We present information about the age, gender, weight, and height of 29,570 consecutive VL patients presenting to 20 locations in six geographic endemic regions of Brazil, East Africa, Nepal, and India between 1997 and 2009. Our compilation shows substantial heterogeneity in the types of patients seeking care for VL at the clinics within the different locations. This suggests that drug development, procurement, and perhaps even treatment protocols, such as the use of the potentially teratogenic drug miltefosine, may require distinct strategies in these geographic settings.