A 12-year-old child from Bihar presents with 3 months of fever, massive splenomegaly, weight loss, and pancytopenia. Bone marrow biopsy shows macrophages laden with oval 2–4 µm intracellular amastigotes (Leishman-Donovan bodies) with a large nucleus and kinetoplast. rK39 rapid antigen test is positive. What is the treatment of choice under the current India National Programme?

• A Miltefosine oral 2.5 mg/kg/day × 28 days (still first-line in 2024)
• B Single-dose liposomal amphotericin B 10 mg/kg IV as first-line treatment under NVBDCP ✓
• C Pentavalent antimony (sodium stibogluconate) 20 mg/kg/day × 30 days
• D Amphotericin B deoxycholate 0.75–1 mg/kg IV alternate days × 15 doses

Explanation

Under the revised NVBDCP (National Vector-Borne Disease Control Programme) India guidelines, the first-line treatment for visceral leishmaniasis (kala-azar) is a single dose of liposomal amphotericin B (AmBisome) 10 mg/kg IV, replacing miltefosine as first-line due to superior efficacy, shorter treatment, and fewer side effects. Miltefosine was the first-line oral drug (100 mg/day × 28 days for adults) but has been repositioned to second-line. Pentavalent antimonials (SSG) have been phased out in the Indian subcontinent due to widespread resistance.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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