A 10-year-old child from rural Bihar presents with eosinophilia, hepatosplenomegaly, and repeated episodes of fever for 2 years. Serological test (rK39 ELISA) is positive. Bone marrow aspiration shows amastigotes within macrophages. The drug of FIRST CHOICE for treatment in India currently is:
- A Sodium stibogluconate
- B Miltefosine
- C Liposomal amphotericin B ✓
- D Paromomycin
Explanation
This is visceral leishmaniasis (kala-azar) caused by Leishmania donovani, endemic in the Bihar–UP–Jharkhand belt. In India, high-level resistance to pentavalent antimonials (sodium stibogluconate) has rendered them obsolete. The NVBDCP guidelines and WHO currently recommend single-dose liposomal amphotericin B (AmBisome) as first-line treatment for kala-azar in India — it achieves >95% cure rates with a single infusion of 10 mg/kg. Miltefosine is an oral alternative but has embryotoxicity and is given only with contraception in women of child-bearing age. Paromomycin is used as a combination partner.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.