rK39-Negative Visceral Leishmaniasis with Renal Complications from Eastern Uttar Pradesh, India: A Case-Based Clinico-Entomological Investigation Suggesting Possible Local Transmission.

PURPOSE: The Government of India has made significant progress toward the elimination of visceral leishmaniasis (Kala-azar); however, sporadic cases continue to emerge, threatening the achievement of the elimination target. We report one confirmed case of Kala-azar from the Maharajganj district of Eastern Uttar Pradesh, an area with limited previous documentation of indigenous transmission.

METHODS: A 60-year-old male with no travel history (Bihar, Nepal), presenting with fever, splenomegaly, and anaemia. He tested negative by rK39, confirming by bone marrow aspirate demonstrated intracellular amastigotes of Leishmania donovani an indigenous case from Maharajganj. The patient developed acute renal impairment (serum creatinine 5.6 mg/dL). Miltefosine therapy was initiated but discontinued due to haematuria.

RESULTS: The detection of the competent vector in close proximity to the patient's residence provides supportive entomological evidence for local transmission. Due to the limited scale of sampling, vector density could not be estimated; however, the confirmed presence of Phlebotomus argentipes indicates ecological suitability for transmission.

CONCLUSION: These cases highlight the importance of maintaining robust surveillance, early diagnosis, and rapid treatment, especially for detecting indigenous transmission in regions nearing elimination. Continued vigilance is essential to achieve and sustain the elimination of Kala-azar in India.