Thakur C P
Balaji Utthan Sansthan, Patna, India.
Indian J Med Res. 2007 Nov;126(5):447-51.
BACKGROUND & OBJECTIVE: Bihar State of India has been an endemic State for kala-azar. There has been many phases of DDT sprays for vector control. An outbreak of kala-azar occurred in Goanpura, 6 km from Patna, Bihar, in 2003. We undertook this study with a new approach of kala-azar elimination in this village with priority to treatment of cases followed by supplementation with supervised DDT spray for vector control.
This study included a camp approach to collect patients at in the camp, screening of patients with rK-39, transporting the patients to the hospital of Balaji Utthan Sansthan, Patna, Bihar, confirming the diagnosis by demonstration of Leishman-Donovan (LD) bodies in splenic aspirates after proper clinical and pathological investigations, and treatment with amphotericin B (Fungizone) at a dose of 1mg/kg body wt for 20 days. If parasites persisted after 20 days, five more infusions were given. The State Government was persuaded to do supervised DDT spray as per the guidelines. All patients were followed up for 6 months for any relapse, and the village of Goanpura for 3 years for occurrence of any new case.
A camp was held in that village on September 11, 2003 after due publicity. A total of 368 patients having different ailments, attended the camp; 25 patients were screened with rk-39 for kala-azar and 21 patients gave positive results. All 21 patients were shifted to Balaji Utthan Sansthan for treatment. After thorough clinical examination and pathological tests splenic aspiration was done. All 21 patients were positive for LD bodies. One patient died and the remaining 20 completed full course of treatment and were cured. No patients relapsed within six months of follow up. Two rounds of supervised DDT spray were done. No new case occurred in the village during three years of follow up. No sandfly was detected in the village during the years of follow up.
INTERPRETATION & CONCLUSION: Camp strategy to collect patients at one place, screening of patients with rk-39, transporting rk-39 positive patients to the hospital, treatment with an effective drug amphotericin B with no incidence of unresponsiveness and relapsed minimized transmission of the disease; only two rounds of supervised intensive spray of DDT eliminated sandflies from the village. This new cost effective approach in which treatment of patients was done with an effective drug followed by supervised DDT spray may be adopted for elimination of kala-azar from Bihar.
印度比哈尔邦一直是黑热病的地方性流行邦。为控制病媒已进行过多个阶段的滴滴涕喷洒。2003年，在距比哈尔邦巴特那6公里的戈安普拉爆发了黑热病。我们采用一种新方法在这个村庄消除黑热病，优先治疗病例，随后辅以有监督的滴滴涕喷洒以控制病媒。
本研究采用设营方式在营地收集患者，用rK - 39筛查患者，将患者转运至比哈尔邦巴特那的巴拉吉乌坦桑斯坦医院，经适当临床和病理检查后通过脾穿刺抽吸物中利杜体的检测确诊，并用两性霉素B（两性霉素）以1mg/kg体重的剂量治疗20天。如果20天后寄生虫仍存在，则再进行5次输注。说服邦政府按照指南进行有监督的滴滴涕喷洒。对所有患者随访6个月以观察是否复发，对戈安普拉村随访3年以观察是否有新病例出现。
在进行适当宣传后，于2003年9月11日在那个村庄设立了营地。共有368名患有不同疾病的患者参加了营地；用rk - 39对25名患者进行黑热病筛查，21名患者结果呈阳性。所有21名患者被转至巴拉吉乌坦桑斯坦医院进行治疗。经过全面临床检查和病理检测后进行了脾穿刺抽吸。所有21名患者利杜体检测均为阳性。1名患者死亡，其余20名患者完成了全程治疗并治愈。随访6个月内无患者复发。进行了两轮有监督的滴滴涕喷洒。随访3年期间该村庄未出现新病例。随访期间该村庄未检测到白蛉。
在一个地方收集患者的设营策略，用rk - 39筛查患者，将rk - 39阳性患者转运至医院，用有效药物两性霉素B治疗且无无反应和复发情况，使疾病传播最小化；仅两轮有监督的滴滴涕强化喷洒就使村庄中的白蛉绝迹。这种先用有效药物治疗患者然后进行有监督的滴滴涕喷洒的新的成本效益高的方法，可用于在比哈尔邦消除黑热病。
