Studies on the leishmaniases in the Sudan. 3. Clinical and parasitological studies on visceral and mucosal leishmaniasis.

The epidemiological, clinical and laboratory findings of 27 patients with visceral leishmaniasis (VL) and six with mucosal leishmaniasis (ML) in Sudan are described. The diagnosis was confirmed by the demonstration of amastigotes in bone-marrow in 20 cases with VL (80%) and impression smears in 2 cases with ML. The enzyme-linked immunosorbent assay and direct agglutination test were positive in all the sera tested. The leishmanin test was positive in all patients with ML, the diameter of the reaction ranging from 18 to 28 mm (mean 23 mm). Only one isolate (from a patient with VL) grew sufficiently well in culture to be typed and this was characterized by isoenzyme electrophoresis as Leishmania donovani zymodeme LON-46. The possibility that the ML isolate could have been L. major zymodeme LON-1 is discussed. The importance of further research to isolate and identify by biochemical procedures a more representative range of isolates of Leishmania from different clinical types in the Sudan, in order to elucidate questions such as the relationship between the vectors and possible animal reservoirs, is emphasized.