BACKGROUND Visceral leishmaniasis (VL) is caused by protozoa of the Leishmania donovani complex. Annually, an estimated 500,000 cases of VL are reported globally posing a public health challenge. The objectives of our study were to confirm and determine the magnitude of VL outbreak, characterize the outbreak clinically and epidemiologically and evaluate the county preparedness and response in Marsabit County, Kenya. METHODS A retrospective review of laboratory registers and patients' clinical notes was done at Marsabit County Hospital. Cases were persons with confirmed VL diagnosis either by microscopy, serology or molecular technique coming from Marsabit County from May to October 2014. Cases were interviewed using structured questionnaire to collect clinical and epidemiologic information. Blood samples were collected from cases for laboratory confirmation. RESULTS A total of 136 cases were confirmed of which 77% (105) were male with a median age of 17 (IQR: 22) years and 9.6% (13) case fatality rate. All cases were admitted at Marsabit County Referral Hospital, Kenya. Medical records of 133 cases were retrieved. Of the 133 cases, 102 (77%) presented with fever, 43 (32%) with splenomegaly, 26 (20%) with hepatomegaly and 96 (72%) were managed with Sodium stibogluconate (SSG) monotherapy. Thirty-four cases (26%) received Full haemogram (FHG) test and none had more than one Liver Function Tests (LFTs) in a span of 6 months. Presenting with headache (OR: 4.21, 95% CI: 1.10-16.09) and hepatomegaly (OR: 4.2, 95% CI: 1.30-14.11) were associated with VL death. No VL case management training had been conducted nor VL treatment guidelines distributed among health care workers (HCWs) in the last 1 year. CONCLUSIONS VL cases were confirmed. Inadequate case monitoring and management was evident. VL case management sensitization training was conducted. The County health department should put in place one health VL surveillance and facilitate periodic case management trainings.

中文翻译：

---

内脏利什曼病暴发的特征，肯尼亚马萨比特县，2014年。

背景技术内脏利什曼病（VL）是由利什曼原虫多诺万尼复合体的原生动物引起的。每年，全球报告估计有500,000例VL病例构成公共卫生挑战。我们研究的目的是确认和确定VL暴发的程度，在临床和流行病学上表征暴发的特征，并评估肯尼亚马萨比特县的县级防备和应对措施。方法在马萨比县医院对实验室记录和患者的临床记录进行回顾性回顾。病例是2014年5月至2014年10月来自马萨比特县的通过显微镜，血清学或分子技术确定的VL诊断的患者。使用结构化问卷调查病例以收集临床和流行病学信息。从病例中采集血液样本以进行实验室确认。结果总共确认了136例病例，其中77％（105）为男性，中位年龄为17（IQR：22）岁，死亡率为9.6％（13）。所有病例均在肯尼亚马萨比特县转诊医院住院。检索了133例病历。在133例病例中，有102例（77％）发烧，43例（32％）脾肿大，26例（20％）肝肿大和96例（72％）均用司妥葡糖酸钠（SSG）单药治疗。有34例（26％）接受了全血红素（FHG）测试，并且在6个月内没有一个以上的肝功能测试（LFT）。出现头痛（OR：4.21，95％CI：1.10-16.09）和肝肿大（OR：4.2，95％CI：1.30-14.11）与VL死亡相关。在过去的1年中，没有进行过VL病例管理培训，也没有在医护人员之间分发VL治疗指南。结论证实VL病例。案件监测和管理不充分是显而易见的。进行了VL病例管理意识培训。县卫生部门应实施一次健康VL监测，并促进定期病例管理培训。