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Query: UMLS:C0024530 (malaria)
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Paralysis from poliomyelitis may follow injections yet injections are extremely popular in the Third World. Some injections are given by hospital doctors and nurses but the majority are given by traditional healers, pharmacists and paramedical workers who have acquired syringes. Many injections may be given to a sick child. I suggest that the early use of vaccines did not persuade people of the mystic of injections and that the mystic predated the use of penicillin. The earliest mystical result would have been the injection of quinine for malaria and antrypal for sleeping sickness. The words brilliant, spectacular and dramatic were first used to describe the mass campaigns against yaws and kala-azar in the 1920s and 1930s. A single injection healed the ugly lesions in a week: cause and effect were visible. In the 1950s penicillin was used in mass eradication campaigns. The countries where injections are so popular correspond roughly with the areas of mass eradication programmes. Many or perhaps most of the injections are not sterile and present a great risk of attendant paralysis. Proof that injections are causal may be impossible. Meanwhile we need to know why injections are so popular and how they can be less so.
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PMID:The popularity of injections in the Third World: origins and consequences for poliomyelitis. 651 26

Clinical analysis of 293 cases of cirrhosis from two moderate sized hospitals in the city of Dacca has been presented. Maximum number of cases were in the age group over 40 with 150 (51.2%) males and 19 (5.8%) females. Significant past history included viral hepatitis (21.5%), kala-azar (11.6%) and malaria (10.24%). History of alcoholism was present only in 16 (5.5%) cases. Weakness (84.3%), weight loss (72%) and anorexia (39.3%) constituted the most common symptoms. Ascites (45%), haematemesis (11.6%) and melaena (28.7%) were the next common symptoms. Hepatosplenomegaly was found in about one-third of the cases. Testicular atrophy was recorded in 41.63% cases whereas gynaecomastia was relatively less common (5.5%). Scanty body hair and white nails were present in almost equal number of cases (14.7% and 18%). The cases presented here are those with overt manifestation. Nevertheless, the clinical features are not materially different from those reported by other authors. In the absence of alcoholism, viral hepatitis is presumably the most important aetiological factor in our cases and the clinical features compare favourably with non-alcoholic cirrhosis of the western writers. Cryptogenic cirrhosis has been considered to be most common type constituting 43.7% of our cases.
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PMID:Cirrhosis of liver. 734 4

The relationship between splenomegaly and visceral leishmaniasis (VL) was investigated during a cross-sectional study in 2,941 individuals in Baringo District, Kenya, where both malaria and VL are endemic. Spleen size was correlated with presence of malaria parasites in thick blood films and with evidence of present or past Leishmania donovani infection as determined by serology and history. Marked splenomegaly (Hackett grade 3 or greater) significantly correlated with present or previous leishmanial infection (chi 2 = 53.5; p < 0.001) whereas moderate splenomegaly (Hackett grade 1 or 2) significantly correlated with malaria parasitaemia (chi 2 = 73.03; p < 0.001). The presence of antimalarial antibodies did not contribute to the differentiation of the cause of splenomegaly. The diagnostic significance of splenomegaly in this population is discussed.
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PMID:Splenomegaly in Baringo District, Kenya, an area endemic for visceral leishmaniasis and malaria. 748

