A 30-year-old woman from Bihar presents with prolonged fever, massive splenomegaly, weight loss, and pancytopaenia. Bone marrow aspirate shows macrophages packed with small oval bodies with a distinct nucleus and kinetoplast. Which organism is this and what is the recommended first-line treatment in India?

• A Trypanosoma brucei — suramin
• B Toxoplasma gondii — pyrimethamine + sulfadiazine
• C Plasmodium falciparum — artemisinin combination therapy
• D Leishmania donovani — liposomal amphotericin B ✓

Explanation

The clinical picture is classic for visceral leishmaniasis (kala-azar) caused by Leishmania donovani, transmitted by the sandfly Phlebotomus argentipes. The amastigote (Leishman-Donovan body) is an oval intracellular body with a distinct nucleus and rod-shaped kinetoplast seen in macrophages. In India, liposomal amphotericin B (AmBisome) is the current first-line treatment following emergence of sodium stibogluconate resistance. Miltefosine is also used. Suramin treats African trypanosomiasis.

Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.