And there they were, right under the microscope lens, just the way I had seen them in books and prepared slides in my tropical medicine training. Amastigotes, the tissue form of Leishmania donovani, the parasite that causes Kala Azar (KA) in southern Sudan. Sammy, our lab supervisor, had prepared the slide from a patient suspected of having a relapse of her disease. I had aspirated the tissue sample from her spleen with a small needle. Clinically suspected first episodes of KA are diagnosed using a rapid blood test (rK39, Optileish), a quick, easy test compared to spleen aspirate and direct visualization. The results of the Optileish test are confirmed using another blood test, the DAT (Direct Agglutination Test). Blood tests remain positive after a first episode of KA and therefore cannot be used to diagnose relapsed disease.
The treatment of KA in countries like Sudan has many challenges: access problems for patients, logistical problems related to diagnostic tools and therapeutics, lack of trained staff to administer treatment, just to name a few. Our first line treatment is sodium stibogluconate (SSG) given in a series of daily injections over 30 days, with a shorter duration of treatment if combined with a drug called paramomycin. But SSG, a drug first developed in the 1930’s, has its problems: painful injections, long treatment regimens, parasite resistance, cost, potential toxicity and lack of effectiveness in patients with other infections. Ambisome is an alternative treatment used for more serious patients but it also has some potential toxicity and is very costly.
MSF has a long history of treating KA in southern Sudan and has been an advocate for better, less expensive KA drugs (see link below). Over the last 20 years, MSF has treated thousands of patients. Francis Gatluak, our KA/TB specialist, has worked with MSF for all of that time, using his knowledge and experience in the management of KA, TB and other health problems. I think of Francis as the heart and soul of the Lankien project. He is both a valuable medical resource and an important link with the community. Cheers Francis and best wishes.
Below: Francis at work admitting a patient with KA
This is a link to MSF’s Campaign for Access to Essential Medicines.