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During a 20-month period, more than 500 splenic aspirations were performed in 89 patients with suspected or proven visceral leishmaniasis. The two complications which occurred (intra-abdominal bleeding and penetration of the intestine in one patient each) both resolved with conservative management. Parasite density in splenic aspirate smears was graded on a logarithmic scale from 0 (no parasites in 1,000 microscopic fields) to 6+ (> 100 parasites per microscropic field). Among 46 newly diagnosed and 17 relapsed or drug-resistant patients with visceral leishmaniasis, the average initial parasite grade was 4.35 ± 0.92 (mean ± SD) and 4.15 ± 1.37, respectively. The grading system was useful in measuring the speed of response to treatment, and in distinguishing slow responders from nonresponders. This was especially valuable for managing patients with drug-resistant visceral leishmaniasis. The system also provided a means of comparing the efficacy of different treatment regimens, and for calculating the optimum duration of treatment.
Accepted for publication October 8, 1982.
Address correspondence to: Academic Affairs Branch, Walter Reed Army Institute of Research, Washington, D.C. 20307.
* This is contribution number 1647 from the U.S. Army Research Program on Parasitic Diseases and was supported in part by grant number DAMD-17-82-G-9498 from the U.S. Army Medical Research and Development Command, and by the UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases. Dr. Bryceson was a WHO consultant to the Clinical Research Centre, Nairobi.
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