Comparative merits of sternum, spleen and liver punctures in the study of human visceral leishmaniasis

Abstract

The relative merits of sternum, spleen and liver puncture in detecting leishmania from kala-azar patients, both before and after urea-stibamine therapy, are discussed, and the technique of each method is briefly described. In a series of 450 proven cases of kala-azar, sternum and spleen punctures were positive in 375 (83·3 per cent.), while in the remaining 75 cases leishmania were revealed by either one of the two methods—64 by spleen puncture and 11 by sternum puncture. In another series of 121 cases, liver puncture was added at the same time. It was found that spleen puncture was positive in 118 (97·6 per cent.), sternum puncture in 108 (89·2 per cent.), and liver puncture in 93 (76·9 per cent.). In 45 of 86 cases under urea-stibamine therapy, leishmania disappeared from bone marrow, spleen and liver at about the same time after the same number of injections, as determined by means of needle biopsy, while in the remaining cases the parasites always disappeared first from the liver. In another series of 203 cases, in which sternum and spleen puncture were performed to time the disappearance of the parasites, it was observed that the parasites in 68 per cent. cases disappeared from these two organs at about the same time after the same number of injections, but showed some discrepancy in time for their disappearance in the remaining 32 per cent. cases. In following treated cases, sternum and spleen puncture were found to check up each other very closely.