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Annex I. Case studies

Case Study 1

A 24 years old man who lives in Dabat presented with high grade fever that persisted for the last one month. He gave a history that he was going to Abdurafi district for sesame cultivation during the cultivation and harvest seasons for the last three years. What are important signs to look for in this patient? What investigations can confirm the diagnosis?



Which one of the following patient(s) are legible for rk39 test?


A-34-year old man from Bahir Dar with splenomegaly of 20cm and BMI of 17kg/m2

A-26-year old pregnant lady from Humera with fever of 5 days duration and splenomegaly

A-30-year old farmer from kola-Diba with travel history to Metema area presenting with fever of one month and splenomegaly

A-21-year old college student who presented with nodular swelling on the nose with induration extending to the upper lip


Case Study 2

A patient was suspected to have VL and splenic aspiration was done. Before the microscopy result was collected, the patient complained of dizziness, fatigue and abdominal distention. What is the possible cause for the new symptoms? What should be the next steps to be taken for this patient?

Case Study 3

A patient who presented with prolonged fever, splenomegaly and weight loss. Investigations showed WBC count of 2100/µl, Hgb of 6g/dl and platelet count of 68,000/µl. HIV testing was done using two rapid tests (the first KHB was positive and the second by statPack was negative). A third RDT (UniGold) for HIV was done and it was negative. Rk39 test was negative, but splenic aspiration was positive with LD body grade of +4. How do you explain the serology test results (HIV test and rK39) in this patient? What should be the next steps in confirming the diagnosis of this patient?

Case Study 4

A-32-year old farmer from Abrahajira area presented with two months of fever. On physical examination he was emaciated and had splenomegaly and petechial rashes on his trunk. He has never experienced such illness before. Rk39 test became positive. What should be the next steps and treatment for this patient?

Case Study 5

A-28-year old commercial farm owner living in Humera presented with weight loss, darkening of his face, recurrent diarrhea and pustular skin lesions. He reported to have been treated for kala-azar twice 9 and 3 months ago. On physical examination he was emaciated, he had oral candidiasis and splenomegaly of 7cm below the costal margin. His lab work up showed, WBC count of 1600/µl, Hgb of 5g/dl, platelet of 38,000/µl, two serial HIV test results were positive and bone marrow showed LD bodies of +6 load. His creatinine was 1.8mg/dl, SGOT was 56u/l and SGPT was 43u/l. Which of the parameters from the patient’s presentation are important in the decision to choose the antileishmania drugs/regimen for this patient’s treatment? Which antileishmania drugs will you choose for treatment? What additional management does this patient need?

Case Study 6

A-24-years old migrant worker from Wegera area was admitted with a diagnosis of kala-azar and started on treatment with SSG and paromomycin. Starting the 7th day of treatment, he complained repetitive vomiting and persistent abdominal pain. What can be the reason? What investigation is needed to strengthen the diagnosis of this complication? How should this be managed?

Case Study 7

A patient who was discharged 2 months ago after treatment for VL presented with papulo-nodular skin lesions around his nose and mouth. Otherwise he had gained weight, the spleen was not palpable. He went to a local clinic and was told that this could be allergic reaction and need to observe any unusual contacts. He was prescribed hydrocortisone cream and appointed him to come after three months. However, the lesions got worse and the patient presented after two months to your hospital. By then, the rash has involved the face, the shoulders, the arms and had spread to the chest. The lips and nostrils had started to form blisters. What si the diagnosis? How can the diagnosis be confirmed and what is the management?

Case Study 8

HIV patient on ARTfor the last six months was treated for VL six months ago with SSG and paromomycin for 17 days. By then the test of cure was negative. But after two months he came again with fever, weight loss and increased spleen size. Splenic aspiration showed +6 LD bodies. This time treatment was given with SSG 20mg/kg IM for 30 days. The test of cure after this treatment was still a load of +6. How should the treatment be continued?

Case Study 9

An anthropologist who wanted to study the migrant population that travel to Metema-Humera areas for agricultural purposes came to ask for a vaccine or a prophylaxis for kala-azar. This is the first time that he planned to travel to this region. What will you advise him?