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Two Exogenous Cases of Visceral Leishmaniasis (Kala-Azar) in the United States with Notes on Cultivation of Leishmania Donovani in Vitro¹

1. Two exogenous cases of visceral leishmaniasis (kala-azar) are reported. These patients were Indian merchant seamen, who had apparently contracted their infections in Assam, India, and manifested their clinical symptoms in the United States. (The cases were referred to the hospital with a tentative diagnosis of malaria).

2. The chief clinical findings consisted of abdominal distress, high fever with an irregular temperature curve ("double crisis"), a markedly enlarged spleen and a slightly enlarged liver.

3. The laboratory findings showed leukopenia and anemia. All "presumptive tests" such as Napier's aldehyde or formol-gel, Chopra's antimony test, and Brahmacharis' serum globulin or "water test" gave positive results for kala-azar.
Smears obtained by sternal puncture from bone marrow showed many aflagellar forms of Leishmania donovani, both intracellularly and extracellularly. These parasites stained well with a combination of the Wright-Giemsa stains.
Positive cultures of flagellates were obtained from bone marrow on blood agar slants (N. N. medium). The flagellates grew readily within a week, were actively motile, and morphologically and culturally were indistinguishable from typical Leishmania donovani.
Positive cultures of Leishmania donovani were obtained likewise from the peripheral blood on slightly modified N. N. medium and showed a growth of flagellates after two weeks of incubation at room temperature.
The strain of Leishmania donovani isolated both from bone marrow and from the circulating blood has been subcultured monthly on blood agar slants. The flagellates grew luxuriantly, not only in the water of condensation, but also colonized on the slanted portion of the medium. The cultural forms taken stain readily and well.

4. Both patients were treated with stibamine glucoside and apparently were clinically cured when they were returned to India.

5. The fact that we have occasionally exogenous cases of leishmaniasis in the United States which have been diagnosed by specialists, suggests that similar, unrecognized cases may occur from time to time, and that it is increasingly important that clinicians and public health officers be on the alert for exogenous leishmaniasis.

Received July 12, 1945.
¹ The writers wish to express their thanks and gratitude to Dr. E. L. Gardner and Dr. Joseph Moore of the U. S. Public Health Service, and to Capt. M. A. Krupp of the U. S. Army for their kind cooperation and aid in this study, and to Mr. Robert Sage of the University of Texas, for his skillful photomicrography.