Abstract
We describe cases of visceral leishmaniasis (VL) from new endemic area in White Nile State on the west bank of the White Nile River in the central region of the Sudan. This area was not considered previously as endemic of visceral leishmaniasis apart from sporadic cases described in 1988. In total, 132 patients between 2- 14 years old from 5 villages presented with prolonged fever and!or spleenomegaly were diagnosed as visceral leishmaniasis based on finding the parasite from bone marrow aspirate (leishmania donovani (LD) bodies). Later direct agglutination test (DAT) and enzyme-linked immunosorbent assay (ELISA) performed to all patients. In 80 of the patients in whom lymphadenopathy is marked aspiration from lymph nodes also performed. The reported incidence rate was 17.6 % (n= 750). Of the 132 patients, 93.1 % had splenomegaly, 91.6% suffer prolonged fever, 81.8% with hepatomegaly, 74.2% with generalized lymphoadenopathy, 27.2% suffer of bleeding tendency, 17.4% had jaundice, 1.5% reported with post kala-azar dermal leishmaniasis (PKDL) and only 0.7% showed eye complications and mucocutanous lesions. Median hemoglobin (Hb) for the studied patients was 7.2 grams/dl and median weight was below normal (- 2.30 SD). DAT was positive in 91.6%, ELISA positive in 94.6% and only 16 (20%) patients (n=80) the parasite isolated from lymph nodes aspirate. Most of the patients 85.6% responded to sodium stibogluconate. In 6% sodium stibogluconate stopped due to toxic effects. In 8.3% of patients, there was resistance to sodium stibogluconate and was treated with liposomal amphotericin B. Four (3%) of the patients died, in 3 of them there was jaundice, bleeding and evidence of liver impairment. One death reported as sudden and may be due to toxic effect of the chemotherapy. More epidemiological implementations are discussed in this study.