Leishmaniasis is a spectrum of diseases ranging in severity from cutaneous (CL), post-kala-azar dermal (PKDL), and diffuse cutaneous (DCL) to mucocutaneous (MCL) and visceral (VL) infections that are endemic in 86 tropical and subtropical countries around the world, accounting for 75,000 deaths per year. Different forms of leishmaniases are generally caused by different distinct species of Leishmania having a digenetic life cycle alternating between an aflagellated amastigote form replicative within the macrophages of the host and a flagellated promastigote form that multiplies within the gut of the sandfly. VL, MCL, PKDL, DCL, and CL forms of the disease can be arranged on a priority basis in accordance with the humoral immune responses of host. Generally, the cell-mediated immunity, particularly the delayed-type hypersensitivity to leishmanial antigens, is associated with CL, MCL, PKDL, and cured VL cases. The serodiagnosis of leishmaniasis appears to be an alternative to parasite detection in biopsy samples either by the staining of amastigotes or by culturing the amastigotes, which transform to a promastigote form and replicate. A battery of immunological procedures have been developed or adapted to demonstrate either humoral or cell-mediated immune responses against Leishmania for diagnosis and epidemiological survey. The sensitivity and specificity of such diagnostic methods depend on the type, source, and purity of antigen employed, as some of the leishmanial antigens have common cross-reactive epitopes shared with other microorganisms, particularly Trypanosoma, Mycobacteria, Plasmodia, and Schistosoma. Serodiagnostic techniques for the detection of antileishmanial antibodies have been employed with about 72 to 100, 23 to 90, 83, and 33 to 100% success in VL, CL, MCL, and PKDL patients, respectively. The Leishmanin skin test (LST) is useful to detect MCL and CL, with about 100 and 84% success, respectively. In PKDL, the gradual fall of antileishmanial antibody titer to some extent and the rise of delayed hypersensitivity to the parasite antigen are the characteristic features associated with the chronicity of the disease. The use of whole promastigote as the source of antigens in the direct agglutination test (DAT) and immunofluorescent test (IFAT) gave cross-reactions with the sera of leprosy, tuberculosis, and African trypanosomiasis patients. Again, the use of cell-free extracts of promastigotes generally gave false positive results with the sera of normal human and Chagas' disease, leprosy, tuberculosis, and malaria patients in enzyme-linked immunosorbent assay (ELISA), dot ELISA, immunodiffusion, immunoelectrophoresis, and counter-current immunoelectrophoresis tests.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Serodiagnosis of leishmaniasis. 763 32

An easy, inexpensive and rapid indirect immunoperoxidase assay for serodiagnosis of Kala-azar (VL) has been tried using whole promastigotes of L. donovani in dried smear form as antigen. A total of 138 sera were tested including sera from parasite positive cases of VL (32), normal controls from endemic (20) and non-endemic (20) areas, cases of tuberculosis (10), leprosy (10), amoebic hepatitis (10), malaria (10) and tropical splenomegaly (26). All the positive control sera were positive in very high dilutions of serum ranging from 1/500 to 1/64,000. None of the sera with other diseases were positive by this method except 3 cases with tropical splenomegaly were positive in low titres. No other cause could be established in these cases for splenomegaly. Sensitivity and specificity of the test were found to be 100 and 95.3% respectively. Predictive values of the negative and positive tests were 100 and 86.5% respectively.
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PMID:An indirect immunoperoxidase assay for rapid serodiagnosis of visceral leishmaniasis. 789 12

In the district of Sahibganj, Bihar, India, there were 23,670 new cases of kala-azar between 1985 and 1990. The Social Development Centre, Dumka, drafted an emergency plan as a solution. 30 village health workers attended a 3-day training course regarding how to administer sodium stibogluconate intramuscularly, spray DDT, conduct door-to-door surveys, and refer affected persons to health centers. Kala-azar awareness programs in the villages imparted information on the treatment and control of the disease explaining that the disease could not be controlled by witch-doctors. DDT was sprayed during January/February and May/June on the inner walls of houses and covered cowsheds in order to eradicate sandfly prevalence. Persons who had had fever for more than 3 weeks underwent examinations for total and differential counts of white blood cells, haemoglobin concentration, aldehyde test, and thick and thin blood smears for the detection of malaria parasites. Treatment consisted of sodium stibogluconate given intramuscularly at 20 mg per kg body weight daily for 20 days in new cases and for 40 days in relapsed patients, with a maximum of 850 mg. Clinical cure was achieved if patients became afebrile and their spleens returned to normal size. If no relapse occurred in 6 months, the patients were regarded as definitively cured. Of the 1640 treated patients, 1592 were cured, and of the 48 patients who relapsed and were treated again with a 40-day course of sodium stibogluconate, 8 relapsed a second time. 44 patients became unresponsive to sodium stibogluconate and were sent to hospitals for treatment. The spraying performed by the village health workers reduced the incidence of kala-azar and malaria in 3 villages, while increased numbers of cases were recorded in 1 village. Remote tribal areas need educative, preventive, and curative programs backed up by mobile hospitals carrying diagnostic and spraying equipment.
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PMID:A kala-azar control programme for remote tribal communities. 794 51

