KALA AZAR: A REVIEW OF ITS INCIDENCE AND EPIDEMIOLOGY IN CHINA AND CLINICAL OBSERVATIONS ON 585 CASES

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Abstract
Kala azar is endemic throughout n. China with epidemic outbreaks subsequent to famine, flood and war. The patients are usually children, but adults up to 40 yrs. are frequently attacked. Usually they are of coolie or farmer class from small villages or city outskirts. A study of the epidemiology points to an erect-haired sandfly as vector and the dog as a perennial host. The most prominent physical signs are emaciation, anemia, enlarged spleen, low grade fever and tachycardia. Complications, of which the most common are pneumonia, dysentery, bronchitis and noma, occurred more frequently in older patients with a protracted illness. Mortality rate was 5.1%, the most common cause of death being pneumonia, only 3 patients having died of uncomplicated kala azar in the series of 585 cases. There were 6 known relapses within 2 yrs. Sternal puncture was the most reliable safe diagnostic method, being positive in 81% of 557 smears. Prophylaxis should consist of eradication of sandfly breeding places, removal of infected dogs and segregation of patients. Treatment with pentavalent antimony compounds was rapidly effective. Convalescence was accompanied first by leuco-cytic increase and later by a rise in Hb, decrease in splenic size and wt. gain. Drug reactions were unimportant consisting of transitory fever, or vomiting. Antimony is con-traindicated in jaundice, hepatitis, pneumonia, or nephritis. The treatment of kala azar is strictly empirical until further information is obtained on the least Sb conc. which is parasiticidal, and its storage and elimination rate.

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