Thakur C P
Trans R Soc Trop Med Hyg. 1984;78(3):391-8. doi: 10.1016/0035-9203(84)90131-7.
This epidemic of kala-azar in Bihar, India, started from a small block and gradually spread to almost all of North Bihar. Vaishali was the district most affected, with the highest incidence rate of 5.9 per thousand in 1978. The epidemic spread more to the east than to the west. In 1977 there were 100,000 cases of kala-azar in Bihar and in Vaishali district the death rate was 28.7% of affected cases. It took five years to control the epidemic. 750 parasitologically confirmed cases of kala-azar were studied. The male:female ratio was 5.5:1. 63.4% of cases were aged 10 to 29 years. Clinical features were classical. Sodium stibogluconate, used as a first line drug, was effective in 92.6% of cases. By increasing the course of antimonial therapy from 10 to 20 days the relapse rate was reduced to 0.5% compared with 15% in the previous epidemic. Kala-azar patients who also had tuberculosis were treated with the antimonial and antituberculosis drugs concurrently and all cases recovered. 86 cases unresponsive to sodium stibogluconate were given pentamidine, which was effective in 93.4%. Side effects with sodium stibogluconate were minimal, but were common and serious with pentamidine. The need for a safer drug effective in cases which do not respond to antimony was very evident. 20 cases of post kala-azar dermal leishmaniasis (PKDL) were reviewed: two had no previous previous history of kala-azar. The relapse rate was higher in PKDL than in kala-azar.
印度比哈尔邦的黑热病疫情始于一个小街区，随后逐渐蔓延至北比哈尔邦的几乎所有地区。瓦伊沙利是受影响最严重的地区，1978年发病率高达千分之五点九。疫情向东蔓延的范围比向西更广。1977年，比哈尔邦有10万例黑热病病例，在瓦伊沙利地区，受影响病例的死亡率为28.7%。控制疫情花了五年时间。对750例经寄生虫学确诊的黑热病病例进行了研究。男女比例为5.5:1。63.4%的病例年龄在10至29岁之间。临床特征典型。作为一线药物使用的葡萄糖酸锑钠，在92.6%的病例中有效。通过将锑剂治疗疗程从10天增加到20天，复发率降至0.5%，而之前疫情中的复发率为15%。同时患有结核病的黑热病患者接受了锑剂和抗结核药物联合治疗，所有病例均康复。86例对葡萄糖酸锑钠无反应的病例使用了喷他脒，有效率为93.4%。葡萄糖酸锑钠的副作用极小，但喷他脒的副作用常见且严重。显然需要一种在对锑无反应的病例中有效的更安全药物。对20例黑热病后皮肤利什曼病（PKDL）病例进行了回顾：其中两例既往无黑热病病史。PKDL的复发率高于黑热病。
