title: A neglected disease of humans: a new focus of visceral leishmaniasis in Bakool, Somalia.
abstract: Visceral leishmaniasis (VL) was observed in children in Bakool region, Somalia, an area where VL has not been reported before. We describe the extent of the problem in this war- and famine-stricken area. A retrospective analysis was done of all cases admitted to a VL treatment centre between July 2000 and August 2001. Patients with longstanding fever, splenomegaly and a positive direct agglutination test (DAT; titre > 1:3200) were treated as suspected VL cases. A rapid epidemiological and entomological assessment was performed in the area. Species identification was attempted from blood samples by polymerase chain reaction-restriction fragment length polymorphism analysis of cysteine proteinase B genes. In 1 year, 230 serologically-positive cases were diagnosed as VL, and response to therapy was good in 91.6% of the 225 treated with sodium stibogluconate. Parasitological confirmation was attempted and obtained in 2 cases. Parasites were found to be most similar to Sudanese and Ethiopian reference strains of the Leishmania donovani complex. In a serological survey of 161 healthy displaced persons, 15% were positive by the leishmanin skin test and 3 (2%) were positive by the DAT. The sandfly captures showed Phlebotomus martini and P. vansomerenae. VL seems to be a longstanding and serious health problem in Bakool region. Food insecurity might have contributed to the emergence and detection of VL in this area.
authors.affiliation: Médecins sans Frontières, Dupréstraat 94, B-1090 Brussels, Belgium.
authors.forename: M V L
authors.initials: MV
authors.lastname: Marlet
authors.forename: F
authors.initials: F
authors.lastname: Wuillaume
authors.forename: D
authors.initials: D
authors.lastname: Jacquet
authors.forename: K W
authors.initials: KW
authors.lastname: Quispe
authors.forename: J C
authors.initials: JC
authors.lastname: Dujardin
authors.forename: M
authors.initials: M
authors.lastname: Boelaert
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000818:Animals; D000967:Antimony Sodium Gluconate / Q000627:therapeutic use; D000981:Antiprotozoal Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003546:Cysteine Endopeptidases / Q000235:genetics; D005260:Female; D006801:Humans; D007223:Infant; D007893:Leishmania donovani / Q000201:enzymology / Q000235:genetics; D007898:Leishmaniasis, Visceral / Q000188:drug therapy / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D017678:Sex Distribution; D012998:Somalia / Q000453:epidemiology
chemical_list: D000981:Antiprotozoal Agents; D003546:Cysteine Endopeptidases; D000967:Antimony Sodium Gluconate