Heart disease in severe anaemia

A description is given of the clinical feature of 40 cases of kala-azar from the Kitui district of Kenya. The chief symptom was pain and discomfort beneath the left costal margin. Cough, epistaxis, diarrhoea, tinnitus, headache, backache and shivering were also noted. Enlargement of the spleen, liver and lymph glands was present in most of the cases. Fever was slight, and never exceeded 102°F. There was usually a moderate normochromic, normocytic anaemia, and only half showed a leucopenia. The formol-gel test was invariably positive 3 months after the onset of the disease. Leishmania were present most commonly in the spleen and liver, and sometimes in the lymphatic glands and marrow. Parasites were not seen in the blood of any of the 40 patients. Small solitary circumscribed skin lesions containing Leishmania were sometimes observed on the legs. None of the 40 patients showed post-kala-azar dermal leishmaniasis, but the condition has been seen on several occasions, and one untreated subject of kala-azar had a generalized eruption with parasites widely distributed in the skin. Pentamidine, pentostam, and urea stibamine were used in treatment. Urea stibamine was the most effective, though a combined course of pentostam and pentamidine cured many patients. The disease round Kitui was very resistant to treatment.