A field-worker in Assam presents with fever, massive splenomegaly, and weight loss over 3 months. Bone marrow aspiration reveals intracellular 2–4 µm oval bodies with a clear halo and a rod-shaped kinetoplast (bar-shaped nucleus) inside macrophages. The treatment of choice for this confirmed diagnosis is:
- A Pentavalent antimony (sodium stibogluconate)
- B Liposomal amphotericin B (AmBisome) ✓
- C Miltefosine oral
- D Paromomycin intramuscular
Explanation
The description — intracellular amastigotes (Leishman-Donovan bodies) with kinetoplast in macrophages from bone marrow — confirms visceral leishmaniasis (kala-azar). In India (where sodium stibogluconate resistance is prevalent in Bihar/Assam), liposomal amphotericin B (AmBisome) is the first-line treatment recommended by WHO and NVBDCP due to high efficacy and reduced toxicity. Pentavalent antimony has high resistance rates in the Indian subcontinent. Miltefosine is an oral alternative but is not the first-line choice when injectable AmBisome is available. Paromomycin IM is a second-line or combination agent.
Reference: Ananthanarayan & Paniker's Textbook of Microbiology, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.