Report of Two Cases of Kala-azar Disease and its Epidemiology in Iran

This article deals with the case histories of two Kala-azar patients treated in ward 3 of the No. 4 Social Insurance children's Hospital in Tehran.  Full details of the disease and treatment have been reported : The First Case was a 4 years old female frcm Abadan. Symptoms preeent on admission were: paleness, fever, weight-loss, shivering, hepatosplenomegaly, oedema and tachycardia. Initial examination showed Leishma.n - Donovan bodies in the bone marrow. The pati­ent was then treated as explained later on in this article. The treatment was unsucceseful and the patient died 12 days after in a state of shock and secondary heart failure. Autopsy revealed mas­sive parasitic invasion in various organs especi­ally in the R.E.S.  The Second Case was a 7 years old male from Abadan. Symptoms on admission were: paleness, fever, weight-loss and splenomegaly to such an extent that the lower edge of the spleen was extended to the pubis region.  Microscopic examination revealed presence of L-D bodies in the bone marrow and the 1spleen. T"vo treatment courses with Glucantime were administered each course took 14 days with an intervai of 2 weeks. After commencement of the treatment the patient showed signs of improvement, the splen­omegaly was considerably reduced and after the first course of treatment reached the naval re­gion; and within 6 months gained its normal size. Kala-azar observed in Iran is of the Medi­terranean variety, cases have been reported from all provinces specially in the South, the main carrier of the disease is Phlebotomus major, the actual hosts are wild carnivores. Recently, however, Leishmanias have been found in reptiles in both Khorassan and Manjil Regions. As the detection of Kala-azar cases in Iran is increasing, attention should be given to the differential manifestations of the disease.  This is particularly neces·sary as very simi­lar symptoms are shown by some infectious. diseases, e.g. typhoid fever, brucellosis; parasi­tic diseases, e.g. malaria and especially blood disorders, such as Leukemia, aplasia of bone marrow and haemolytic aneamia. the treatment of the disease with penta­valent antimonials has produced very satisfac­tory results. Considerable attention should be given to the patients from the management of aneamia, nuritional disorders, etc.