In a comparative study 88 patients were diagnosed as suffering from kala-azar (visceral leishmaniasis) using 3 parasitological methods simultaneously. Splenomegaly was absent in 4 cases. In 84 patients with splenomegaly, splenic aspiration appeared to be the most sensitive method (96.4%), followed by bone marrow aspiration (70.2%) and lymph node aspiration (58.3%). There was no relation between titres in the direct agglutination test and parasite load as determined by the number of parasitological methods which were positive or parasite density in splenic aspirates. Splenic aspiration and bone marrow aspiration were compared as an assessment of cure in kala-azar. In 6 (13%) of 46 patients tested, parasites were found, all by splenic aspiration. Bone marrow showed parasites in one of these. The literature with regard to parasitological investigations before and after treatment is reviewed.

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132 patients with suspected kala-azar (visceral leishmaniasis) were included in a prospective study to compare the performance of the direct agglutination test (DAT) with smears of lymph node, bone marrow and splenic aspiration. A titre greater than 1:3200 was considered positive. 67 patients provided positive smears and 65 were smear-negative. Compared with the results obtained from smears, the sensitivity of the DAT was 94% and its specificity 72%. Of 18 patients who were negative by smears but positive by DAT, 3 were treated on strong clinical suspicion of kala-azar and responded well to therapy. One other patient had post-kala-azar dermal leishmaniasis. Of the remaining 14, 8 were tested with the leishmanin skin test; 6 gave a positive result, suggesting past or sub-clinical infection. In 4 smear-positive patients, the DAT was negative; in 2 of these, the test remained negative during 6 months' follow-up. In a sero-epidemiological survey in a camp for displaced people, 30 of 600 sampled individuals gave a positive DAT. Of these, 11 had been treated for kala-azar; 4 others were leishmanin positive. The DAT is a useful screening test (sensitivity 94%; predictive value of a negative test 92%), but it does not differentiate between past kala-azar, sub-clinical infection and active disease.

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Background: In countries where malaria is endemic, its transmission is a hazard of blood transfusion and could lead to serious if not fatal complications. To assess the likely importance of transfusion induced malaria in Sudan; a descriptive cross sectional facility based study was carried out. Material and Methods: A total number of 1564 blood donors were screened for malaria parasite by thick and thin blood film using Geimsa' staining technique. All the 397 transfused patients who received the donors' blood during the study period were investigated for malaria before transfusion by the same technique, followed up for four days after transfusion and reinvestigated, if any signs of malaria were present. Results: Results showed that the prevalence of infected donors was 6.5%, the majority of them were between 20 and 40 years old; the required age for donation. The recognized species were predominantly (98.1%) Plasmodium falciparum and secondly Plasmodium vivax (1.9%). Mainly ring (50.5%) and trophozoite (40.2%) stages were detected, and most of the positive blood films (96.9%) showed densities less than 1000 parasites/µl. Post transfusion malaria (PTM) was observed in 2.9% of the single transfused and in 4.9% of the multiple transfused patients. Conclusion: It was concluded that the infectivity of asymptomatic donors is considerable. Moreover, the exclusion of this percentage minimizes the risk of transfusion-induced malaria and does not affect donation flow.