March, 2025

March 20, 2025

Year

A 33-year-old man from Bihar, residing in Salem, Tamil nadu for 10 years, presented with an 8-year history of erythematous chin lesions and upper-lip & right nostril involvement with swelling for 3 years. A biopsy from the lesion was sent for culture and subsequently PCR. The culture fluid showed the following on day 14.

  1. What is the stage of the parasite in the culture
  2. What is the disease?
Figure: Giemsa stain of the culture fluid, 100X

Answer

  1. What is the stage of the parasite in the culture, and what medium is recommended?
    Promastigote stage of Leishmania spp., elongated, slender, and measure 10–12 µm in length, a large central nucleus and a kinetoplast near the anterior end with flagellum. This stage is found in the sandfly midgut and in culture, with Novy–McNeal–Nicolle (NNN) medium.
  2. What is the disease condition of this patient?
    Post-Kala azar dermal leishmaniasis (PKDL). PCR identified species as Leishmania donovani, thus excluding CL and MCL associated species in Asia
Figure: Giemsa stain of the culture fluid, 100X

Current treatment guidelines for PKDL in India, Bangladesh and Nepal

  1. Amphotericin B deoxycholate, 1 mg/kg per day by infusion, up to 60–80 doses over four months
  2. Miltefosine orally 100mg BD for 12 weeks. In patients with deranged renal parameters, liposomal amphotericin B is the preferred drug of choice.

Reference
https://iris.who.int/bitstream/handle/10665/361887/9789290209812-eng.pdf

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