An immunological test based on indirect (plate) ELISA has been successfully standardized and modified using promastigote soluble antigen. The test carried out on 813 subjects from a kala-azar endemic area (including parasitologically confirmed patients, subjects presenting with clinical symptoms of visceral leishmaniasis and endemic controls) and a non-endemic area (with diseases other than kala-azar and apparently normal subjects) was found to detect, specifically, antileishmanial antibodies. The plate ELISA has been simplified to a more sensitive dot-ELISA where the results are read within 2-3 h. The antigen requirement is 250 ng per test. No cross-reactivity with sera from patients of malaria, tuberculosis, leprosy, amoebiasis and filariasis was observed. The follow up monitoring of antibodies in successfully treated kala-azar patients showed a decline of antibodies. A drop of blood taken on filter paper is sufficient to conduct the test. Dot ELISA therefore is a simple, inexpensive and stable test in serodiagnosis of visceral leishmaniasis.
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PMID:Evaluation of enzyme-linked immunosorbent assay in the diagnosis of kala-azar in Malda district (West Bengal). 814 6

The direct agglutination test (DAT) has been assessed as a diagnostic procedure for visceral leishmaniasis. Fifty-six of 58 sera (96.5%) from confirmed cases of visceral leishmaniasis, whose bone marrow aspirates contained Leishmania donovani amastigotes, had agglutinating antibodies above the cut-off titre of 1:800. None of the sera from healthy control subjects from non-endemic or endemic areas had anti-leishmanial antibodies. Similarly, none of the sera obtained from cases of malaria or tuberculosis had agglutinating antibodies above the cut-off titre. A significant decline in agglutinating antibody titre in 3 cases following antileishmanial chemotherapy appeared to correlate with regression of clinical symptoms and the absence of amastigotes from bone marrow aspirates. One of 3 cases developed post-kala-azar dermal lesions and sera from this subject had an elevated agglutinating antibody titre. It is concluded that the DAT is a sensitive and specific test to confirm visceral leishmaniasis. As the formalin-fixed promastigotes, stained with Coomassie blue, which are used as antigen could be stored at 4 degrees C for 6 months without any loss of ability to detect anti-leishmanial antibodies, the DAT is recommended for use under field conditions.
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PMID:Evaluation of the direct agglutination test as an immunodiagnostic tool for kala-azar in India. 823 90

This paper reviews the evidence of a link between flood control and vector-borne disease in Bengal/Bangladesh. Malaria is historically associated with reduced flooding and embankment construction in the flood plains of Bengal. The land west and south of the Jamuna river was highly malarious in 1916 but is not so today. The lands east of the Jamuna now have a higher, though still small, risk. The reduction in health risk can be attributed to the intensification of land use and human population density. Although there are many mosquito species, the abundance of the former malaria vector appears to have declined as environmental change removed its breeding sites. Visceral leishmaniasis (kala-azar) is a serious disease which is fatal if left untreated. It occurs in irregular, periodic epidemics and is currently increasing in Bangladesh. In the past, malaria and kala-azar were confused and the prevalence of both may have been increased by embankment programmes. Both diseases are unstable and there is insufficient historical information to predict, with certainty, the consequences of environmental change. Reduced flooding accompanied by increased pollution will probably control the malaria vector. More information is needed about the response of the kala-azar vector to flooding. Bancroftian filariasis is non-fatal but causes chronic morbidity. It has had a widespread but usually low prevalence in Bangladesh, with both rural and urban foci. There are few recent data. Increasing organic pollution and drainage obstruction are expected to favour the vector and increase transmission.
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PMID:An historical review of malaria, kala-azar and filariasis in Bangladesh in relation to the Flood Action Plan. 825 Jun 23

When infected with Leishmania species, patients develop specific antibodies that constitute the basis of serodiagnosis. using Western blot analysis we studied the specificity of anti-leishmania donovani antibodies in patients with visceral leishmaniasis, healthy subjects living in an endemic and non-endemic areas, and patients of other infectious diseases like malaria, leprosy, tuberculosis and tropical splenomegaly. Sera from patients with kala-azar recognised numerous antigens that had a molecular weight of 150 KD, 145 KD, 120 KD, 92 KD, 87 KD, 72 KD, 65 KD, 56 KD, 50 KD, 40 KD, 26 KD, 21 KD, 14 KD, AND 12 KD. The 150, 145, 120, 92, 87, 81, 65, 25, 21, 14, and 12 KD antigens had the greatest specificity for kala-azar sera while the bands of molecular weights 72, 56, 50, and 40 KD were found to be cross reactive with sera of patients of other diseases.
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PMID:Evaluation of antibody responses in Indian kala-azar by immunoblot. 862 3


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