Comparison of generic and proprietary sodium stibogluconate for the treatment of visceral leishmaniasis in Kenya.

OBJECTIVE: To compare the use of generic and proprietary sodium stibogluconate for the treatment of visceral leishmaniasis (kala-azar). METHODS: A total of 102 patients with confirmed kala-azar were treated in a mission hospital in West Pokot region, Kenya, with sodium stibogluconate (20 mg/kg/day for 30 days)--either as Pentostam (PSM) or generic sodium stibogluconate (SSG); 51 patients were allocated alternately to each treatment group. FINDINGS: There were no significant differences in baseline demographic characteristics or disease severity, or in events during treatment. There were 3 deaths in the PSM group and 1 in the SSG group; 2 patients defaulted in each group. Only 1 out of 80 test-of-cure splenic aspirates was positive for Leishmania spp.; this patient was in the SSG group. Follow-up after > or = 6 months showed that 6 out of 58 patients had relapsed, 5 in the SSG group and 1 in the PSM group. No outcome variable was significantly different between the two groups. CONCLUSION: The availability of cheaper generic sodium stibogluconate, subject to rigid quality controls, now makes it possible for the health authorities in kala-azar endemic areas to provide treatment to many more patients in Africa.

An outbreak of West Nile fever among migrants in Kisangani, Democratic Republic of Congo.

In February 1998, an outbreak of acute febrile illness was reported from the Kapalata military camp in Kisangani, the Democratic Republic of Congo. The illness was characterized by an acute onset of fever associated with severe headache, arthralgia, backache, neurologic signs, abdominal pain, and coughing. In 1 individual, hemorrhagic manifestations were observed. The neurologic signs included an altered level of consciousness, convulsions, and coma. Malaria was initially suspected, but the patients showed negative blood films and failed to respond to antimicrobial drugs. A total of 35 sera collected from the military patients in the acute phase were tested for the presence of IgM against vector-borne agents. Serum IgM antibodies against West Nile fever virus were found in 23 patients (66%), against Chikungunya virus in 12 patients (34%), against dengue virus in 1 patient (3%), and against Rickettsia typhi in 1 patient (3%). All sera were negative for IgM antibody against Rift Valley fever virus, Crimean Congo hemorrhagic fever virus, and Sindbis virus. These data suggest that infections with West Nile fever virus have been the main cause of the outbreak.