Public health aspects of visceral leishmaniasis in Montenegro

Leishmaniasis belongs to the parasitic communicable zoo noses, caused by members of Leishmania species. The infected phlebotomies sand fly carries the parasites, which cause the different forms of disease. Retrospective/prospective review of records for documented cases of visceral leishmaniasis (VL) in period from 1992 to 2012 in Montenegro shows 83 diagnostic cases, and 1 (1.20%) case with dermal leichmaniasis. with 3 (3.61%) deaths cases. Analyses of age show: 36 (43.37%) children and 47 (56.63%) adults. Examinations are based on epidemiological, clinical, hematological, patohystological and serological investigations. Infection can be sub-clinically or clinically manifested with acute, sub-acute, and chronic type. Incubation in clinically manifested infections ranges from several weeks to several months. In our study, the prevalence of general infective syndrome is registered in all of 83 manifested cases (100%). Enlarged spleen in 79 (95.18%) cases, enlarged liver in 37 (44.57%) cases, anemia in 49 (59.04%) cases, pancytopenia in 32 (38.55%) cases, and increased activity of serum aminotransferases in 37 (44.57%) cases. The diagnosis was confirmed by an analysis of bone marrow biopsy material by direct microscopy of serial sections colored by Romanowski and Giemsa s staining, and by immune-biochemical methods. Serological diagnostic is confirmed by using agglutination test. In Montenegro (in humans and dogs) two types of leishmania (L) (L. donovani, L. infantum were presented). As to therapy treatment, the common treating is with antimony drugs: glucantime is relatively satisfactory for a long time. During 2008 there were registered cases not responding to the therapy and those were manifested with relapses after therapy. In the first line of therapy, we used meglumine antimony (Glucantime) in 78 (93.97%) patients. Resistence developed in 7 (8.97%) during treatment, and relapse occurred in 5 (6.41%) patients. It was 1 (1.20%) patient treated with Miltefosine the one who had a relapse, and with Amphotericin B (Ambisome) 4 (4.82%) patients.

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